Hand Hygiene Monitoring Technology: Advice for Product Evaluation and Purchasing

Infection Control Today invited manufacturers of automated hand hygiene monitoring systems to provide information that will assist infection preventionists in evaluating and purchasing these technologies.

Infection Control Today invited manufacturers of automated hand hygiene monitoring systems to provide information that will assist infection preventionists in evaluating and purchasing these technologies.

ICT: What is the name of your system?

BioVigil: Biovigil Hand Hygiene Compliance & Surveillance System

DebMed: DebMed® GMS (Group Monitoring System)

GOJO Industries: SMARTLINK Hand Hygiene Solutions

HandGiene Corp.: HandGiene HHMS (Hand Hygiene Monitoring System)

IntelligentM: IntelligentM Smartband System

Proventix: nGage

UltraClenz: Patient Safeguard System (PSS)
Versus: SafeHaven (an automated hand hygiene monitoring system from Georgia-Pacific integrated with Versus RTLS); Versus Advantages Hand Hygiene Safety (HHS) is the software.

ICT: What are the components of your system?

BioVigil: HCW-worn badge, room sensors, charging station, wireless base station, web-based SW application.

DebMed: The DebMed® GMS utilizes wireless communications technology built into product dispensers to automatically track soap and sanitizer dispenser activations in patient-care areas. This information is send over a cellular network, combined with published benchmark data to calculate hand hygiene compliance, and presented to users in the form of web-based reports.

GOJO Industries:
- Innovative measurement tools to track and report real-time hand hygiene compliance rates as a stand- alone system or to work with partner-RTLS systems.
- Advanced, touch-free dispensers that are designed to work with SMARTLINK Technology to capture and transmit hand hygiene events.
- Superior formulas such as PURELL® Advanced Instant Hand Sanitizer and PROVON® antimicrobial soaps.
- Expert, clinician-based support to guide your team toward improved and sustained improvement.

HandGiene Corp.: The components that make up the HandGiene HHMS include RFID enabled dispensers and stand-alone readers, RFID badges, web-based Compliance Monitoring Software and a variety of FDA approved soap and sanitizer formulations.

IntelligentM: The IntelligentM system is made up of Smartbands, worn by healthcare workers, and Smart Tags placed on hundreds of pieces of equipment and products around a hospital.

Proventix: The system consists of four components: (1) radio-frequency identification (RFID) badges worn by healthcare workers; (2) Communication Units (CUs) are a family of devices that interact with various hospital devices and healthcare worker interactions and can be implemented in a variety of ways to meet the hospitals needs. CUs are located above the soap or alcohol dispenser and can detect the healthcare workers presence and track the hand-hygiene event (or other mechanical or electrical device engagement). The CU displays important professional, performance and user-identified content through an active two-way communication display (LCD screen); (3) a wireless bridge unit that communicates messages between the nGage central server and CUs; and (4) the nGage server that collects data for review and performs detailed individual and aggregate analysis. The system is built on an open architecture that allows for additional functionality and the opportunity to connect to other devices.

UltraClenz: The PSS system has several components:
- A manual or touch-free soap or sanitizer dispenser UltraClenzs ProClenz dispensers are equipped with a monitoring interface for ease of installation. The PSS system can be adapted to be used with all commercial wall mounted dispensers by simply attaching a connector switch to the dispenser.
- A Caregiver Badge An electronic badge worn by the healthcare worker (HCW.) The caregiver badge is designed to present the caregivers hand hygiene compliance status via a red, yellow or green LED. The badge includes an audible alert in order to advise the Caregiver of a non-compliant patient interaction. The badge transmits its current status or change of status to the bed or dispenser beacon it is interacting with. The beacon will then transmit the badges hand hygiene compliance status to the Bentley system, (UltraClenzs Patented Proprietary Wireless Communication System), which in turn transmits the data to an offsite server for reporting.
- A dispenser beacon is mounted next to the manual or touch-free dispenser being monitored. It sets the caregiver badge to the compliant state (green LED) when the dispenser is activated. Once activated, the dispenser beacon transmits the event to the Bentley system and from there up to the offsite server for analytical purposes.  The event includes the badge ID, the badge hand hygiene compliance status, the dispenser ID, and a date and time stamp.
- A bed beacon and antenna A bed beacon is a device mounted on or next to a patients bed or chair which defines the patient zone.  When a HCW approaches a patient or enters the patient zone, the bed beacon triggers a patient contact event and transmits the event, through the Bentley system, up to an offsite server. The event includes the badge ID number, the badge hand hygiene compliance status, the bed ID number and a date and time stamp.  The bed beacon changes the badge hand hygiene compliance status, to yellow (LED) for a first contact or red (LED) for a non-compliant contact event.
- Bentley A patented proprietary wireless network that retrieves data from the dispenser beacons, and bed beacons and transmits the data to a cloud based server for data analysis and reporting.

Versus: SafeHaven includes the Versus RTLS integrated into Georgia-Pacific soap/sanitizer dispensers
Versus V-Direct RTLS sensory network
Versus Clearview Badges
Versus Advantages HHS software

ICT: Does your system use RFID or WiFi? Are there issues with interference of the RFID signal caused by other electronic equipment?

BioVigil: Neither is used, thus no interference.

DebMed: Using wireless communications technology, the DebMed® GMS has been designed to be completely standalone, and does not require integration or connection to any other hospital systems. The system operates on a frequency band open to usage by any equipment that operates within certain power and duty cycle limits, and these systems are specifically designed to run alongside each other without interference. It can be installed into any environment without impacting the performance of any existing equipment, wireless networks or low power radio systems already installed (such as Wi-Fi, nurse call systems, pager systems, etc.).

GOJO Industries: The GOJO SMARTLINKActivity Monitoring System(AMS) uses RF (Radio Frequency). In addition, the GOJO SMARTLINK Technology is capable of working with industry leading RTLS (Real-Time Locating System) applications that utilize RF, LF, IR, and WiFi to record and report hand hygiene performance. Implementing RF-based wireless devices in hospitals can be a challenge with the existing, and complex, network of wireless medical devices.  However, the GOJO SMARTLINK  Technology is configured to operate on frequencies that can co-exist with existing medical devices; therefore, lessening the risk of interference with the SMARTLINK Technology, as well as, the other devices used to save lives and improve patient care.

HandGiene Corp.: The HandGiene HHMS uses both RFID and Wi-Fi.  There has been no interference of the RFID signal experienced.

IntelligentM: IntelligentM uses RFID technology in a completely unique patent pending way that does not interfere with any hospital equipment. It does not require hard wiring or WiFi so it minimizes cost and maximizes convenience.

