Transcript Understanding Electronic Hand Hygiene Monitoring Systems

Understanding Electronic Hand
Hygiene Monitoring Systems
Presented by: Tim Cambier
9/19/16
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Agenda
 Learning Objectives
 What’s the Problem?
 How Technology Lives Within Your Hospital
 Understanding the Hand Hygiene Monitoring Landscape
 Hand Hygiene Monitoring Technology & Devices
 Key Considerations in Selecting a Hand Hygiene Monitoring System
 Q&A
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Learning Objectives
 Understand the importance of proper hand hygiene
behavior
 Understand the role of technology in hospitals
 Build literacy on hand hygiene monitoring approaches and
technologies
 Understand the role of the Infection Preventionist in
identifying, implementing, and managing a hand hygiene
monitoring solution
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The Problem: Healthcare Associated
Infections (HAI)
Improper hand hygiene is one of the primary causes of
HAIs, which result in approximately 772,000 infections and
75,000 deaths a year in the United States, and lead to
Billions in excess healthcare costs
 CDC cites proper hand hygiene as the #1 intervention in
fighting HAIs
 Direct observation is time-consuming, biased, and
statistically insignificant
 HCW Hand Hygiene Compliance rates in the US
average less than 50%
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Addressing the Problem:
World Health Organization Multimodal Hand Hygiene
Improvement Strategy
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 System Change – accessibility of resources and products
 Training / Education – regular training on the correct procedures
 Evaluation and feedback – monitoring and reporting performance
 Reminders in the workplace – reinforcing proper behavior
 Institutional safety climate – HCW, patients, visitors; awareness
Improved hand hygiene compliance among healthcare workers in a 200- bed hospital by as little as 1%
would prevent approximately 1 episode of infection due to MRSA and would result in MRSA prevention–
associated cost savings of almost $40,000 per year.2
1 WHO | Testing the WHO Guidelines on hand hygiene in health care in eight pilot sites worldwide. (n.d.). Retrieved September 12, 2016, from
http://www.who.int/gpsc/country_work/pilot_sites/introduction/en/
2 Keith L. Cummings, Deverick J. Anderson, and Keith S. Kaye, “Hand Hygiene Noncompliance and the Cost of Hospital‐Acquired Methicillin‐Resistant
Staphylococcus Aureus Infection,” Infection Control and Hospital Epidemiology 31, no. 4 (April 2010), doi:10.1086/651096.
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How Technology Lives Within Your
Hospital
• Technology-based initiatives
are happening throughout
hospitals, at all levels, for
various, and sometimes
related reasons
• Using technology to solve
one problem can often benefit
or lend value to other parts of
your organization
Key Question: Do we have any of these systems at our facility now? If so, can hand
hygiene monitoring be an additional use case or not?
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How Technology Lives Within Your
Hospital - Systems
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Data
Voice
Wireless
Hardware
Software
Asset Tracking
Temp Monitoring
Patient Flow
Staff Workflow
Patient Safety
Hand Hygiene
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Staff Assignment
Alarm Mgmt.
Bed Status
Fall Prevention
Room Status
Hand Hygiene
Network
Infrastructure
Real-Time
Locating
Systems
Nurse Call
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Physician Orders
Patient Records
Workflow Mgmt.
HL7 Interfaces
Billing/Scheduling
Electronic
Hospital
Records
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Staff Access
Patient/Staff Safety
Video Monitoring
Medication Control
Wander Monitoring
Security and
Surveillance
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Hand Hygiene
Dispensing Systems
Workflow Mgmt.
