Facilities turn to electronic surveillance to remind health care staff to wash their hands and verify compliance as they push to reduce health care-associated infections.

With patient care and financial stakes higher than ever, the competition is intensifying among companies that offer or are developing high-tech hand hygiene monitoring systems for use in health care facilities.

The Centers for Disease Control and Prevention (CDC) say that clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in health care settings. But, despite efforts to counter the trend, hand hygiene compliance rates remain less than 50 percent, states a report by the Institute for Healthcare Improvement.

The consequences are dire. Hospitals experience an estimated 1.7 million health care-associated infections (HAIs) each year at an annual cost of $37 billion to $45 billion, according to the CDC. Nearly 100,000 die each year from HAIs.

Starting Oct. 1, Medicare is scheduled to reduce payments to hospitals for excessive readmissions. Since Oct. 1, 2008, the Centers for Medicare & Medicaid Services no longer provide additional payment for certain HAIs that occurred during a hospital stay.

There are more incentives to comply with hand hygiene regulations. The Joint Commission, Oakbrook Terrace, Ill., requires that hospitals try to improve compliance with hand hygiene guidelines established by the CDC or the World Health Organization coupled with each hospital's goals. Failure to comply with the standards may adversely affect an organization's accreditation status.

A problem until now is that traditional compliance monitoring methods of self-reporting and observational reporting, known as the "secret shopper" method of assigning someone in the hospital to watch staff hand hygiene behavior, have severe accuracy limitations, studies show. Voluntary hand hygiene usually is not effective.

Right time

With this convergence of events, incentives and flawed monitoring methods, the time was right for hand hygiene compliance to go high-tech. At least that's what several companies are banking on as they roll out new products to help hospitals grapple with the issue.

"It's the right time and right place for these products with the CDC hand hygiene guidelines and the knowledge that HAIs are preventable given the appropriate processes," says Harvey Nix, CEO, Proventix, Birmingham, Ala.

Brent Nibarger, chief client officer, Biovigil Systems, Ann Arbor, Mich., says health care workers do not deliberately disregard hand hygiene requirements, but simply can get overwhelmed by their workload. Additionally, patients and family are demanding visual confirmation that hand hygiene regulations are followed.

Each monitoring product has its own individual features, but all have the same goal: to remind or encourage health care workers to wash or sanitize their hands when required. Many report wirelessly on whether an individual worker has complied with hand hygiene requirements for each required episode.

Health care experts say electronic monitoring products hold considerable promise to increase hand hygiene compliance rates. Charles Johnston, executive vice president, UltraClenz LLC, Jupiter, Fla., says electronic monitoring products can help, but it's still up to doctors and nurses to comply with regulations.

"We all know that health care workers get very busy, they're seeing lots of patients, they're doing multiple things at once," he says. "All we're trying to do is send that reminder, 'Hey, did you wash your hands?'"

In the marketplace

For Craig T. Davenport, CEO, HyGreen Inc., Gainesville, Fla., the proof of his product's effectiveness is in the reported results. The Hand Hygiene Reminder System was in­stalled in a 28-bed pediatric unit in Miami Children's Hospital for a six-month period from September 2010 through March 2011.

The hospital reported at the annual Society for Healthcare Epidemiology of America conference last year that infections were reduced by 89 percent and hand hygiene compliance stayed above 90 percent for doctors and nurses in the unit. Davenport says that since the product was installed hospitalwide, compliance has been about 97 percent.

The product, consisting of a hand-wash sensor, bed monitor, badge and proprietary software system for tracking hand hygiene events, reminds health care staff to wash or sanitize their hands as they enter a patient room. After washing, they place their hands under a sensor that sends a wireless message to their badge. The badge turns green after analyzing vapor emanating from their hands after cleaning.

A wireless monitor above the patient bed searches for the message. If not found, the badge vibrates to remind the worker to wash. All interactions are recorded in real time in the product's HyMarks Reporting System.

Davenport says the product's intent is strictly benign. "We believe that health care workers want to wash their hands. You don't enter the profession of health care and provide care to people wanting to do harm," he says.

The Hand Hygiene Compliance Monitoring solution from AeroScout, Redwood City, Calif., enables hospitals to automatically monitor if, when and where staff members are sanitizing their hands.

The system consists of the company's Wi-Fi radio frequency identification (RFID) technology integrated with soap and gel dispensers, Wi-Fi tags worn by caregivers and MobileView Hand Hygiene Monitoring software. The solution supports the efforts of health care organizations to more efficiently monitor and record compliance data and increase staff hand hygiene compliance.

As a caregiver enters or leaves a patient room and dispenses soap or gel, the embedded AeroScout Exciter sensor in the dispenser is activated. This causes the tag worn by the caregiver to send a message over the hospital's standard Wi-Fi network identifying the caregiver, signaling the activation of the dispenser and recording the time and location.

Standard reports permit managers and infection control experts to monitor and manage hand hygiene compliance and also to target opportunities for hand hygiene process-improvement efforts. The product is scheduled to launch later this year.

Maintaining workflow

The nGage system from Proventix is a point-of-care monitoring system that utilizes wireless infrastructure and RFID technology to monitor and encourage hand hygiene compliance. Proventix partners with Ecolab, St. Paul, Minn., to integrate its dispensers and products.

