Irisys Technology Aims to Enhance HH Compliance by Cutting Subjectivity from Monitoring Process

Infrared technology could be a key strategy to improving healthcare workers hand-hygiene compliance and a high-tech weapon in helping to reduce the spread of healthcare-acquired infections (HAIs), according to the results of a trial in a U.K.-based general medical unit.

The study of the Irisys Intelligent Handwash Monitoring System was supported by the National Institute for Health Research (NIHR), which commissions research in the U.K. on behalf of the Department of Health and National Health Service.

Accuracy is key to gauging the effectiveness of hand-hygiene intervention strategies, says Anne Macmillan, business development director for Irisys Healthcare. The area of automated compliance monitoring is still new and evolving.  Some of the first approaches taken by others have attempted to use generalized averages instead of measuring behavior derived from the actual environment being monitored and therefore exclude significant groups that should be counted as part of their studies. The Intelligent Handwash Monitors smart-sensor technology, however, yields unbiased, objective data that drives informed decision making. Both opportunities and actual events are crucial to illustrate the complete hand-hygiene picture.

The technology helps to monitor healthcare workers behavior in relation to the World Health Organizations Five Moments for Hand Hygiene and is designed to eliminate the potential for bias, assumption and error. Rather than relying solely on human observation or generalized averages, it utilizes unobtrusive smart-sensor technology to establish baseline compliance; monitor workers behavior in response to intervention-strategy implementation; and report outcomes. A trial using the technology was conducted in three key phases over 12 weeks:

Phase I: Smart sensors installed at the units entrance captured footfall, or the number of workers and visitors entering and leaving, as well as handwash/hand-sanitizing opportunities versus actual handwash/hand-sanitizing events. All persons entering and exiting the unit entrance were required to carry out hand-hygiene.  Human observers also audited hygiene opportunities and sanitizer events. These datasets facilitated the development of intelligent software algorithms.

Phase II: Optimized equipment and detection algorithms captured datasets that were again audited by human observers.  These independent datasets verified the systems accuracy.

Phase III: A 12-week period (three consecutive, four-week intervals) validated the systems ability to measure a baseline and subsequently the effect of an intervention and how an intervention was sustained.  A four-week monitoring period established baseline compliance followed by four weeks of positive feedback delivery in the form of visual message stimuli that bolstered proper handwashing and hand-sanitizing protocol. The longevity of individuals observed changes was investigated for four weeks after visual stimuli were removed.

The study found in this specific environment individuals improved critical hand-hygiene compliance by 73 percent just one week after visual cues prompting proper and frequent handwash and sanitizer practices were placed at the entrance the general medical unit. Compliance returned to the average baseline of 23 percent three weeks after the visual stimuli were removed.

Throughout the study, the system monitored opportunities to use hand-sanitizer dispensers and compared them to actual usage of dispensers to determine daily compliance, achieving 95 percent accuracy. Results based on 45,108 subjects and 13,406 hygiene events found:

- Average baseline compliance of 23 percent;
- Overall average compliance improved 57 percent during the intervention period
- Greatest compliance increase when feedback was new with average daily compliance rising  by 73 percent the week immediately following the introduction of visual stimuli
- Compliance returned to baseline levels just three weeks after visual stimuli were removed
- Compliance varied daily and weekly particularly on weekends
- Sanitizing gel compliance was noticeably lower during weekends but increased during the intervention period.

This study shows infrared technology could have a tremendous effect on how healthcare facilities look to help reduce the spread of infections that can transmit from worker to patient or vice versa if correct hand-hygiene is not practiced, says Dr. Frank Miskelly of Imperial College London. The technology could also enable a more easily adoptable and promotable system-wide, team approach to a patient-safety culture. 

While additional trials of the technology will be conducted, preliminary findings have already given some insight into potential HAI-reduction strategies which should be part of a sustained and adaptive intervention program. In addition to wide-scale deployment to give clinical managers the data to target and evaluate interventions, the system could be an asset for research teams investigating behavioral change.

Results suggest visual stimuli can raise hand-hygiene compliance, but those stimuli need to be maintained and contain variety to sustain improvements, Miskelly says. Many trials that rely solely on direct human observation have been conducted at facilities and due to the Hawthorne Effect are well known to influence human behavior. We expect specific feedback to workers on their true performance would further raise compliance, but additional studies are required to confirm this theory.

Irisys Hand Hygiene Compliance research has been supported by the National Institute for Health Researchs Invention for Innovation (i4i) program to help provide a solution to drive improvements in hand hygiene.