Consumable Usage
IP Policies
Hand Hygiene
Compliance
How Technology Lives Within Your
Hospital - People
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Information Technology
Bio-Med
CNO
CMO
EVS
Supply Chain
Network
Infrastructure
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Information Technology
CMO
CNO
Nursing
Infection Preventionist
• Physicians
Electronic
Medical
Records
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Information Technology
Bio-Med
CMO
CNO
Infection Preventionist
Nursing
Supply Chain
Quality & Safety
Real-Time
Locating
Systems
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Information Technology
Bio-Med
Nursing
Infection Preventionist
Supply Chain
Credentialing
Quality & Safety
Security and
Surveillance
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Information Technology
CMO
CNO
Nursing
Supply Chain
Quality & Safety
Nurse Call
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Information Technology
CMO
CNO
Infection Preventionist
Nursing
Quality & Safety
Bio-Med
Supply Chain
Hand Hygiene
Compliance
Hand Hygiene Management Approaches
Video
Surveillance
Cost
PersonSpecific
Monitoring
Area/Group
Monitoring
Automated
Observation
Impact
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Understanding the Hand Hygiene
Monitoring Landscape
Automated Observation
• Provides easy data collection and reporting via smart device
• Presents data automatically through software dashboard
• When combined with an electronic hand hygiene monitoring
system it allows for targeted observation
• Allows for consistent reporting & significant reduction in data
transposition errors
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Understanding the Hand Hygiene
Monitoring Landscape
Area / Group Monitoring
• Tracks ALL HH performance but does not distinguish “who”
• Can report across entire hospital, floor, unit, room, shift
• Most often utilizing a standalone network and software
dashboard - not integrated with Hospital Information Systems
• Ideal for smaller hospitals with limited budgets
• Can be used as a stepping stone to gather early learnings and
explore how to utilize technology to manage HH performance
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Understanding the Hand Hygiene
Monitoring Landscape
Area / Group Monitoring
Operates Outside of
Hospital Network
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Understanding the Hand Hygiene
Monitoring Landscape
Person Specific Monitoring
• Utilizes electronic badges to collect individual or role-based
HH metrics
• Can integrate with existing hospital infrastructure
(Nurse Call, RTLS, Capacity Management, etc.)
• Can correlate HH performance to patient / staff workflow and
other external factors (time in room, proximity to patient, etc.)
• Can report across entire hospital, floor, unit, room, shift
• Provides much greater capability and reporting
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Understanding the Hand Hygiene
Monitoring Landscape
Person Specific Monitoring
RTLS
EHR
Security
Hospital
Operations
Integrated into
Hospital Network
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Nurse Call
Hand Hygiene Monitoring Technology
Badge-based
Monitoring
Electronic
Observation
Community
Monitoring
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Hand Hygiene Monitoring Technology
By far the most ubiquitous and
pervasive technology in Healthcare
and growing in use
What you need to know:
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Requires I.T. and/or Bio-Med assistance to connect across
hospital network
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Deployed for WOWs and medical devices - this technology is
already in place
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Penetrates walls and clothing to track equipment, patients, and to
record temperature readings
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Maximizes ROI of existing I.T. network investments
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Hand Hygiene Monitoring Technology
Prevalent where the technology's
resistance to interference and lowenergy use makes it an easy choice
What you need to know:
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Embedded in most smart phones and growing in use for medical
equipment connectivity – truly a “smart connected” technology
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Becoming broadly deployed across healthcare
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Integrates with Wi-Fi and can be encrypted for secure data and voice
transmission
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1-2 year battery life for general use
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Hand Hygiene Monitoring Technology
Using sound waves to measure the
distance, movement and direction of
people or objects.
What you need to know:
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Works well to isolate objects in a confined space; does not
penetrate walls
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Requires a proprietary network to receive and transmit signals
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Although easier to support, it does not maximize investment in
existing Wi-Fi network
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Hand Hygiene Monitoring Technology
Radio Frequency Using electromagnetic waves to
Identification
automatically identify and track tags
(RFID)
What you need to know:
attached to objects. The tags contain
electronically stored information.
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Used to manage mobile medical equipment, improve patient
workflow, monitor environmental conditions, and protect patients
and staff
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Active RFID tracks high-value, frequently moved objects; Passive
RFID tracks lower cost items at a room or zone level (static)
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Commonly used within RTLS systems
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Requires a separate network to send and receive data packets
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Hand Hygiene Monitoring Technology
Infrared(I
R)
Using thermal radiation to detect and
make visible objects within a line of
sight
What you need to know:
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Requires a line-of-sight to detect and transmit
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Relies on a separate network devices to connect IR signals
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Commonly used for night vision and thermal detection or objects
(heat mapping)
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Not as prevalent in hand hygiene monitoring solutions; if used, it
is generally combined with RF or other technologies
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Hand Hygiene Monitoring Technology
Asset
Tags
Provide the location and condition of
critical resources
What you need to know:
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Needs vary by use case and not all use cases in a solution
set are the same
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Used to automatically identify and track the location of
objects or people in real time, usually within a building or
other contained area
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Hand Hygiene Monitoring Technology
Electronic
Badges
Used to locate and manage
staff activities
What you need to know:
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Small, battery powered or re-chargeable device worn by a
healthcare worker for role-based or person-specific
monitoring (hand hygiene, workflow, security, etc.)
