Image courtesy of Sonitor Technologies Inc.

Automated hand-hygiene compliance monitoring (HHCM) systems are gaining more acceptance and adoption across health care organizations as well as support from regulatory and patient safety groups. They also have become more sophisticated and can interface with other equipment and information databases within hospitals.

The importance of proper hand hygiene in preventing infections is emphasized by The Leapfrog Group in its safety grade hand-hygiene requirements. “Requirements such as these have led many health care facilities to explore automated HHCM systems as a means to meet these standards,” says John Stehle Ph.D., CIC, consultant for professional services at CenTrak, Newtown, Pa.

“The Leapfrog Group Hospital Survey includes direct observation requirements,” says David Urbanic, sales director at GOJO Industries Inc.’s Purell Smartlink Solutions, Akron, Ohio. “Post-pandemic, hospitals are re-energizing efforts around safety culture and are exploring technologies to help drive these efforts.” 

Advances in algorithms and analytics have been occurring over the past few years as HHCM systems have evolved. “From an algorithm perspective, more intelligence has been built in to increase accuracy in compliance results,” says Matt Crane, CEO at Sonitor Technologies Inc., Greenwich, Conn. “It’s now easier to interpret areas of improvement and opportunities, with structures and formats appropriate for Leapfrog and other compliance reporting.”

Hardware and data

The latest trends in HHCM are focused on simplifying the process of adding hand-hygiene monitoring hardware and expanding the utility of collected data, according to Andreas Stavropoulos, director of product at Vizzia Technologies, Atlanta. “One example on the hardware front is the increasing number of options that allow hospitals to use their existing soap dispensers. On the data side, we’re seeing lots of work to deliver useful data to endpoints that the customer needs, such as digital whiteboards, internal analytics tools and staff training platforms.”

To motivate health care workers and increase compliance rates, some HHCM systems incorporate “gamification” elements and provide real-time feedback. “By turning hand hygiene into a game-like experience, these systems aim to enhance engagement and promote better adherence to protocols,” says Sanjay Gupta, president and CEO at BioVigil Hand Hygiene Solutions, Ann Arbor, Mich. “Feedback mechanisms, such as alerts, reminders or personalized messages, can reinforce positive behavior and improve compliance.”

BioVigil Hand Hygiene Solutions offers an electronic hand-hygiene solution that uses an integrated system of sensors, badges and software. “Our technology includes hardware and software that monitors and tracks hand-hygiene behavior facilitywide and to individual users. We also provide hospitals with robust analytics that help them achieve significant behavioral change,” Gupta says.

BioVigil systems feature onboard chemical sensing, which eliminates the need to replace or retrofit sanitizer and soap dispensers (or change sanitizer or soap product vendors). It also allows hand-hygiene events to be registered anywhere and confirms that sanitizer is present on a caregiver’s hands when registering a hand-hygiene event.

The AccuWash Technology sink beacon, a recent BioVigil innovation, uses thermal energy and a sensor to detect when hands go into a sink. That starts a timer, which provides visual cues as the user is washing, and as they reach the Centers for Disease Control and Prevention-recommended 20 seconds. When the wash is complete, the sink beacon turns green. If the user stops early, the activity is not recorded as compliant.

GOJO offers the Purell Smartlink Activity Monitoring System (AMS), which tracks everyone entering and exiting the patient room as well as all actuations from its touch-free dispensers. The system provides 24/7 data on hand-hygiene performance at the facility, unit and room level. GOJO also has developed an app-based system, Purell Smartlink Direct Observation (OBV), which helps capture and process direct observation data to give hospitals insight into hand-hygiene compliance. The app also can track personal protective equipment compliance.

“The Purell AMS system is best used to track trends in hand-hygiene performance, so you know when an intervention is needed and whether it was successful,” Urbanic says. The Purell OBV is used with AMS to provide multiple approaches to monitoring hand hygiene, as recommended by the recent “Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene” update sponsored by the Society for Healthcare Epidemiology of America, he says.

Several years ago, GP Pro, Atlanta, a division of Georgia-Pacific, launched the SafeHaven portable hand-hygiene monitoring system, which combines Internet of Things (IoT)-enabled wearable hand-hygiene devices with individualized monitoring, reporting and analytics. Recently, the company introduced the Gen2 SafeHaven portable hand-hygiene monitoring system, which advances the solution’s multimodal approach to sustained hand-hygiene improvement. 

GP Pro’s updated system features portable hand-hygiene devices, which provide access to hand sanitizer at the point of care; an emphasis on positive rather than punitive feedback, which helps drive sustained hand-hygiene performance; and the SafeHaven web dashboard, which provides infection prevention teams with individualized real-time performance information and goal progression.

“As a total hand-hygiene solution, the SafeHaven system enables, monitors and amplifies compliance, and turns data into actionable, individualized insights that allow for targeted interventions,” says Ashley Butler, vice president and general manager of GP Pro’s skincare category.

CenTrak’s hand-hygiene compliance sensor detects when an individual wearing a real-time location system (RTLS) badge activates the dispenser or hand-washing station according to a facility’s unique protocols. Compliance data can be viewed at the organizational, departmental, role or individual level, allowing health care facilities to meet reporting requirements, audit hand- hygiene processes and enable workflow enhancements.

Data from CenTrak’s electronic hand-hygiene system provides real-time, actionable data 24/7, according to Stehle. “With the understanding of true compliance rates (which often differ from those collected by direct observation methods) enterprisewide, decision-makers can use data to provide feedback, training and education, and inform staffing and infrastructure in support of increasing hand-hygiene compliance.” Also, CenTrak reports can be configured to a facility’s needs with customizable room rules, such as the requirement to use soap versus sanitizer, as well as workflow adjustments to configure the appropriate time frame for staff adherence based on room type.

