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Improving hand hygiene compliance in ICUs

As doctors and nurses move from bed to ICU bed, their hands can carry highly dangerous germs from one susceptible patient to another. While hand hygiene SOPs already exist, there is no practical way of monitoring their implementation. Dr Rachna Dave, Founder & CEO, MicroGO LLP describes a solution that coaches healthcare professionals as well as monitors their compliance with hand hygiene.

GOassure LITE+ (patent pending) assures good hand hygiene practices (20 secs of hand rubbing). It coaches the healthcare worker (HCW) each time he performs hand hygiene according to the six steps of hand hygiene and electronically monitors hand hygiene opportunity-based SOPs of the healthcare organization in real time. At present, we focus only on areas where alcohol-based hand rubs (ABHRs) are part of the SOP.

Assuring good hand hygiene at each Hand Hygiene Opportunity (HHO)

The current hand hygiene process is drawing ABHR either from a manual or automatic dispensing system. These systems act only as dispensers and don’t assure 20 secs of hand hygiene and do not remind the HCW to perform according to the set SOP.

The attrition rates are higher in most healthcare organizations. Plus, due to the work burden, reminders to perform right practices become necessary. Lite+ not only assures 20 seconds of hand hygiene but coaches the HCW in its six steps each time.

Electronic monitoring of the SOPs decided by the Hospital Infection Control Committee (HICC)

The current method of monitoring hand hygiene compliance at most healthcare organisations is by internal audits (performed by HICC members or non-HCWs at times, to avoid bias) known as direct observation, or by indirect monitoring (like counting inventories). The direct observation method could be an accurate assessment of compliance but is resource-intensive and brings enough possibility of the Hawthorne effect (a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed). The indirect observation method does not require vast resources but is inaccurate.

Electronic monitoring is available in other countries but suffers from the disadvantage of not covering all hand hygiene opportunities. GOassure LITE+ covers all opportunities right from the hospital entry until the ICU and in addition, also assure good hand hygiene practices at each opportunity. The compliance data achieved at each opportunity is captured, calculated as compliance % and is displayed on the dashboard, thus focussing on both qualitative and quantitative results.

The device in practice

Let’s consider an ICU complex with 10 beds. The SOP is usually defined as:

  • Every HCW entering the complex will perform hand hygiene at entry and exit.
  • Every HCW will perform hand hygiene according to the ‘five moments of hand hygiene’ while attending the patient on each ICU bed.

We shall advise 11 units: one at the main entry and ten units at each bedside. The HCW enters the main door where LITE+ installed. As he/she enters the complex, an HHO is created for him/her which he/she is alarmed to by audio or visual means. The hand hygiene performance/non-performance is accordingly captured. When the HCW moves to the ICU bed, the hand hygiene opportunity created is alarned to the HCW. The % compliance data is now captured and the data is accordingly presented on the dashboard for a real time feedback loop.

Advantages of using the system

The advantages of our technology have to be measured holistically, both direct and indirect. Direct or measurable advantages are reduction in hospital acquired infections (HAIs) and its associated costs and increase in revenue from new patients, resulting in less lengthy stay for patients with HAIs. Good hand hygiene practice at each opportunity assures the quality of hand hygiene at the organisation. Non-measurable advantages include successful implementation due to constant feedback loop monitoring, consistent standards of protocol, data-driven SOPs and finally, the safety of the HCW and the assurance that they will be safe for themselves, patients and their family.

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