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Automated Measures of Hand Hygiene Compliance among Healthcare Workers Using Ultrasound: Validation and a Randomized Controlled Trial

Published online by Cambridge University Press:  02 January 2015

Dale A. Fisher ,
Theresa Seetoh ,
Helen Oh May-Lin ,
Sivakumar Viswanathan ,
Yanling Toh ,
Wong Chiang Yin ,
Loh Siw Eng ,
Tan Shire Yang ,
Steve Schiefen  and
Minkyu Je
...Show all authors
Dale A. Fisher*
Affiliation:
Department of Medicine, National University Health System, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Theresa Seetoh
Affiliation:
Department of Medicine, National University Health System, Singapore Ministry of Health Holdings, Singapore
Helen Oh May-Lin
Affiliation:
Department of General Medicine, Changi General Hospital, Singapore
Sivakumar Viswanathan
Affiliation:
Agency for Science, Technology, and Research, Singapore
Yanling Toh
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Wong Chiang Yin
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Loh Siw Eng
Affiliation:
Department of General Medicine, Changi General Hospital, Singapore
Tan Shire Yang
Affiliation:
Department of Medicine, National University Health System, Singapore
Steve Schiefen
Affiliation:
HanGenix, North Chelmsford, Massachusetts
Minkyu Je
Affiliation:
Institute of Microelectronics, Agency for Science, Technology, and Research, Singapore
Ruey Feng Peh
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Fiona Wei Ling Loke
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Michael Dempsey
Affiliation:
Center for the Integration of Medicine and Innovative Technology, Boston, Massachusetts
*
Infectious Disease Division, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, NUHS Tower Block, IE Kent Ridge Road, Level 10, 119228, Singapore (mdcfda@nus.edu.sg)
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Abstract

Objective.

The primary objective of this study was to validate a novel method of assessing hand hygiene compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary objective was to assess the impact of audio reminders and quantified individual feedback.

Design.

An observational comparison against manual assessment followed by assessment using an open-label randomized control method.

Setting.

Patient zones were established in 3 wards of 2 large teaching hospitals, including 88 general and 18 intensive care unit ward beds.

Participants.

Consented regular ward nursing, medical, and allied health staff.

Methods.

Concordance between 40 hours of manual observation using trained hand hygiene auditors and automated measures of opportunities and compliance. Subsequent measured interventions were reminder beeps and written individual feedback.

Results.

When compared with manual observations, ultrasound monitoring underestimated percentage compliances by a nonsignificant mean (95% confidence interval [CI]) difference of 5.2% (−20.1% to 9.8%; P = .491). After the intervention, adjusted multivariate analysis showed mean (95% CI) overall compliance in the intervention arm was 6.8% (2.5%−11.1%; P = .002) higher than in the control arm. Results stratified by compliance at entry and exit showed that the effect of intervention was stronger for compliance at exit than at entry.

Conclusions.

Our automated measure of hand hygiene compliance is valid when compared with the traditional gold standard of manual observations. As an interventional tool, ultrasound-based automated hand hygiene audits have significant benefit that can be built upon with enhancements and find increasing acceptance with time.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 919 - 928
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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