Sonitor Technologies has offered an HHCM system for years but did not provide a software application. The application had to be purchased from a third party. “After several years in development, we recently introduced Sonitor’s Hand Hygiene Application,” Crane says. “This cloud-based application is designed to work seamlessly with our infrastructure. The solution is already operating in several large health care institutions.”

Vitalacy Inc., Los Angeles, has added the Vitalacy SmartBadge to its suite of patient safety products. Designed to fit behind an ID badge, the device captures and delivers individual-, unit- and facility-level hand-hygiene performance data to hospital leaders. “This is an upgradable platform that hospitals can utilize depending on the changing goals of each facility,” says Haley Dukelow, vice president of operations. “It shares compliance data with hospital leaders and staff. Staff assigned to a wearable badge have their own login to a private user interface, so they can see wash opportunities, compliance, wash counts, and entry and exit wash differences.” 

The Vizzia InVIEW software platform from Vizzia Technologies allows users to see their real-time data, including equipment or staff locations, tag button presses and hand-hygiene events. It presents data in a list or map format based on preference, while embedded analytics allow users to dig deep and find answers to their questions. InVIEW includes prebuilt analytics and gives users the ability to create their own reports, according to Stavropoulos.

“Vizzia Technologies has experience with proximity-based solutions, which require hardware to be added to the soap dispenser, and systems that use high-precision location data to validate that a wash-up has been completed,” Stavropoulos says. “Data collected can be used in an anonymous fashion or can be tied to a specific caregiver based on customer preference. It also can be integrated into training platforms and incentive programs.”

AiRISTA, Sparks, Md., offers a wide range of wearable tags with sensors that measure motion and proximity. The tags are used on the pump itself to detect the vibration fingerprint of the pump’s activity; they also are worn by clinicians to receive credit for a dispense. “The B4n tag not only credits the wearer with a dispense, but if a dispense is required and the clinician misses an opportunity, the tag will notify the clinician via a display on the tag. The same reminder can be delivered to the clinician over audio devices such as television speakers or Amazon Alexa,” says Vince Grove, vice president of marketing. 

Also, AiRISTA has developed the Sofia software platform, which provides executive dashboards that allow users to view real-time and historic compliance rates. Hand-hygiene performance is separated by unit and individual user. Performance also can be measured when different rooms within a unit use different protocols. “If a hospital does not correlate RTLS locations with each dispense, the platform can monitor compliance based on the room and number of visits by each clinician,” Grove says. 

Despite their many benefits, HHCM systems are not yet typically found in off-site health care facilities, such as clinics, ambulatory centers and stand-alone emergency facilities.

“As the IoT and RTLS market has matured in health care, cost-effective technology options now make it possible for off-site facilities to adopt electronic monitoring,” Stehle says. “However, many systems were designed for acute care hospitals, so these smaller facilities must deploy a flexible solution that can be customized to their daily workflows.”

While smaller off-site facilities have shown interest in HHCM systems, the cost to implement them is typically too high, according to Grove. “However, the cost to install 10 to 20 dispensers at a remote facility becomes economical with lower cost Bluetooth Low Energy tags, cloud-delivered software and simplified architectures that allow for self-deployment.”

Looking ahead

The ability to combine data from different sources into a recommendation engine will be a big advance in the near future, according to Bahram Nour-Omid, executive chairman of the board and co-founder of Vitalacy Inc. “Integrating hand-hygiene performance with other insights such as asset-use tracking, electronic health record integration and other operational platforms will bring new opportunities to increase patient safety, hospital efficiency and profitability.” 

In fact, health care providers will reach a point where they cannot afford not to invest in HHCM technologies, says Butler at GP Pro. “We will see these solutions evolve so they can capture every hand-hygiene action taken — whether it’s by a wall-mounted sanitizing station, sink or wearable device. The technology will become as integrated into health care as electronic patient files, remote patient monitoring and mobile health.”

Artificial intelligence (AI) and computer vision technologies could play a significant role in enhancing HHCM systems, BioVigil’s Gupta predicts. “These systems could utilize cameras or depth-sensing devices to track hand movements and gestures. AI algorithms could analyze the video data in real time, detecting hand-hygiene events and providing immediate feedback or reminders to health care workers.”

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SenseClean Solution integrates with a soap dispenser and staff badge to automate hand-hygiene reporting. Sonitor Technologies Inc.

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Integrating Purell touch-free dispensers and Smartlink technology with an existing hand-hygiene program makes it easy to improve safety goals. GOJO Industries Inc.

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This electronic hand‑hygiene compliance monitoring solution helps reduce health care infections and improve patient safety. CenTrak

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The SafeHaven portable hand-hygiene monitoring system provides a multimodal approach to sustained performance improvement, combining IoT-enabled wearable devices with individualized monitoring, reporting and analytics. GP Pro

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This automated hand-hygiene monitoring solution has many wearable options to meet the workflow needs of any hospital. Vitalacy Inc.

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The Sofia real-time location system platform includes drill-down dashboards for investigation of hand-hygiene compliance. AiRISTA

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The green hand on the BioVigil badge is a visual confirmation to patients that their health care worker has performed appropriate hand hygiene before interacting with them. BioVigil Hand Hygiene Solutions

Neal Lorenzi is a Mundelein, Ill.-based contributor to Health Facilities Management.