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Smart sensor technology trial demonstrates infection-prevention hygiene monitoring has arrived

Irisys : 10 June, 2013  (Company News)
Infrared technology is becoming a key strategy in improving healthcare workers' hand-hygiene compliance and helping to reduce the spread of healthcare-acquired infections, according to the results of a trial in the National Institute for Health Research (NIHR) which is a UK-based general medical unit.

The study of the effectiveness of the Irisys Intelligent Handwash Monitoring System was supported by the National Institute for Health Research (NIHR), which commissions research in the UK on behalf of the Department of Health and National Health Service.


"Accuracy is key to gauging the effectiveness of hand-hygiene intervention strategies," said Anne Macmillan, Business development Director for Irisys Healthcare. "The area of automated compliance monitoring is still new and evolving.  Some of the first approaches taken by others have attempted to use generalised averages - instead of measuring behaviour derived from the actual environment being monitored - and exclude significant groups that should be counted as part of their studies. The Intelligent Handwash Monitor's smart-sensor technology, however, yields unbiased, objective data that drives informed decision-making. Both handwashing opportunities and actual events are crucial to illustrate the complete hand-hygiene picture."


The technology helps to monitor healthcare workers' behaviour in relation to the World Health Organisation's Five Moments for Hand Hygiene and is designed to eliminate the potential for bias, assumption and error. Rather than relying solely on human observation or generalised averages, it utilises unobtrusive smart-sensor technology to establish baseline compliance; monitor workers’ behaviour in response to intervention-strategy implementation; and report outcomes.  A trial using the technology was conducted in three key phases over 12 weeks:


Phase I:       Smart sensors installed at the unit's entrance captured footfall (the number of workers and visitors entering and leaving) as well as handwash/hand-sanitising 'opportunities' versus actual handwash/hand-sanitising 'events'.


All persons entering and exiting the unit entrance were required to carry out hand hygiene.  Human observers also audited hygiene opportunities and sanitiser events. The datasets facilitated the development of intelligent software algorithms.


Phase II:       Optimised equipment and detection algorithms captured datasets that were again audited by human observers.  The independent datasets verified the system's accuracy.


Phase III: 
   A 12-week period (three consecutive, four-week intervals) validated the system's ability to measure a baseline - and subsequently the effect of an intervention - and how an intervention was sustained.  A four-week monitoring period established baseline compliance - followed by four weeks of positive feedback delivery in the form of visual stimuli that bolstered proper handwashing and hand-sanitising protocol. The longevity of individuals’ observed changes was investigated for four weeks after visual stimuli were removed.


The study found - in this specific environment - individuals improved critical hand-hygiene compliance by 73 per cent just one week after visual cues prompting proper and frequent handwash and sanitiser practices were placed at the entrance of the general medical unit. Compliance returned to the average baseline of 23 per cent three weeks after the visual stimuli were removed.


Throughout the study, the system monitored opportunities to use hand-sanitiser dispensers - and compared them to actual usage of dispensers - to determine daily compliance, achieving 95 per cent accuracy. Results based on 45,108 subjects and 13,406 hygiene events found:


  • Average baseline compliance of 23 per cent;

  • Overall average compliance improved 57 per cent during the intervention period;

  • Greatest compliance increase when feedback was new - with average daily compliance rising by 73 per cent the week immediately following the introduction of visual stimuli;Compliance returned to baseline levels just three weeks after visual stimuli were removed;

  • Compliance varied daily and weekly - particularly at weekends; and

  • Sanitising gel compliance was noticeably lower during weekends - but increased during the intervention period.

"This study shows infrared technology could have a tremendous effect on how healthcare facilities look to help reduce the spread of infections that can transmit from worker to patient - or vice versa - if correct hand-hygiene is not practised," said Dr Frank Miskelly, Imperial College London. "The technology could also enable a more easily adoptable and promotable system-wide team approach to a patient-safety culture."


While additional trials of the technology will be conducted, preliminary findings have already given some insight into potential HAI-reduction strategies which should be part of a sustained and adaptive intervention programme. In addition to wide-scale deployment to give clinical managers the data to target and evaluate interventions, the system could be an asset for research teams investigating behavioural change.


"Results suggest visual stimuli can raise hand-hygiene compliance, but those stimuli need to be maintained and contain variety to sustain improvements," Dr Miskelly said. "Many trials that rely solely on direct human observation have been conducted at facilities and – due to the Hawthorne Effect – are well known to influence human behaviour. We expect specific feedback to workers on their true performance would further raise compliance, but additional studies are required to confirm this theory."


Irisys Hand Hygiene Compliance research has been supported by the National Institute for Health Research's (NIHR) Invention for Innovation (i4i) programme to help provide a solution to drive improvements in hand hygiene. The views expressed with reference to the findings of this independent research are those of Irisys and not necessarily those of the NHS, the NIHR or the Department of Health.

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