Proventix: nGage utilizes wireless infrastructure and active and passive RFID technology. nGage can co-exist with many other wireless networking standards. Facility testing has not identified interference with medical devices or other technology. The system is FCC, IC and UL certified.

UltraClenz: PSS does not use RFID or Wi-Fi. Badge and beacon communications are proprietary, secure and very robust in noisy RF and RFID environments. Bentley was specifically designed so the use of Wi-Fi could be avoided. This allows for PSS to be installed in a healthcare facility without the need to interact with the facilitys IT or communications infrastructure.

Versus: Versus utilizes infrared (IR) and active RFID. Versus is FCC compliant and does not experience interference nor interfere with other electronic equipment.

ICT: How does your system work?

BioVigil: Infrared room sensors trip the HCW badge with each room entry and exit, which invokes a series of audible and visual alerts that are defined by the client. 

DebMed: The DebMed® GMS compares two pieces of information used to calculate hand hygiene compliance at the unit level: the number of times healthcare workers did clean their hands (events), and the number of times healthcare workers should have cleaned their hands (opportunities).
- Hand Hygiene Events
The DebMed® GMS captures the number of times healthcare workers cleaned their hands by monitoring soap and hand sanitizer dispenser usage.  Each time a dispenser is activated, it sends a cellular signal indicating a hand hygiene event has occurred on the unit.
- Benchmarking Hand Hygiene Opportunities
The number of times healthcare workers on the unit should have cleaned their hands is calculated based on benchmarks established in the breakthrough HOW2 Study, published in the February 2011 issue of the American Journal of Infection Control. The HOW2 Study benchmarked the expected number of hand hygiene opportunities based on hospital type (size), as well as unit type (medical-surgical intensive care units, general medical units, and emergency departments), using the World Health Organizations (WHO) Five Moments for Hand Hygiene. The WHO Five Moments for Hand Hygiene is a higher clinical standard, as cleaning hands before and after patient care only accounts for half of all hand hygiene opportunities.
- Making the Benchmark Specific to a Hospital Unit
The benchmark from the HOW2 Study forms the basis of the compliance calculation.  The calculation is then adjusted for each hospital unit by adding in proprietary unit-specific data.
- Hand Hygiene Compliance Index
The actual number of hand hygiene events captured from the soap and sanitizer dispensers are divided by the expected number of hand hygiene events, resulting in the compliance index.

GOJO Industries: A sensor above the patient doorway tracks entry/exits as hand hygiene "opportunities" while  the SMARTLINK Technology in the soap/sanitizer dispensers calculate the hand hygiene "events." All information is sent via an internet gateway to the software system.  The software calculates the hand hygiene events over opportunities into the "compliance rate." We offer a stand-alone Activity Monitoring System (AMS) that calculates rates at the group-level and we have partnered with many prominent RTLS vendors and with their systems can monitor at the individual/badge level.

HandGiene Corp.: The HandGiene HHMS monitors the movements of covered staff and employees as they move about the facility, in and out of patient rooms, patient treatment areas or the bathroom. Our HHMS records all instances of compliance or non-compliance with the facilitys established hand hygiene protocols and provides real-time feedback, compliance recording and report functions. Monitoring occurs down to bed level. The HandGiene HHMS utilizes real-time web-based compliance monitoring software that provides a wide range of user customizable report and analysis functions.

IntelligentM: Healthcare workers wear Smartbands that interact with Smart Tags placed on hand sanitizer dispensers, soap dispensers, IV packaging, catheters, etc. The Smartbands can determine compliance for both the "how" and the "when" components of hand hygiene and can alert healthcare workers -- on the spot -- if they are not washing/sanitizing correctly or when they are required to do so. The Smartband vibrates once for a compliant handwashing event and three times for a non-compliant washing that should be repeated.

Proventix: The nGage system is a point-of-care compliance monitoring system that motivates healthcare workers to follow hand hygiene standards set by healthcare regulatory agencies. CUs (one of the Proventix family of devices) are installed in each patient room in close proximity to the soap or alcohol dispenser and in hallways next to sanitizer dispensers. The system and families of devices can be implemented in several ways:
Option 1: The nGage system can monitor 100 percent of hand hygiene dispensing and utilize Proventixs vast database to approximate healthcare worker compliance;
Option 2: Includes Option 1 but in addition, user identity is recorded to correlate healthcare worker compliance events;
Option 3: Includes Option 2 but also records individualized opportunities for a hand hygiene event to benchmark individual and aggregate compliance to other similar hospital and unit types; and
Option 4: Includes Option 3 but also includes unique messages to badged and non-badged individuals with educational, personal and/or patient level information, with the ability to integrate with other data sets and/or provide individualized communication. 
As a healthcare worker wearing an RFID badge enters a room, the CU detects the presence of the RFID badge through a secure wireless network, and the system records whether or not the badged healthcare worker performs a cleansing event. nGage not only measures the number of times a specific wearer of the badge cleanses but also knows how many opportunities there were to cleanse. The data is recorded on a central server via a secure wireless network.

UltraClenz: PSS was designed to protect the patient. All HCWs are assigned a caregiver badge. After the HCW washes or sanitizes their hands, the dispenser beacon sends a signal to turn their badge green. The badge data gets sent though Bentley to the cloud based server. The information sent includes the location of the dispenser that was used, the date and time stamp of the dispense event, and who activated the dispenser.  When the HCW approaches the patient zone, the bed beacon identifies him/her and sends a signal to the badge alerting the HCW that a patient interaction has occurred. The HCWs badge state will adjust back to green once the caregiver washes/sanitizes their hands. If the HCW does not perform a hand hygiene event after leaving the patient zone the following will occur:
- If the caregiver walks away from the patient bed and returns (re-contacts) after 1 minute, the badge will turn red. This will be a non-compliant event for not performing a hand hygiene event after leaving a patient and prior to re-contact.
- If the caregiver walks away from the patient bed, the badge will time out within 5 minutes (this time delay is programmable) and automatically turn red. This will be a non-compliant event for not washing/sanitizing after patient contact.
- If the caregiver walks away and approaches a second patient zone before washing/sanitizing, the patient Bed Beacon will turn the Badge to red non-compliant state, warning the HCW that they are out of compliance.
- Anytime a HCW performs a hand hygiene event the badge will automatically turn back to the green state.

Versus: SafeHaven includes the Versus RTLS integrated into Georgia-Pacific soap/sanitizer dispensers. The RTLS sensor in the dispenser identifies the staff person using the dispenser. The dispenser sensor transmits the badge ID to the Versus V-Direct sensory network. The sensory network transmits the data into the Versus Advantages software for display of real-time activity, usage trends and historical reporting.

