Technology is helping doctors, nurses track their hand washing
Some area hospitals are using devices to improve hygiene
Running from patient room to patient room, it can be surprisingly easy for doctors and nurses to forget to wash their hands, especially if they’re dealing with an emergency.
Hospitals have been working to boost hand hygiene for years, but health care providers still wash or sanitize their hands only about half as much as they should, according to the Centers for Disease Control and Prevention.
Now some Chicago area hospitals are trying a new tack to help them remember — tracking technology.
The University of Chicago Medical Center, Elmhurst Hospital, Edward Hospital in Naperville, Gottlieb Memorial Hospital in Melrose Park and MacNeal Hospital in Berwyn are all investing in technology that can monitor hand washing and hand sanitizing — sometimes down to the individual employee — through electronic sensors.
The new approach to hygiene comes as employers across a number of industries use technology to keep tabs on worker activity.
Some wonder whether hospital employees will chafe at being tracked. Questions also remain about whether it will reduce infections. But proponents say the hand hygiene technology is an effective way to hold hospital workers accountable for cleanliness and keep patients
healthier.
On any given day, about 1 in 31 hospital patients have an infection acquired while in the hospital or one developed after surgery. In 2015, there were about 633,300 health care-associated infections in acute care hospitals across the country, and about 72,000 patients with those infections died, according to the most recent CDC data.
Good hand hygiene “truly is the No. 1 way to prevent the spread of infection,” said Annemarie Schmocker, manager of infection prevention at Elmhurst Hospital. “If you’ve performed hand hygiene and done it well, we know that we’re mitigating that risk of transmission.”
Elmhurst Hospital and Edward Hospital in Naperville installed technology made by Ravenswood-based company SwipeSense in late fall. Employees who work with patients, including nurses, doctors, therapists, transporters and housekeepers, will all soon wear a square badge around their necks to track when they have — or haven’t — cleaned their hands when visiting patients.
When an employee cleans his or her hands, a sensor below the soap or alcohol dispenser recognizes the badge and captures that data. Small devices plugged into the walls of patient rooms also detect when an employee has entered and exited a room. The data is routed to SwipeSense, and hospital managers can see the data in real time through an online dashboard. The company also gives managers regularly scheduled reports.
Health care providers might need to clean their hands as many as 100 times in a 12-hour shift, before touching patients, after touching patients or their immediate environments, and after contact with blood, body fluids or contaminated surfaces, according to the CDC.
Vivian Giordano, an advance team lead nurse, called the new sensors a good way to prevent infection, though she admitted that using so much sanitizer can dry her skin.
“It kind of reminds staff not to fall behind on hand washing,” Giordano said. “Running in and out of the rooms, it’s easy to forget.”
Until now, the hospital, like many others, tracked hand hygiene through “secret shoppers,” employees who sat near patient rooms, taking note of which workers cleaned their hands and which didn’t. But that method captured only a small fraction of what was really going on, said Pamela Dunley, president and CEO of Elmhurst Hospital.
“This is much more precise,” Dunley said.
MacNeal Hospital has been using SwipeSense since 2016. When it first started testing it for the company, the hospital’s employees were cleaning their hands less than 30% as often as they should, said Dr. Chuck Bareis, chief medical officer at MacNeal. Now the hospital has more than 70% compliance, he said.
Gottlieb Memorial Hospital is in the process of installing a system made by Minnesota-based Ecolab that will allow it to track employees’ hand hygiene, and Loyola University Medical Center is piloting the same system.
The University of Chicago Medical Center uses a system made by Gojo Industries, the company behind Purell. That system does not track individual employees but records the number of times soap and sanitizer is dispensed and the number of times employees exit and enter patient rooms, said Emily Landon, the hospital’s medical director for infection control.
When the hospital started using the system in 2014, employees were cleaning their hands only about 20% to 30% as often as they should, Landon said. Now, most of the hospital is at 50% to 60% compliance, with some units at 100% compliance, she said.
