By Ari Naim
Healthcare-acquired infections (HAIs) are among the leading causes of patient disability and mortality as well as financial loss for health care institutions with hundreds of millions of patients affected and the United States losing approximately $6.5 billion annually. Despite efforts to solve the HAI problem, 3.5 percent to 12 percent of patients are affected each year. HAI are often due to factors such as insufficient application of hygienic practices and hospital protocols.(1)
To solve this problem, various organizations and institutions have published recommendations for improving reporting, research, and surveillance systems, advocating for standard precautions, and improving staff education and accountability, as well as other solutions.(1) For example, the World Health Organization (WHO) developed a concept called “My Five Moments of Hand Hygiene”, which is a framework that helps healthcare workers (HCWs) identify moments when hand hygiene is required to prevent the transmission of pathogens during patient care.(2)
The five moments of hand hygiene concept attempts to solve one aspect of disease transmission in healthcare facilities (patient-provider transmission), but infections can also spread by patient-equipment contact and even via patient-visitor contact. Innovative, automatic, and cost-effective solutions like real time location systems (RTLS) can be a valuable tool in decreasing the burden of HAI and the spread of other infections.
Points of RTLS Utilization in a Hospital Setting
Improving Hand Hygiene
Improved hand hygiene has been shown to lower the incidence of HAI as well as multi-drug resistant bacteria and patient colonization. Several strategies, including educational programs and marketing, have been implemented in hospitals across the world to improve hand hygiene. While educational programs have been shown to improve practices among HCWs, other behavior-modifying strategies, such as audit and feedback, must be implemented to affect change.(1)
One way to do such audits is with RTLS technology. This type of system can provide customizable data for the hand hygiene practices of an entire hospital or for a single HCW. By badging HCWs, patients, visitors, and equipment, the activity of a single hospital room can be tracked. For example, an RTLS would be able to demonstrate whether or not a HCW washed their hands upon entering a room, the time at which they interacted with a patient or equipment, and if they washed their hands after the interaction before moving to the next patient room. By using this data, hospitals can audit hand hygiene processes, reduce the spread of unnecessary infections, improve patient outcomes and lower costs.
Optimizing Hospital Protocols
Isolation protocols, another requirement of HCWs, are useful in that they create barriers in an attempt to halt the spread of communicable diseases. Failure to follow through with such protocols, however, can lead to a devastating outbreak of disease, as was the case with the recent worldwide Ebola outbreak. As of June 28, 2015, the Centers for Disease Control and Prevention (CDC) estimates that there were 15,119 confirmed cases of Ebola worldwide with 11,235 disease-related deaths; the United States had 4 cases of Ebola with 1 disease-related death.(4)
The CDC has published recommendations for control procedures specifically for Ebola. However, protocols such as this are ineffective if HCWs do not maintain protocol integrity. In a case such as this, RTLS could track the movement of the index patient as well as their contacts (e.g., hospital staff, other patients, visitors and hospital equipment) and can track the use of personal protective equipment by HCWs. The real-time data obtained from RTLS would allow hospital administrators to act quickly to enact change in poor practice patterns or a failure to follow appropriate protocol, thus giving administrators the opportunity to isolate deadly infections.
RTLS may benefit decontamination protocols as well by tagging pieces of equipment and tracking them in real-time. For example, flexible endoscopy is a widely used diagnostic and therapeutic procedure, but it is also frequently associated with HAI. Accurate decontamination of flexible endoscopes is a multi-step process that involves cleaning, high-level disinfection, rinsing, and drying before storage. If one step of this process fails, there is increased risk of infection transmission from one patient to another.
A review of the literature showed that the rate of HAI after GI endoscopy is approximately 1 out of 1.8 million procedures.(5) However, the true rate of infection is difficult to pinpoint for reasons such as lack of surveillance. Many of these infections are due to inadequate decontamination procedures, which may be prevented by improving quality control systems. Improving quality control by tracking equipment through each stage of a decontamination protocol can be performed using RTLS.
Utilizing clinical-grade advances, healthcare institutions can augment already existing protocols to mitigate the spread of HAI and other infections. This technology can enable institutions to save lives, decrease overall cost and increase reimbursements.
Ari Naim is cofounder, president and CEO at CenTrak.
1. Healthcare-Associated Infections Fact Sheet. World Health Organization Web Site. http://www.who.int/gpsc/country_work/burden_hcai/en/. Copyright 2015. Accessed June 30, 2015.
2. Sax H, Allegranzi B, Uckay I, Larson E, Boyce J, Pittet D. “My five moments of hand hygiene”: a user-centered design approach to understand, train, monitor and report hand hygiene. [abstract] J Hosp Infect. 2007;67(1):9-21.
3. The Medical City Significantly Reduces Hospital Acquired Infections [press release]. Newtown, PA: CenTrak®. January 9, 2013. http://www.centrak.com/medical-city-reduces-hospital-acquired-infections/. Accessed July 22, 2015.
4. 2014 Ebola Outbreak in West Africa – Case Counts. Centers for Disease Control and Prevention Web Site. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Updated June 30, 2015. Accessed June 30, 2015.
5. Kovaleva J, Peters FTM, van der Mei HC, Degener JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013;26(2):231-254.