ICT: If your system requires the wearing of a badge/tag, is there an optimal location on the healthcare worker to improve accuracy?

BioVigil: On the chest area i.e., shirt, scrub, or lab coat collar.

DebMed: The DebMed® GMS does not require that healthcare staff wear badges.

GOJO Industries: The GOJO SMARTLINK AMS does not require healthcare workers to wear badges. However, at GOJO, we have partnered with industry leading RTLS providers to supply an "integrated touch-free dispenser solution" that participates in badge-based hand hygiene monitoring.  Every time a badged healthcare worker activates a GOJO touch-free dispenser, a hand-shake is made between the dispenser and badge to confirm a wash or sanitize event has taken place.  Each RTLS provider has defined the optimal location for how a HCW is equipped with a badge.

HandGiene Corp.: The RFID tag utilized as an integral part of the HandGiene HHMS is an active tag.  It can be worn under multiple layers of clothing such as when clipped to a shirt pocket of a staff member who is also wearing a suit jacket and a lab coat.  In fact the HandGiene tag can be in the monitored person's pocket and still be accurately read by the HandGiene HHMS.

IntelligentM: Our system is designed to not have this issue. It is worn on the wrist.

Proventix: For best results and accuracy, we ask healthcare workers to consistently wear their badge in the same location.

UltraClenz: The HCW badge is an electronic radio frequency (RF) badge. The badge can be worn on a belt, pocket, on a lanyard around the neck or even inside a pocket. The badge does not rely on line of sight or infrared (IR) to activate. The badge is very flexible with regard to where it can be worn.

Versus: Versus badges include a clip for easy attachment. Best practices encourage the wearing of badges near the collar/lapel area.

ICT: What have been the results of real-world testing and/or use in hospitals? Provide citations for these studies.

BioVigil: 98 percent compliance within 48 hours post implementation, improved patient satisfaction scores, zero infections for six months and counting. St. Marys, Richmond Heights, Mo. Oral presentation delivered at APIC June 2013.

DebMed: DebMed® has several client case studies demonstrating how the DebMed® GMS system increases hand hygiene compliance and decreases infections, which are available upon request by contacting DebMed®.

GOJO Industries: Yes. We conducted a pilot study of our Activity Monitoring System at JPS Health Network in Fort Worth, Texas from June through October 2012. Some of the key finding in this study were a 92 percent increase in compliance rate during the study period and a 56 percent increase in the compliance rate during the post-study. (Source: GOJO Pilot. Fort Worth, Texas Hospital. Two units studied June October 2012.)

HandGiene Corp.: The HandGiene HHMS has been beta tested in multiple facilities, however the results of these beta tests have not yet been published.

IntelligentM: This information is not yet public, as it is being evaluated by customers. The results have been positive as a general description.

Proventix: Princeton Baptist Medical Center's MICU conducted a six-month study utilizing the nGage system. At the end of the six months, hand hygiene dispenses had increased from a total of 9,995 to a total of 35,713 hand hygiene dispenses. During the same six months, the MICU infection markers per 1,000 patient-days rate decreased by 35.1 percent when compared to the same months during the previous year. Based on previously published cost data, the reduction in infection markers corresponds to a decrease of 239 patient days and reduced net losses of $200,079. Reference: Reproducibility of Results in Decreasing Healthcare Associated Infections with the Use of Electronic Hand Hygiene Surveillance Technology (2012). Brenda D. Edwards Brazzell, RN, BS, manager, infection prevention, Princeton Baptist Medical Center, Baptist Health System, Birmingham, Ala.
At Andalusia Regional Hospital, researchers conducted a six-month prospective case study of the effects of electronic surveillance technology on hand hygiene activity using soap and sanitizer dispenser counts and patient satisfaction survey results. Healthcare workers utilized nGage and the frequency of the patient response of "always" on the patient satisfaction survey tool question of, "How often did the patient care staff wash their hands or use an alcohol hand rub before providing patient care?" At the end of the six-month data collection period, researchers noted an 82.6% increase in both soap and alcohol-based hand sanitizer dispenses when stratified by admission. Patient satisfaction survey results where the patient responded "always" increased by 9 percent overall. Reference: Improving Hand Hygiene Practice through Utilization of Automated Hand Hygiene Monitoring and Feedback Technology (2012). Candie B. Northey, RN, BSN, CIC, patient safety officer, National Division, LifePoint Hospitals, Andalusia Regional Hospital, Andalusia, Ala.

UltraClenz: As of today, the PSS system components have undergone the successful completion of several beta tests. Additionally, PSS has been fully deployed in Palms West Hospital in Loxahatchee, Fla.  The successful installation of the system was completed in October 2012.  PSS has been received very positively by the HCWs at Palms West.  The system will be deployed across three additional hospitals in the third quarter of 2013.

Versus: Positive outcomes have been generated from Versus RTLS clients over the past 20 years. Versus hand hygiene solution was utilized by two of the eight hospitals during the 2010 Hand Hygiene Project: Best Practices From Hospitals Participating in the Joint Commission Center for Transforming Health Project (http://www.hret.org/hand-hygiene/index.shtml). As stated in the study, the participating hospitals defined and measured hand hygiene, analyzed data, and improved processes and workflow using Lean Six Sigma. The hospitals helped identify 15 major root causes of failure to clean hands and worked on developing targeted solutions for each root cause or contributing factor. The Joint Commission standard for hand hygiene changed as a result of the hand hygiene project. Previously the standard called for hospitals to demonstrate hand hygiene compliance at a rate greater than 90 percent. A hospital that failed to comply would receive a Requirement for Improvement (RFI) and have 90 days to show improvement to 90 percent. As of August 2010, all eight participating hospitals reported hand hygiene compliance rates at about 82 percent. Many of the hospitals have reported a decline in HAIs as their hand hygiene compliance rate has increased. Solutions developed by the hospitals are part of the Targeted Solutions Tool (TST), a web-based tool provided free to Joint Commission-accredited organizations. The TST allows organizations to customize solutions to address their specific barriers to excellent performance.

ICT: Does your system also include product-usage monitoring in any way?

BioVigil: No.

DebMed: The DebMed® GMS does not measure product usage as it relates to liquid volume. The system utilizes wireless communications technology built into product dispensers to automatically track soap and sanitizer dispenser activation in patient care areas.

GOJO Industries: The Activity Monitoring System does provide dispenser-specific usage data (number of dispenses), but this data is not translated automatically into product consumption. 