On occasion, the hospital has caught workers cheating, such as by going from dispenser to dispenser to boost their numbers, Landon said. The hospital doesn’t use the data to discipline employees, but rather tracks compliance and lets them know when the numbers fall too low, she said.
“People don’t make a conscious decision (not to clean), it’s just not a habit,” Landon said.
That’s not to say, however, that such technologies are foolproof, or beloved by all.
An Atlanta-based company, Georgia-Pacific, plans next year to launch a product that will consist of a small hand sanitizer device that attaches to an employee’s uniform and can report data to the cloud. It will give employees hourly goals for hand sanitizing and measure how well they’re performing.
It will not, however, track exactly where each employee cleans his or her hands, said Amna Handley, the company’s director of clinical development.
“Clinicians do not like nor do they want to be tracked while they’re in the hospital,” Handley said. “It’s just not a very respectful approach.”
SwipeSense devices primarily track hand cleaning in patient rooms, not in employee spaces such as bathrooms or break rooms.
Elmhurst Hospital has no plans to discipline employees based on hand hygiene data, though managers may talk to workers who seem to be having issues. Elmhurst conducts investigations when patients develop infections, and hospital leaders will look through the SwipeSense data as part of those investigations, Schmocker said.
MacNeal Hospital also hasn’t used the technology to discipline employees, Bareis said, though hospital leaders are considering it.
Hospital leaders say mitigating circumstances might keep some workers from cleaning their hands. Maybe a doctor was running into a patient’s room to respond to an emergency. A nurse might have had her hands full while entering a room. Or maybe an employee was entering and exiting an empty patient room repeatedly in a short time span, cleaning it or preparing it for another patient.
It can also be difficult to gauge whether such systems are reducing infections across hospitals because infections can have many causes. Hospitals also have many ways to prevent infection, such as machines that steam clean rooms and processes for preparing patients for surgeries.
In general, health care associated infections have become less common — hospital patients were about 16% less likely to have such infections in 2015 than 2011, according to the CDC.
MacNeal leaders suspect better hand hygiene might have helped reduce infections from C. difficile, a bacterium that can cause diarrhea and life-threatening colon inflammation, Bareis said.
University of Chicago Medical Center saw the risk of MRSA and C. difficile in its intensive care units decrease slightly as hand hygiene improved, Landon said. The hospital reported nine cases of MRSA and 181 cases of C. difficile in 2018, according to data submitted to Medicare.
MRSA and C. difficile are the two of the most common health care-associated infections, according to the CDC. Health care-associated infections tend to be more common in patients with compromised immune systems, such as cancer patients, and patients in intensive care units, Landon said.
Whether the new technologies will improve infection rates is “the milliondollar question,” Bareis said. It’s an important question, he said, because such technologies don’t come cheap.
SwipeSense declined to say how much it charges for its system, saying it depends on bed counts and which applications a hospital chooses. Gojo Industries also declined to give specific figures. Ecolab said costs can vary, but its system generally runs about $800 a bed annually.
“It’s not cheap, I can tell you that,” said Dunley, with Elmhurst Hospital. “But a patient getting sick is not cheap either.”
Infections often mean longer, more expensive hospital stays for patients. And hospitals with higher rates of health care-associated infections can face consequences ranging from lower grades from hospital rating groups to financial penalties from the federal government.
More than 25 Illinois hospitals faced payment reductions from the federal government for ranking in the bottom 25% of acute care hospitals nationwide when it came to hospitalacquired conditions for the 12 months ending in September.
Over the last 10 years, nearly 2% of claims to the Doctor’s Co., which provides medical malpractice insurance, have involved health care-associated infections, said Jacqueline Ross, an analysis and coding manager for the company.
SwipeSense said its own data show hospitals can reduce health care-associated infections by as much as 55% during the first year of using the technology.
Local hospital leaders are hopeful they’ll see positive results. At Elmhurst Hospital, many employees said they don’t see the technology having a big impact on their behavior because they were already cleaning their hands — but they welcome the reminder.
“If they’re tracking it, you’re going to think about it way more than if they’re not,” said Elmhurst nurse Claire Nelson.