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Electronic Monitor Hand-Washing in Hospitals

Posted Dec 07 2011 7:26am
email Electronic Monitor Hand Washing in Hospitals


24fixes handwashingimg blog427 Electronic Monitor Hand Washing in Hospitals
A board in the surgical intensive care unit at North Shore University Hospital in Manhasset, N.Y., reminds people to sanitize their hands.
, but at the I.C.U.’s in North Shore University Hospital in Manhasset, N.Y., the conversation has some unusual contributors.  Two L.E.D. displays adorn the wall across from each nurses’ station.    last Friday in the surgical I.C.U., the weekly rate was 85 percent and the current shift had a rate of 91 percent.  “Great Shift!!” the sign said.   At the medical I.C.U. next door, the weekly rate was 81 percent, and the current shift 82 percent.

That’s too low for a “Great Shift!!” message.  But by most standards, both I.C.U.’s are doing well.  Those L.E.D. displays are very demanding   Three years ago, using the same criteria, the medical I.C.U.’s hand hygiene rate was appalling it averaged 6.5 percent.  

Hospitals do impossible things like heart surgery on a fetus, Most hospitals report compliance of around 40 percent and that’s using a far more lax measure than North Shore uses.   I.C.U.’s, where health care workers are the most harried, usually have the lowest rates between 30 and 40 percent.  B

How do hospitals even know their rates?   .  The current standard of care is to send around the hospital equivalent of secret shoppers staff members who secretly observe their colleagues and record whether they wash their hands.   This has serious drawbacks:  it is expensive and the results are distorted if health care workers figure out they’re being observed.  

24fixes handwashingB blog427 Electronic Monitor Hand Washing in Hospitals
In the past few years, several new technologies have emerged that can help hospitals to measure and improve hand hygiene rates.   I’ve written in Fixes about some hospitals that have tried them and  found good results .  But medicine pays attention only when there are studies in a peer-reviewed journal, and there hasn’t been one until now.   The North Shore study , published this week in the journal Clinical Infectious Diseases, and

Dr. Bruce Farber, the head of infectious diseases at North Shore, says that but this attitude is new.  If he had proposed experimenting with video cameras a few years earlier, he said, he might have met with a lot of resistance.  But he found none.  “I don’t think there’s any pushback in terms of people thinking this is a real problem and we need to do things,” he said.  “The next crux is: what works and what doesn’t work?”

There is an overwhelming need to find out.  many or most of them from the hands of health-care workers.  Hospital-acquired infections are the fourth leading cause of death in America. than the  100,000 deaths each year from hospital-acquired infection .

Recently, hospitals have been given a financial incentive as well.  In 2008, and the list is expanding every year.   The health care reform bill does the same with Medicaid, and insurance companies are beginning to follow.  Treating these infections is hugely expensive the average cost is at least $15,000.   These infections cost somewhere  between $28 billion and $45 billion a year.

I wrote earlier about hospitals trying a sensor system:  health care workers get a badge that sniffs alcohol an ingredient in hand sanitizer and hospital soap.  The sensor can tell when the worker last washed hands.  If the worker crosses a perimeter around a patient and hasn’t washed his hands, the system beeps to remind him.

25fixes handwashing blog427 Electronic Monitor Hand Washing in Hospitals
North Shore instead uses a video monitoring system made by a company called Arrowsight.  Cameras on the ceiling are trained on the sinks and hand sanitizer dispensers just inside and outside patient rooms. (Patients are not photographed.)  A monitor at each door tracks when someone enters or leaves the room   Arrowsight employees in India monitor random snippets of tape and grade each event as pass or fail.

What makes the system function is not the videotaping alone it’s the feedback.  The nurse manager gets an e-mail message three hours into the shift with detailed information about hand hygiene rates, and again at the end.    “They look at the rates,” said Isabel Law, nurse manager of the surgical I.C.U..  “It becomes a positive competition.  Seeing “Great Shift!!” is important.  It’s human nature that we all want to do well.  Now we have a picture to see how we’re doing.”

Data on infection rates was not in the journal article, but Dr. Farber said that

The development of Arrowsight’s technology shows    This is Arrowsight’s first foray into health care.  The company’s main business is meat: half the beef processing plants in America use its video system to monitor workers’ hygienic practices.

Adam Aronson, Arrowsight’s chief executive, said that at one plant cameras focused on a hand sanitizer dispenser right outside the bathroom. With monitoring and feedback, hand hygiene rates went from about 4 percent to over 95 percent, and the achievement was sustained.

Aronson showed the results to his father, Mark David Aronson, a professor at Harvard Medical School.  His father told him that 3,000 people die every year of the food-borne illnesses the cameras in meat plants were trying to prevent but 100,000 die of hospital-acquired infections.  “You have a civic duty to try to get this into hospitals,” his father said.

Aronson met with 10 hospitals; no one was interested, and he gave up.

Then five years ago, his sister nearly died of infection after giving birth, and his mother contracted a bone infection that has left her with a permanent limp.  He decided to try again.  One of his employees had an uncle who ran a tiny surgery center in Macon, Ga.  “It had very low rates of hand hygiene and we got them over 90 percent within weeks,” he said.  

At first Farber feared he wouldn’t be able to get approval; the conventional wisdom was that employees don’t like being videotaped.  But then he thought about a recent experience at the dry cleaner:  he had picked up some of his daughter’s clothes, but one of her suits was missing.   He went back to the shop and told them the date and approximate time of his visit.  They pulled up a video that indeed showed him leaving her suit behind.  “If dry cleaners are doing that, we need to do that in the hospital,” he thought.

Like the other high-tech hand hygiene systems, Arrowsight’s is expensive.  But if low-tech isn’t working, it’s a good investment

It is now nearly four years since the cameras went in to North Shore, and hand hygiene rates remain high, although higher in the surgical I.C.U. than the medical I.C.U..   William Senicola, the nurse manager of the medical I.C.U., said one reason for the difference was that there had been an emergency with a patient that morning, which gave the staff other priorities. “It has to do with volume,” he said.  He said that three months into the program, one of the nurses on his staff called him on a Saturday morning at home.  She told him that she had gotten up to go to the bathroom in the middle of the night and banged into the wall as she automatically reached for the alcohol gel dispenser she expected to find.  “That’s a real change in culture,” he said.  “That’s when we knew we were there.”

Via NYT: An Electronic Eye on Hospital Hand-Washing

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