HandGiene Corp.: The HandGiene HHMS monitors the volume of product used and instantly notifies appropriate staff when a particular dispenser is running low on soap or sanitizer. Should that dispenser run out of soap or sanitizer, a constant signal is sent for it to be refilled as the dispenser itself makes user customizable audio and/or visual alerts.  The HandGiene HHMS compliance software allows administrators to produce reports focused on soap and sanitizer usage.  These reports can further differentiate between specific types of products that were dispensed, including soap or sanitizer; with or without alcohol; liquid, gel or foam.

IntelligentM: No.

Proventix: Yes, nGage monitors the number of dispenses that occur at each soap or sanitizer dispenser. In addition, Proventix can power touch less auto dispensers, allowing them to become battery-free with patent-pending ProTek® technology. This technology incorporates dispenser solution level reporting that notifies environmental services staff when solution needs to be replaced, saving time and avoiding waste of soap and sanitizer.

UltraClenz: The PSS system has the capability to monitor usage by counting dispense events and estimating low chemical volume levels.  An automated solution is not yet in place but is being designed.

Versus: Yes. Georgia-Pacific dispensers meter an accurate amount of soap / sanitizer upon activation and send a record of the activation to Versus Advantages. Versus Advantages continually evaluates recorded dispense records sending a maintenance required message to Environmental Services when a refill or other maintenance is needed.

ICT: What are the disadvantages to traditional hand hygiene observation and monitoring and why does technology provide a better solution to hand hygiene compliance?

BioVigil: Disadvantages of conventional methods are well established and perhaps best summarized by: Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC and van Beeck EF. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidem. Vol. 31, No. 3. Pp. 283-294. March 2010. Electronic systems provide 24/7 personal accountability with 98 percent-plus  accuracy and a completely unbiased audit trail. The BV system also validates to patients, family members and coworkers the actual HHC status in real-time with each and every interaction.

DebMed: It is not only costly and time-consuming to conduct direct observation, but the observation itself is likely to change behavior, as people behave differently when they know they are being watched. This is known as the Hawthorne effect, which artificially inflates hand hygiene rates as the clinicians clean their hands more frequently than they normally would because they know they are being observed. In fact, a study done in Germany showed a difference of almost three times (2.75 times), making the compliance data inaccurate and unreliable. There is clearly a need for a better way to monitor and improve hand hygiene compliance. Depending on the system, electronic monitoring maximizes efficiencies and reduces costs, standardizes the way hand hygiene compliance is reported and increases accuracy, eliminates the Hawthorne effect, captures 100 percent of hand hygiene events, and eliminates the time delay by delivering real-time feedback with 24/7 access to reports.

GOJO Industries: Traditional observation and monitoring has some shortcomings:
- Small sample sizes (estimated at 1 percent)
- Can be labor and resource intensive to execute
-Data collection and data points are not standardized
 -It's difficult to combine and analyze data
- Is subject to the Hawthorne effect
Technology provides a better monitoring solution with:
 - 24/7 monitoring
-  Automated data collection
-  Objective, standardized measurement
-  Full accountability

HandGiene Corp.: Traditional hand hygiene observation and monitoring is limited in a myriad of ways specifically related to the methods used, areas covered, time of the day, etc.  It is very infrequently conducted 24/7/365 and almost never facility wide at all times.  Lastly, the opportunity for human bias and the possibility for compilation errors exist and have to be considered. The HandGiene HHMS operates every day, all day and is not affected by interpersonal relationships. It monitors everyone in the same manner and holds everyone accountable to the same requirements as determined by the administration. Further, all monitoring is done without any HIPPA concerns while providing monitoring down to the bed level.

IntelligentM: IntelligentM provides data that is more accurate, more detailed, more actionable and involves healthcare workers' hand hygiene compliance data at the hospital, unit and individual level. Visual observation does not account for each employee and each handwashing event.

Proventix: Current hand hygiene compliance methods are often inaccurate and non-standardized. As stated in several studies, observation only captures a fraction (typically between 1 percent and 3 percent) of the hand hygiene events performed. Due to this small sample size, as well as the time, cost and bias associated with periodic surveillance, it cannot provide reliable compliance estimates. Healthcare workers often overestimate the frequency and quality of their handwashing, making self-report unreliable. Aggregate volume measurements are also inexact because they cannot provide compliance rates or even hand hygiene opportunities. Technology provides a better solution because it is completely objective in its measuring functionality and capability. The nGage system accurately measures standardized hand hygiene events on a continual, around-the-clock basis and provides near real-time feedback to healthcare workers. Technologies like nGage that are expandable provide multi-functional capabilities and can be leveraged to create operational efficiencies and additional value for the hospital.

UltraClenz: The basic disadvantage to traditional monitoring is that HCWs are often aware they are being observed and therefore make an extra effort to perform the proper hand hygiene protocol during the observation period. This bias can create the Hawthorne effect resulting in inaccurate data. When HCWs are not being observed their behavior reverts back to pre-observation behaviors. Using electronic technology, hand hygiene activity can be monitored continuously during a 24-hour period and include nights and weekends. PSS can give directors and charge nurses a real-time, 24-hour-a-day look at compliance. Additionally, PSS focuses primarily on patients and the HCW interaction with patients. With regular feedback and coaching, supervisors have a tool that can help increase their compliance rating and change HCW behavior. Additionally, by providing real-time feedback, the HCW is immediately made aware of non-compliant hand hygiene. This allows the HCW to self-correct which will ultimately lead to behavior modification. Our system is patient centric and focuses on when the HCW performs or misses hand hygiene opportunities. We do not focus on wash in/wash out or on just entry and exits of rooms. Our primary focus is to be able to determine the hand hygiene state of a HCW when interacting with a patient allowing for us to monitor that compliance even in multi-bed rooms. PSS is based on the Five Moments of Hand Hygiene established by the World Health Organization (WHO).

Versus: Traditional hand hygiene observation and monitoring have several limitations to procuring consistent, unbiased, timely HH data. Some identified areas where manual observation is inferior include:
- Fly By staff mentality identified -- Hitting dispenser quickly equals a partial dispense; a partial dispense is not compliant by the CDC standards, but an observer may still mark that person as compliant. Automatic dispensers provide appropriate soap/sanitizer amount as recommended by the CDC
- Biased rating -- Some observers may rate certain staff at a higher compliance rate due to their affiliation with the subject/seniority. Automated monitoring continuously records all staff participation or non-participation.
- When being observed, staff members are more apt to follow protocol, however it is impossible to manual observe every possible staff person 24/7. Automated monitoring provides non-biased HH data which is 1,000  times more comprehensive than observation. The monitoring can be used 24/7 across all staff levels and shifts in real time
- When real-time, high-quality hand hygiene data is available by staff type, then business rules can expose actionable options to management. This results in identifying both super-compliers and super-spreaders; positively reinforcing top quartile performers; and providing additional training for bottom quartile performers
- Adding dispenser feedback to the staff person drives awareness of their actions. Green light confirms efficacious dose compliance.
- The facility can create appropriate business rules based on staff function to enhance staff buy-in. Standard CDC "gel-in, gel-out"  business rules are rarely always sufficient. Depending on the staff persons role (RN, environmental services) or location to the patient, rule-writing can accommodate special cases of when compliance is mandatory.