As a health care worker wearing an RFID badge enters a patient room, a communi­cation unit installed near the hand hygiene dispenser detects the presence of the tag through a wireless network. When a dispensing occurs, the system determines the person in the proximity of the dispenser and records the event, says Nix.

The system measures the number of times a worker with a tag cleanses, but also how many hand hygiene opportunities arise. The data is transmitted to a cloud-based server that is accessible via a secure Web-based system, he says. The system provides data feedback immediately, daily, weekly or monthly.

The Biovigil Systems product, which launches in June, includes a base station, room sensor and personnel badge. The infrared (IR)-based room sensor, which is mounted at the doorway of the monitored area, identifies when workers enter or exit a room.

The badge flashes red and emits a sound to remind the worker to sanitize his or her hands. After sanitizing, the badge detects compliance through the use of an on-board chemical sensor IR receiver and then turns the visual indicator green. Information of the event is picked up wirelessly by the base station, which is typically installed at the central nurses' station. Data is wirelessly transmitted to a cloud-based application for analysis by authorized users.

Nibarger of Biovigil says customers will pay a subscription fee of about $10 to $12 a month per user rather than buying the system, something he discourages hospitals from doing as the technology continues to evolve.

UltraClenz LLC is expected to introduce its new Patient Safeguard System midyear, says Marina Willis, president and COO. The system was installed in two Florida hospitals for pilot testing for about three months. It includes:

  • A caregiver badge de­signed to present the caregiver's hand hygiene compliance status via a series of light-emitting diodes (LEDs).
  • A dispenser beacon that is mounted next to the dispenser being monitored. It will set the caregiver badge to the compliant state (green LED) when the dispenser is activated.
  • A bed beacon and antenna to create the patient zone. When a caregiver approaches the patient bed, the bed beacon will communicate with the badge and confirm the care­giver's hand hygiene status.
  • A proprietary wireless network called Bentley retrieves data from the dispenser beacons and bed beacons and transmits the data to an off-site, cloud-based server for data analysis and reporting. Reports can be generated by location, caregiver type, time or individual.

The system will track hand hygiene events and also contact with patients. Once a health care worker washes or sanitizes his hands, his badge will turn green. If the worker approaches a patient, the badge will turn to yellow, a cautionary state, explains Willis.

If the worker approaches a second patient either in the same room or a different room while in the yellow state, his badge will turn red and report a noncompliance event. In addition, if the worker leaves one patient for more than five minutes, the care­giver's badge will turn to red, indicating a noncompliance state for not washing after patient contact.

One distinctive feature is that it does not use Wi-Fi or RFID, says Willis. The proprietary wireless network was designed so the system could be installed without interfering with a hospital's information technology infrastructure.

The system from Airista, Sparks, Md., utilizes wireless and sensory technologies to verify personnel identification and detection of hand hygiene compliance. The product is Wi-Fi based, which allows hospitals to leverage their existing network to help decrease total cost of ownership, say company officials.

Hand hygiene dispensers are equipped with Airista's detection device, which communicates with caregivers' Wi-Fi tags to identify them. Warning alerts of noncompliance are made through audio and visual notifications.

The existing dispensers and hand-washing stations are equipped with wireless devices that detect the usage of hand hygiene dispensers. The data collected is sent over the facility's Wi-Fi network to Airista's Monitrac server located at the facility or its data center. The information is viewable through the company's Web-based Unified Visibility Solutions Console. 

Ekahau Inc., Reston, Va., offers a hand hygiene system that includes location-enabled staff badges and beacons that are embedded into dispensers. The staff badges enable the real-time location system to monitor staff-patient interactions automatically, as well as when a staff member washes his or her hands before and after interacting with a patient.

By leveraging the two-way communications capabilities of the system, staff members can receive reminders and status information on the text display of their badges. To ensure full compliance, the transmitters are activated only when hands are sanitized, eliminating the collection of false information, says Cindi Loveall, marketing director, Ekahau.

The HHMS from HandGiene Corp., Jersey City, N.J., includes RFID-enabled dispensers, stand-alone readers, RFID badges and Web-based compliance monitoring software. The system monitors health care workers as they move in and out of patient rooms down to the patient bed area and elsewhere throughout the hospital.

Compliance or noncompliance is recorded in a database that administrators and individual users can access in real-time through Web-based software. They can review data about specific employees, wards, stations, departments, shifts, an entire hospital or hospital system, says Richard Verdiramo, vice president, HandGiene.

The point-of-care hand hygiene system from Sprixx, Santa Barbara, Calif., features a personal, wearable sanitizing gel dispenser that counts each use and records data from the event. The data is downloaded into a central database with proprietary management software.

Using the system, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., anesthesia providers reduced nosocomial infections in the operating room by more than 50 percent. Ventilator-associated pneumonia was reduced by 61 percent and catheter-related blood stream infections by 50 percent in the intensive care unit.

Jeff Ferenc is senior editor for Health Facilities Managementmagazine.

Sidebar - For more information

For further details on the electronic hand hygiene monitoring systems featured in this month's "Marketplace" article, readers can contact the following vendors:



»Biovigil Systems

»Ekahau Inc.

»HandGiene Corp.

»HyGreen Inc.



»UltraClenz LLC