A Case Study: Will Improvements in Hand Hygiene Compliance Reduce Infections?

Updated: Jun 5, 2019

By Janel Nour-Omid, Vitalacy VP Product and Marketing

The Vitalacy team recently had the opportunity to implement our automated patient safety platform in about half of the medical and surgical beds in an academic medical center. Recognizing their higher-than-average healthcare-acquired infection (HAI) rate, the medical center sought to find a solution to decrease infection rates and focus on patient safety improvement. Despite the medical center reporting hand hygiene compliance rates, through direct observation, of more than 90 percent based on 1,500 direct observations per quarter, their infection rates were much higher than expected.

The implementation of Vitalacy’s automated patient safety compliance technology discovered that the actual hand hygiene compliance rate was closer to about 30 percent. This data was gathered as an initial baseline where wristbands were worn by healthcare providers without receiving any feedback. Upon activating the SmartBand feedback and reminders, we noticed an increase in the compliance rate to more than 70 percent over the course of about one week. Our successful experience implementing this automated patient safety system is included in a recent Vitalacy white paper, “Finding New Ways to Prevent Healthcare-Acquired Infections and Conditions".

Compliance up, infections down

The medical center’s hand hygiene compliance remained consistently above 70 percent based on about 225,000 observations per quarter through 2018. The medical center noticed a decrease in infection incidence on the monitored units for more than two consecutive quarters, confirming the direct correlation between hand hygiene and infections. Just from January 2017 through September 2018, Vitalacy reported on more than 1.17 million hand hygiene observations – a tremendous increase from 1,500 direct observations per quarter.

Multidisciplinary work group provides an engagement opportunity leading to better compliance

Realizing the potential organizational impact of our solution, we began collaborating directly with care providers to further improve on user engagement. By creating a multidisciplinary work group, we began receiving various feature requests for the product with the main objective of increasing care providers’ comfort with wearing SmartBands – such as:

  • Designing a badge option that can be clipped on a shirt collar or sleeve

  • Developing step counting and fitness tracking features on the SmartBand

  • Increasing the SmartBand's battery life

  • Fully customizing vibration reminders frequency and feedback patterns

The feedback regarding the patterns and frequency of vibration reminders led to further discussions around the human behavior element associated with it and the type of reminders that would be most effective. For example, caregivers suggested having the device provide a vibration after a hand wash was completed as a positive reinforcement rather than after a hand wash was missed.

The work groups created the opportunity for broad multidisciplinary participation from as many departments as possible – for example, each patient care unit, infection control, facilities management, environmental services, nursing management, and more. This engagement model still continues to prove highly impactful towards product development and innovation.

Mobile app creates fun competition between units

Our team was able to use the work group model as an opportunity to introduce care providers to our mobile app. The app was designed to show every user their own compliance rate on a daily basis and even compare their progress to other individuals and units. “This started a fun competition between them,” remembers Tal Cohen, Vitalacy’s VP of Engineering. “They started to compare themselves to each other, which increased the awareness of hand hygiene and made the product more user-friendly.”

In most initial discussions around the adoption of automated monitoring systems, the general pushback received from staff stems from their concerns that the monitoring might lead to punitive measures. Hearing these concerns was what sparked ideas around introducing a caregiver-facing mobile app designed to empower them with their own data. By responding to care provider feedback and by introducing our mobile app, we were able to drastically increase buy-in, participation and engagement.

Project champion pushes project forward to increase compliance and decrease infections

As part of this process, one of the extremely passionate nurse managers volunteered to be the project’s champion, taking the entire project under her wing. She pushed the project forward and made it successful not only through encouraging the platform's adoption, but by constantly introducing new strategies to continue to increase engagement of the staff and leaders.

Refining the product based on user feedback and empowering and engaging the caregivers significantly increased participation and overall hand hygiene compliance. This is really where we saw a decrease in infection rates.

Suggestions from care providers lead to further Vitalacy innovations

The caregivers at the medical center were constantly providing feedback and ideas that helped Vitalacy to develop ways to evolve and enhance its platform. Noting that the Vitalacy solution can track the movement of caregivers through their work day, the project champion asked if the system could track when and for how long care givers interacted with patients. Her question rose primarily from a concern about the high fall rate at the medical center due to severely immuno-compromised end-stage cancer patients at high risk for falls and other complications.

Her question led to the research and development of Vitalacy’s purposeful nurse rounding data module, which was shortly after implemented for the first time at this medical center. This rounding module identifies which staff member completed rounding in each room, at what time, and for how long. By being able to analyze activity by staff and by room, managers can ensure that care providers are notified in instances where patients have not been visited as necessary; this information helps prevent patient falls and allows managers to view staff performance levels to target education and training. The flexibility of this feature even allows for the timing and frequency of visits to be set for each patient and adjusted to alert differently for higher-risk patients.

Some other innovations stemming from staff suggestions include an infrared thermal sensor installed above patient beds that can alert staff when a patient at risk for a fall sits up and a wristband for immuno-suppressed patients that can detect pulse and temperature, since a change in either reading must be addressed immediately in these types of patients. Another suggestion was to increase patient awareness of hand hygiene. This was done through developing messaging on the Vitalacy platform targeted for patients and their families helping to explain the role of the wristbands and sensors in patient safety. We found that many patients who heard of this project felt more confident in their choice of institutions, as the implementation of a system like Vitalacy helps assure patients that their safety is of the highest priority.

Learn more about how Vitalacy’s automated patient safety platform works to reduce healthcare-acquired infections and conditions at https://www.vitalacy.com/solutions.

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