ICT: How does your system contribute to standardized observation, measurement and reporting?

BioVigil: Totally obsoletes it while replacing it with a fully automated system that produces standard or custom summary reports as defined by the system administrator.

DebMed: The DebMed® GMS encourages higher compliance through group monitoring, which is recognized by infection preventionists as being more effective than other monitoring systems that track individuals actions that are often seen by staff as punitive or as an invasion of privacy. The DebMed® GMS also goes beyond electronic monitoring to provide supporting tools such as staff meeting facilitation guides and visual reminders to help enable positive behavior change, ultimately creating a safer environment for the patient.

GOJO Industries: Our system provides reliable, 24/7 reporting of hand hygiene compliance throughout the unit. Our reports can be customized to hospital standards or needs. We believe this always-on reporting will help the infection preventionist to easily identify problem areas where observation can be used to determine the root cause.

HandGiene Corp.: The HandGiene HHMS operates in a very simple manner that can readily be adjusted by a facilitys administration.  All reports are user customizable and can be saved for later use. Everyone is held to the same standard, as the system in its monitoring activities does not differentiate by type of staff or their respective position within the facility. In the report functions, administrators can create, save and print reports based on the specific criteria created for their specific query.

IntelligentM: IntelligentM is configurable to an individual hospitals standardization for observation, measurement and reporting. Employers and employees receive feedback.

Proventix: The nGage system captures all hand hygiene events and opportunities 24 hours a day, seven days per week and 365 days per year. Because there is no bias in technology as compared to self-reporting and periodic surveillance, continuous monitoring and consistent reporting allows the healthcare worker to know his or her hand hygiene compliance level. Proventix clinical reports provide customizable analytics for hospitals, and nGage allows the ability to report compliance by healthcare worker, nursing unit/care area, department and caregiver specialty, hand hygiene solution dispenses and caregiver rounding.  These reports can be aggregated across all individuals, units, roles and hospitals because of the standardization.

UltraClenz: As previously stated, PSS is based on Your 5 Moments for Hand Hygieneestablished by the WHO. PSS meets three out of the five WHO moments of hand hygiene including, before touching a patient, after touching a patient and after touching a patient's surroundings. PSS has a number of basic reports that can present compliance based on date, badge number, room number or employee type.  These reports can detail a chronological list of events including hygiene events, patient contacts and compliance status during the course of a day or shift.

Versus: By using Versus HHS, automated documentation of dispenser use provides:
- Independent, 24/7 tracking of usage by who, when, where
 - Dedicated HH specific reports included with software application are available for trending and comparison reports which highlight weak/strong areas of compliance both on an individual or macro basis
 - Quickly demonstrates compliance data with new patient safety regulations and mandates

ICT: How does your system provide validation for accuracy and reliability overall?

BioVigil: Every HHC event is tracked by user, by room, by entry vs. exit, by day, by time, by each HHC response and alert component.

DebMed: The DebMed® GMS draws on a breakthrough study, published in the American Journal of Infection Control (AJIC) in February 2011, known as the HOW2 Benchmark Study which established statistically significant numbers of hand hygiene opportunities in various types of units in different hospital settings. Subsequent studies have proven the accuracy and reliability of the DebMed® GMS system and are available through contacting DebMed®.

GOJO Industries: As part of our GOJO SMARTLINK Hand Hygiene AMS installation process, our technicians work closely with key hospital stakeholders to validate the system, ensuring that devices are accurately capturing and reporting hand hygiene events.  To insure reliability, The GOJO SMARTLINK Hand Hygiene AMS includes automated reporting tools that allow GOJO to proactively monitor the status of the devices used to record and report hand hygiene activity.  When a device experiences an issue, GOJO is immediately notified of the problem, and then works with their support network to quickly resolve the issue.  A validated system coupled with a strong support network result is a system that is reliable and available 24/7.

HandGiene Corp.: The HandGiene HHMS is fully integrated transmitting all data in real-time. Each hand hygiene opportunity and the compliance or non-compliance is recorded and verified in real-time. The RFID tag worn by monitored individuals is an active RFID tag, which transmits a signal that can be read through multiple layers of clothing by the stand-alone readers and the soap or sanitizer dispensers.  Every effort was made during the development of the HandGiene HHMS to eliminate opportunities for monitored individuals to fool the system or for false readings to occur. In fact should any dispenser run out of soap or sanitizer, a constant signal is sent in real-time and email and/or text alerts are sent to the responsible parties to refill the dispenser.  Anyone who is read by that dispenser as trying to dispense soap or sanitizer while the dispenser was empty does not get credit for a compliant hand hygiene event.

IntelligentM: The IntelligentM Smartband provides a vibratory alert when recording events resulting in the ability for a healthcare worker to verify, with 100 percent accuracy, that the system working reliably. Detailed reports of all results are provided.

Proventix: nGage provides visual confirmation through the CU by indicating when the healthcare worker is in the wash zone, or the zone where they will receive credit for their hand cleansing. Additionally, researchers from the University of Chicago Medical Center and the University of Maryland School of Medicine performed a study evaluating nGage to manual observations of caregiver hand hygiene behavior. The study validated the accuracy of the systems detection of caregiver entry into and exit from the patient care areas and found that no interference with medical devices or other technologies was detected. Reference: Validation of an Automated System for Monitoring Hand Hygiene Compliance (2011). Emily Landon Mawdsley MD, Heather Limper MPH, Lisa Pineles, Stephen G. Weber MD MSc, Daniel Morgan MD; University of Maryland School of Medicine, University of Chicago Medical Center.

UltraClenz: PSS can be validated through the traditional means of observation. For example, data can be validated by sending an observer into the hospital in order to create a department specific check list of all hand hygiene events at that specific location. The data can then be validated and compared with the recorded data in PSS. Keep in mind that every time a HCW comes In contact with a patient, PSS records that interaction. Additionally, the system records the hand hygiene status of the HCW. For the first time, both the numerator (HCW hand hygiene) and the denominator (patient interaction) necessary to analyze Hand Hygiene compliance has been met through the use of PSS. 

