Infection control

Computerized system promotes hand-washing in hospitals

TORONTO – Researchers at the Toronto Rehabilitation Institute (Toronto Rehab) are developing state-of-the-art technology that will help caregivers reduce hospital-acquired infection rates and provide safer patient care.

Each year in Canada, about 8,000 patients – or approximately 22 people a day – die from hospital-acquired infections. It is estimated that as many as half of these deaths are attributable to inadequate hand cleansing on the part of healthcare workers.

“Blaming the spread of infections in hospitals on healthcare workers is not really fair,” says Dr. Geoff Fernie (pictured), Toronto Rehab’s Vice President of Research. “Healthcare professionals typically work in very busy clinical environments with multiple competing demands for their time and attention. It is very difficult for them to remember to clean their hands each and every time they have contact with a patient.”

While everyone can improve their hygiene habits, according to Dr. Fernie, a healthcare worker would need to disinfect his/her hands 100 to 150 times per eight hour shift to achieve 100 per cent compliance. That is approximately once every five minutes and, during especially busy times, the need to disinfect could be as high as 70 times per hour. That works out to the equivalent of once per minute.

“We need to help caregivers remember to cleanse their hands at critical junctures in their daily care routine,” adds Dr. Fernie. “Our new hand hygiene technology will help healthcare professionals improve the consistency of their hand cleansing practices and support them in maintaining a safe and healthy environment for their patients and themselves.”

All workers in patient care environments would be outfitted with a small sensor attached to their identification lanyard. This sensor is part of an overhead electronic monitoring system that reminds healthcare staff by way of an auditory signal (a beep) to cleanse their hands, if they have not already done so, when they approach or leave different patients.

A portable alcohol gel dispenser that is attached to their waist or a static alcohol gel dispenser mounted to a wall – both equipped with sensors – can detect whether or not hands have been washed prior to and after individual patient/caregiver contact. The system also records the time of entry and exit of each designated patient area and the number of times hands are disinfected to obtain an overall record of hand cleansing compliance.

“A sink located in a patient room or elsewhere on the unit is not always convenient to get to between patients especially on very busy shifts. A wearable unit that is equipped with an alcohol gel dispenser and sensors that remind you to cleanse your hands is a convenient and more effective way to ensure that you adequately disinfect your hands before attending to your patient,” says Veronique Boscart, a Toronto Rehab nurse and researcher who worked on the system’s first pilot study. “When you are busy, disinfecting your hands every time you have contact with a new patient is very difficult to sustain over time.”

A few hospitals in Europe and the United States have implemented successful hand hygiene programs and report increases in hand cleansing frequency and decreases in certain types of hospital infections. However, achieving better staff hand hygiene practices does not happen overnight and is difficult to sustain.

“A cultural change needs to take place so that cleaning your hands when you walk into a patient’s room will be the norm,” says Dr. Allison McGeer, Director of Infection Control at Mount Sinai Hospital who is on the team developing the system. “Changing behaviour to establish this new culture will take time. This hand hygiene system is an effective tool to help healthcare workers achieve better hand hygiene now.”

“There are many factors that influence the development of hospital-acquired infections. While it is well established that the most effective way to stop the spread of infections in hospitals is hand hygiene using an alcohol hand gel, good hand hygiene must be used in combination with other measures, such as better hospital design, adequate cleaning and disinfection of the hospital environment and medical equipment, effective use of aseptic technique and appropriate use of personal protection gear such as masks, gowns, gloves, and face shields, and optimal antibiotic management.” says Dr. McGeer.

Under proposed new standards for infection prevention and control developed by the Canadian Council on Health Services Accreditation in March 2007, hospitals will be required to monitor infection rates and participate in hand hygiene initiatives to maintain their accreditation.

The Ontario Ministry of Health and Long-Term Care is also concerned about hospital-acquired infections. Between December 2006 and August 2007, the Ministry tested a new hand hygiene improvement program called Just Clean Your Hands in 10 Ontario hospitals.

Among the various results compiled from healthcare worker and patient surveys and observational auditor comments, the study found that when cleaning their hands, 75 per cent of healthcare workers were more likely to use an alcohol based hand sanitizer than soap and water. Given the urgent need to significantly reduce mortality rates caused by hospital-acquired infections, Dr. Fernie anticipates that demand for the new hand hygiene system will be considerable.

“We’ve been successful in obtaining the research funding required to get us to this stage in the development process. What we need now is significant investment to accelerate development, refine the product and get it into the hands of those who are in a position to save thousands of lives each year,” says Dr. Fernie.

Dr. Fernie predicts that the system will be on the market in the next two years.

Toronto Rehabilitation Institute (Toronto Rehab) is at the forefront of one of the most important and emerging frontiers in health care today – rehabilitation science. Toronto Rehab is one of Canada’s leading academic rehabilitation science centres providing adult rehabilitation services, complex continuing care, and long-term care. More information is available at www.torontorehab.com.