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May be an obstacle for unionized or hospitals with policies
regulating the use of individual tracking devices
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Badges are developed to use specific wireless
technologies for communicating with the system
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Hand Hygiene Monitoring Technology
Network &
Locating
Devices
The backbone of a hand hygiene
monitoring system
What you need to know:
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Used to locate an object in a specific location (hallway, room, etc.)
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Room sensors detect other devices in a room or zone (e.g. badges,
dispensers, asset tags)
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Commonly send data to a gateway device which sends data through
the proprietary or hospital network to a processing device (on-site
server or cloud-based service)
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Internet of Things
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IoT Application for Hand Hygiene
Benefits of connected devices:
 Can monitor status of devices & consumables
 Reduces product waste and increases sustainability profile
 Improves inventory management
 Increase labor efficiency enabling focus
 Supports accountability of services provided
 Increases accuracy in bid planning
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Key Considerations
• Form a cross-functional team
• Develop processes and
competencies to support the system
• Develop clear requirements
• Review multiple solutions
• Understand the implementation plan
• Understand what you are getting
• Validate for accuracy and capability
• Prepare staff and leadership
• Build programs to achieve
sustainable performance
• Set achievable goals
Technology alone will not succeed
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The Impact of Hand Hygiene
Monitoring
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The Impact of Hand Hygiene
Monitoring
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The Impact of Hand Hygiene
Monitoring
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Hand hygiene rates were increased and sustained when electronic hand hygiene
monitoring was combined with complementary hand hygiene improvement
strategies.
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Installing technology without complementary hand hygiene improvement
strategies did not improve or sustain hand hygiene rates.
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Successful outcomes with electronic hand hygiene monitoring require
complementary improvement strategies as well as:
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Executive leadership/Physician commitment and engagement
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Hand hygiene champion
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Unit-level leadership engagement
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Commitment and tenacity
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Q&A
Thank you!
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Appendix
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The Role of the Infection Preventionist
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Lead the development of the business case and present to internal KDMs
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Charter the team who will evaluate and select the solution
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Lead the gathering of requirements (using a whole systems approach)
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You play a key role in the
Select potential solution providers and oversee early evaluations (pilots)
overall success of a Hand
Perform system validation and provide final approval toward full implementation
Hygiene Monitoring
Develop policies, educational materials, and training for staff
Solution!
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Review and manage contracts and service agreements
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Receive reports and identify improvement programs to increase and sustain HH
performance
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Identify champions to drive use and promote proper hand hygiene behavior
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The Journey of Implementing the
Solution
Determine What Problems Need to be Solved
• Increase hand hygiene performance & decrease HAIs
• Improve patient experience and safety
• Consistent and continuous unbiased reporting
• Badges or Community based performance?
• Evaluate the impact of interventions over time
• Integration with existing hospital information systems
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The Journey of Implementing the
Solution
What to Look for in a Dashboard
• Secure interface
Web Portal Experience
• Easy to navigate with intuitive key indicators
• Displays data in a historic / present format
• Customizable Ad Hoc Reporting
• Alerts and Push-reporting
• Available on multiple devices (PC, iPad, Android)
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Mobile Apps
The Journey of Implementing the
Solution
Confirm Solution Capabilities
• Robust [secure] Dashboards and ad hoc reporting
• Frequency of Data Updates - real-time, near real-time, etc.
• Workflow rules set for each discipline or area
• Accuracy, reliability, and scalability
• Battery life and replacement program; badge deployment program
• Uptime expectation / Service Level Agreements
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The Journey of Implementing the
Solution
Preparing for Implementation
• Hand Hygiene Monitoring vs. Direct Observation – be ready for a
potentially difficult conversation
• Identify where to monitor and why
• Data -> Information -> Interventions – Have your plan ready
• New process development and staff competencies
• Educate staff on proper hand hygiene practices (C-suite to front-line)
• Have a well-rounded skin care program – people, product, programming
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Selecting a Hand Hygiene Monitoring
Solution
What to Anticipate Post-Installation
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Validate to build the believability factor
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24x7 non-subjective hand hygiene metrics (oh, and lots of data!!!)
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Hawthorne effect in hand hygiene performance
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Dealing with high/low performers
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Staff concerns and issues (e.g. badges, dosing, skin health, HH credit)
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The overall impact on HAI reduction
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Clinical support to help interpret the data and manage intervention plans
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Increased support from EVS and Housekeeping for product replenishment
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