Versus: With hundreds of installations spanning over 20 years, the Versus IR locating platform established the clinical-grade performance level required by RTLS for automating events in real-time. Other RTLS vendors have had to add more hardware to their systems to attain more granular locating data. This will increase the cost, implementation and maintenance of their systems. With Versus, as quickly as every second, real-time updates of patient, staff and asset movements are recorded thru a singular room-based IR sensors. The location and/or interaction with other badged people or tagged assets are able to send alerts, notifications and automate other processes.

ICT: How does your system handle limitations such as capturing hand hygiene opportunities and behavior beyond entering and exiting/situational context of hand hygiene opportunities, and multiple-patient rooms?

BioVigil: The BV system is primarily designed to support a gel-in/gel-out policy. In addition, other in-room WHO moments can be captured by presenting hands to the badge and using the manual button to associate context.  Multiple patients in a room are simply treated and monitored as an additional zone.

DebMed: Studies show that only cleaning hands before and after patient care accounts for merely 48 percent to 50 percent of hand hygiene opportunities, leaving patients at risk for infection.  In order to reduce infections and improve patient safety, it is important for hospitals to track all World Health Organizations (WHO) Five Moments for Hand Hygiene. The DebMed® GMS is the worlds first evidence-based group monitoring system to electronically monitor, track and report compliance rates in real-time, based on the WHO Five Moments for Hand Hygiene. The Five Moments for Hand Hygiene are:
Moment 1: Before Patient Contact
Moment 2: Before an Aseptic Procedure
Moment 3: After a  Body Fluid Exposure Risk
Moment 4: After Patient Contact
Moment 5: After Contact with Patient Surroundings

GOJO Industries: The GOJO SMARTLINK AMS, by design, is not equipped to capture hand hygiene opportunities and behavior beyond entering and exiting.  However, our SMARTWATCH solution is a web-based tool compatible with iScrub (an iPad/iPhone/iTouch application) which supports in/out or 5 moments observation data.  This allows healthcare workers to observe hand hygiene performance inside, and outside, the patient care area noting situational context during the process.

HandGiene Corp.: The HandGiene HHMS provides monitoring to the bed level so it is not limited to just entering and exiting a patient room or treatment area.  Through the use of multiple stand-alone readers in a multiple-patient room staff interaction with each patient and compliance with requisite hand hygiene protocol in these varied situations is properly and efficiently handled.

IntelligentM: Our system captures both the hand hygiene events and the hand hygiene opportunities for an individual healthcare worker in real time. We are not reliant on studies done at other locations or hypothetical opportunities for hand hygiene. This is why we have so many tags around the hospital, so we capture all events.

Proventix: With our 24/7 electronic system, Proventix has captured over 25 million hand hygiene events on the individual level.  This large amount of specific data allows the transparency to see where issues may occur with certain healthcare workers and then provide personalized feedback for coaching, encouragement, and comprehensive behavior modification. This large database of aggregate data also allows Proventix to study mid-episode hand cleansings helps to identify workflow and normalized behaviors. Being able to understand workflow, focus on improvement at the source and provide tools for increasing individual hand hygiene compliance are some of the ways Proventix is set apart. Additionally, Proventix's LiteMinder technology provides a visual reminder to healthcare workers if they have not cleansed upon entering the patient room prior to coming in contact with the patient.

UltraClenz: PSS has the ability to track not only hand hygiene events but patient interactions as well. Once a HCW washes/sanitizes their hands, the badge will turn green. If the HCW approaches patient (A) the badge will turn to yellow, a cautionary state. If the HCW approaches a second patient (B) either in the same room or a different room while in the yellow state, their badge will immediately turn red and report a non-compliant event.  In addition to the above, if the patient leaves patient A for more than 5 minutes and the HCW does not perform a hand hygiene event, the HCWs badge will turn red to a non-compliant state. Most importantly, if the HCW approaches a second patient within the same room and does not perform a hand hygiene event, the event is recorded. This feature is unique to PSS. 

Versus: Thanks to the accurate location zones defined by the infrared (IR) sensors and the ability to transmit the dispenser usage and badge ID quickly via the RF sensors, the SafeHaven dispensers can be positioned where needed, even identified per bedside.
Combined with a very intelligent rules engine, compliance timers, alert messages, and icon changes, a facility can customize each floor, department or even patient type to specific hand hygiene protocols. A facility can begin using the system in a very traditional method of monitoring overall usage in one department. If desired, they can advance their data collection to define individual usage metrics and even institute custom rules for specific patient types, time of day, etc.

ICT: How do you address the perception by healthcare workers that hand hygiene technology is intrusive and constitutes a "Big Brother" approach to monitoring compliance?

BioVigil: We hear this concern as well. Most often we ask the following question: Knowing all about HAI risks would such a HHC device or system have material meaning and value to you if you (or a loved one)) is the patient? It is interesting to see how quickly the perception changes. We find that empowering employees with their own data and the fact that patient impact of the system is so favorable due to the badge HHC status lights that the concern really does not last long. Any remaining perception problems thereafter are the responsibility of hospital management leadership and communications. HHC monitoring systems are no more, or less of a Big Brother issue than those we all commonly live with everyday such as traffic cameras, toll booths, passports, On-Star, cell-phones or any one of a thousand other tools used in industry to improve safety, quality and/or workflow efficiency. If an employer is paying you and there is an expected standard to be maintained, no one should have a problem with a measurement tool to ensure its compliance. If such a tool can also demonstrate itself to have material impact on patient satisfaction scores and outcomes, then all the better.

DebMed: The DebMed® GMS does not monitor healthcare workers individually. The system monitors hand hygiene compliance at the hospital unit level and encourages collaboration among staff to improve compliance; this method is recognized by industry thought leaders and experts as being more effective than other monitoring systems that track individuals actions and can be seen by staff as punitive or as an invasion of privacy.  By encouraging teamwork, it drives individual accountability and creates a positive culture of safety based on behavior change.

GOJO Industries: The Real time Locator System (RTLS) is person specific, based upon identifying the HCW wearing the badge. Depending on the approach to non-compliance, there is potential for a HCW to feel threatened as if Big Brother is watching.  Much of the perception will depend upon the way the system is launched and presented to the staff. If the RTLS compliance monitoring system is presented as an opportunity to improve hand hygiene compliance and possibly reduce HAIs, chances are good that the system will be better received than if a punitive approach is taken.  The leadership team supporting the hand hygiene compliance improvement project should decide what approach works best for their unique hospital culture. For those cultures where individual identifiers will not work, GOJO offers the SMARTLINK Activity Monitoring System (AMS) which monitors the hand hygiene compliance of anyone entering and exiting the patient room, including visitors and patients. Some healthcare systems plan to begin with the Activity Monitoring System and then gradually introduce the RTLS system after the staff is comfortable with the concept of monitoring hand hygiene compliance electronically.

HandGiene Corp.: The HandGiene HHMS was developed with input from healthcare professionals during multiple rounds of research. These results were integrated into the function of the HandGiene HHMS. For example, the HandGiene HHMS has both visual and audio alerts to remind healthcare workers to comply with hand hygiene protocols. Proactive steps were taken to remove the patient from the function of being the handwash police. All monitored individuals are given access to the web-based compliance software so they can review their own hand hygiene compliance rate and compare them to certain benchmarks, which are set by the administration. Further, the HandGiene HHMS does not require the monitored individual to add any additional steps to the hand hygiene protocol such as placing their hand under or next to something in order for the presence of alcohol to be detected.

IntelligentM: Every major hospital accreditation organization and a significant number of states require hospitals to monitor, record and report hand hygiene data. IntelligentM captures and reports this information. We also encourage hospitals to remind employees that this information will truly help improve care and will make them a more safe/effective provider. We believe employees understand the importance of this issue and improving the standard of visual observation.

Proventix: We have found that we can overcome "Big Brother" concerns through education. We emphasize to hospital leadership that the techniques used to motivate caregivers must be positive, encouraging and rewarding of high performance, as opposed to punitive. Proventix trains and encourages frontline managers to recognize high-performing employees for their efforts and progress to motivate everyone to success. We reiterate that maintaining good hand hygiene is the right thing to do to protect patients, caregivers and visitors and that the system is in place to help them improve their own performance when necessary.

UltraClenz: We believe that HCWs care deeply about the safety and health of their patients and that they will look favorably upon any system that can improve patient outcomes. In that respect, we feel that   we are partnering with the HCW to reduce infection. PSS does not monitor HCW private space or habits. PSS monitors when HCWs wash or sanitize their hands and their hygiene status when they come into contact with a patient under their care.  Theoretically, if the HCW washed prior to coming into contact with patients and after contact with patients, their report will be exemplarily.  PSS is not meant to be punitive its true intent is to educate and remind the HCW to perform proper hand hygiene prior to coming into contact with patients. 

Versus: Versus RTLS is most often deployed in healthcare facilities for multiple use cases (nurse call automation, asset management, patient workflows, staff assist alerts).  The benefits of reducing manual data entry, phone calls, and endless searching provide a valuable return for all staff utilizing the RTLS. Automating hand hygiene monitoring provides consistent, non-biased documentation of who and when. Versus reporting displays real-time and historical trending charts to highlight consistent and improving users compared to those who are not achieving the best practices established by the hospitals.

ICT: How do you educate users about the function of the system and to maximize its operation?

BioVigil: On-site training, web-based training tools, automated and manual reports, email and text alerts and communications (optional), support outbreak investigations. 

DebMed: The DebMed® GMS provides onsite training, ongoing customer support and an online toolkit with supporting tools such as staff meeting facilitation guides and visual reminders to help enable positive behavior change, ultimately creating a safer environment for the patient.

GOJO Industries: After the system has been installed and system operation has been validated, we provide end-user training to facilitate effective site navigation and report generation. We also offer SMARTLINK clinician-based support with all our operations.  We provide an expert clinician who becomes part of your team. This clinician will guide you through set up and implementation and provide detailed improvement plans. This support is also available as a consulting service to provide ongoing leadership and support to drive continual improvement.

HandGiene Corp.: The HandGiene HHMS uses web-based compliance software that every monitored user can access.  Each user can actively monitor their own respective performance and compliance with the facilitys protocols.   Reports are easy to generate, save and share by email, printing or fax so that proactive discussions can occur enhancing the staff and administrations movement towards improved hand hygiene compliance rates.

IntelligentM: We provide full training and on-going support for iM as long as the system is deployed at a hosptial.

Proventix: The Proventix clinical team provides training to nurse managers and staff regarding the system, why it is in place and how it should be used through training videos, educational materials and in-person sessions. Proventix strongly encourages leadership from the highest levels within the organization, as this tends to promote and motivate end users to be supportive and accepting of the system. Proventix also encourages leadership to be judicious with the data that is generated to prevent the data from being used in a punitive way. The clinical team reminds hospital executives and staff that hand hygiene compliance is important, and we know it is challenging, but we can accomplish it together.

UltraClenz: UltraClenz has created several different training tools to assist with the education of hand hygiene practices by HCWs. The tools provided are: a video detailing how the system functions, an accessible list of Q&As on the system and hand hygiene practices, and a physical handout given to each individual employee once physical training on the system has been completed. 

Versus: The SafeHaven solution includes access to clinical trainers during implementation that can assist with best methodology for utilizing the RTLS automation,  review of basic system functions, and (if  implemented) rule writing regarding timers of where and how long a person is considered compliant. Training materials include technical training for Super Users, and on-site User Training. Training methods include PowerPoints, Computer-based training (CBTs), videos and on-line tutorials. The solution also provides reminder posters, mirror clings, bookmarks and attachable dispenser signage. These items are complimentary and easy to change out to keep the information fresh and top of mind. Versus trainers can also work with the facility in showcasing the Hand Hygiene Heroes of the Day to promote a positive atmosphere and reward those that are doing well and showing improvement.

ICT: What is the cost of your system?

BioVigil: Fully managed service (rental) business model on a price-per-badge ($12.50-20/per badge/ per month).

DebMed: The DebMed® GMS is significantly more cost-effective than systems that track individuals, making it one of the most affordable electronic monitoring systems on the market, and it requires no capital investment.

GOJO Industries: Our solutions and pricing are customized to the needs of each facility.

HandGiene Corp.: The HandGiene HHMS is a very reasonable all encompassing solution to the dilemma of monitoring the hand hygiene compliance of staff throughout a facility.  The approximate cost of equipment for a private and semi-private patient room is $2,000 and $2,300, respectively.  Firm pricing, including installation costs is determined after a site visit and evaluation.  There is an initial software setup fee. After installation, the only on-going cost is for soap and sanitizer, which a transfer cost as the facility is already purchasing both soap and sanitizer, and the annual replacement of the RFID tags, which need to be replaced on a schedule based on projected battery life. There are no annual software fees, or maintenance fees or equipment charges. Once the HandGiene HHMS is installed the facility owns it. The projected ROI is six months or less for any installation of the HandGiene HHMS.

IntelligentM: iM costs about $10 per user per month. There is a $30,000 one-time installation cost. Note that the system does not require involvement or time of the hospital's IT team.

Proventix: Cost is based upon functional requirements and negotiated with specific clients.

UltraClenz: We designed PSS from the ground up with its primary focus being to monitor hand hygiene compliance. One of the primary focuses behind PSS was cost. PSS costs a fraction of what is currently being distributed in the market. The overall system cost is dependent on many factors such as: the size of the facility, the roll out of the system (departments vs. hospital wide), the amount of people using the system (nurses, doctors, visitors), etc. 

Versus: As the most deployed RTLS in healthcare, we find a high percentage of our hand hygiene inquiries already have the Versus RTLS deployed in their facility for other types of use cases (nurse call automation, asset management, patient workflows). In such instances, adding the hand hygiene application is simply a use case addition. The cost of the sensory network is leveraged across multiple departments and IT applications thus providing a low total cost of ownership. The SafeHaven solution also includes complimentary training support materials, reminder posters and communication materials to reinforce hygiene participation throughout the facility. Versus will provide individual quotes for each facility based on their existing infrastructure and additional use case deployment.

ICT: How do you help infection preventionists make the business case for its purchase?

BioVigil: Summarize and support published research studies. Perform site surveys; establish current benchmarks, overhead cost, efficiency and structure for manual observation methods. Build economic models for improvements in infection rate, increase patient satisfaction scores, reimbursement. Support on-site system evaluations.  Work with the hospital C-suite to establish tangible system goals and objectives and economic ROI model. Offer a no-risk business model where we can easily remove the system if it does not deliver results as expected.

DebMed: The DebMed® GMS is the only hand hygiene system that meets the WHOs Save Lives: Clean Your Hands recommendation for electronic monitoring systems. In addition, the DebMed® GMS goes beyond electronic monitoring to provide an online toolkit with supporting tools such as staff meeting facilitation guides and visual reminders to help enable behavior change.  It costs about 80 percent to 90 percent less than systems that monitor compliance using individual badges and requires no capital investment  The DebMed® GMS provides a more accurate way to monitor hand hygiene compliance and reduce  Healthcare-associated Infections (HAIs) which account for nearly 99,000 deaths, costing up to an estimated $45 billion each year for U.S. hospitals.

GOJO Industries: Most healthcare administrators know that each year in the US there are approximately 1.7 million HAIs with 99,000 deaths related to HAIs.(1) That is an average of 300 HAI related deaths per day, which is unacceptable. Although there is no price tag to assign to the loss of a loved one, HAIs can costs hospitals and impact their bottom line.  According to the CDC, hand hygiene is the number one way to reduce HAIs.  If a robust hand hygiene program could eliminate one central line associated blood stream infection there would be a savings of at least $25,000. In times of healthcare economic reform and uncertainty, hospitals cannot afford for their patients to acquire infections while under their care. By monitoring hand hygiene electronically, and having an accurate reflection of compliance rates, hand hygiene program owners will know where to target their resources to improve hand hygiene compliance through education and coaching. Reference: 1. Klevens, et.al. (2007). Estimating healthcare associated infections and deaths in U.S. hospitals in 2002. Obtained from: ttp://www.cdc.gov/hai/burden.html

HandGiene Corp.: Governmental requirements and regulations and insurance company mandates, including Medicare/Medicaid has made a healthcare facilitys utilization of some form of hand hygiene monitoring system (HHMS) a necessary reality. The facility-wide deployment of the HandGiene HHMS is a reasonable, justifiable business expenditure. Assuming a conservative cost of treating each HAI is $30,000. Then the cost of one HAI covers the installation of the HandGiene HHMS in approximately 15 patient rooms. A 100-bed hospital has an estimated 210 HAIs/year at an approximate cost to treat of $6.3 million non-reimbursed. This same facility could install the HandGiene HHMS for an approximate, exaggerated cost of less than $500,000 including the installation of additional dispensers in all hallways, bathrooms, treatment areas, labs, etc. and food service areas and cafeterias. Assuming that the HandGiene HHMS only reduces the HAI rate by 50 percent, the facility still saves 3.15 million less the cost of the system or 2.6 million or an ROI of two to three months.

IntelligentM: We are happy to work with infection preventionists making the business case for iM. Our system pays for itself for a year by saving a single MRSA outbreak or three CLABSI infections. It's a tremendous value.

Proventix: We provide discussion points with infection preventionists to help make the business case for nGage. nGage is an extension of the hospital's quality improvement team, and it is like having employees on the job 24/7 without having to provide benefits. nGage provides two-way communications, behavior modification models, data analytics and an insight into hospital culture. ROI opportunities include the reduction of healthcare associated infections (HAIs) and other HAI prevention efforts, including the reduction of readmissions, reduction of MDRO, reduction of slips and falls, hourly rounding and the potential to improve HCAHPS. Operational efficiencies for a hospital include data integrations based on the open architecture, the ability to push data to the system for view at nurses' station screens, incorporation of two-way communication at the CU with quality and educational content, asset tracking, head-height angle monitoring, temperature monitoring, analytics and work-flow assessments.

- Low cost and easy to install
- Low maintenance
- Ability to report hand hygiene compliance by hospital, department or individual
- Differentiates between type of healthcare worker
- Reduces the need for physical observation
- Automates and streamlines data analysis
- Potential to lower infection rates
- Potential to decrease overall HAI costs
- Immediate feedback on hand hygiene practices to all HCWs

Versus: The business case for utilizing a Versus HHS is justified by providing otherwise unattainable hand hygiene usage data 24/7. There is an immediate day-one cost savings by not having to deploy an actual person(s) to manually record dispenser usage. Additionally, there is a time and cost savings incurred by having reports automatically generated for multiple parameters. The data collected 24/7 by the Versus HHS, identifies which individuals/floors/departments/shifts are below the rest of the facility, specific education can be targeted to those outliers. The goal would be to improve the super-spreaders hand hygiene participation. Many HAIs are transmitted by health care personnel, and hand hygiene is a primary means to reduce these infections. In 2002, the estimated number of HAIs in U.S. hospitals was approximately 1.7 million, with more than 98,000 deaths annually, according to the CDC. It has been discussed that by increasing handwashing you may have a reduction in HAIs. The added financial burden attributable to HAIs is estimated to be between $28 billion to $33 billion each year. As identified in the 2010 Hand Hygiene Project, most hospitals thought their compliance rates were 70 percent to 90 percent, when they were actually less than 50 percent. If a hospital is able to increase their compliance rate, even just a few percentage points, it is highly likely that millions of dollars can be saved and possibly a patients life.