Real-time and location-based hand hygiene monitoring and notification: proof-of-concept system and experimentation

Rising infection rates in health care cause complications for the patient, extended hospital stay, financial difficulties and even death. One of the crucial factors that reduce those infections is better hand hygiene. Due to the lack of automated systems that can help monitoring hand hygiene compliance, some hospitals use direct observations, surveys, dispensers usage measurements and other such methods to monitor the compliance of care providers. This paper presents an alternative system that takes advantage of emerging off-the-shelf infrastructures in hospitals and in particular of real-time location systems (RTLS) and automated hand sanitizer dispensers. Our RTLS-based hand hygiene monitoring and notification system (RHMNS) improves upon current methods by enabling interactions with care providers through notifications when they do not execute expected hand hygiene actions, even for fine-grained location situations such as moving between patients a multi-bed room. RHMNS supports two approaches that share the same infrastructure while differing in their way of deciding on missed hand hygiene opportunities. The activation-based approach, which offers better results than the time-based one, exploits new intelligent dispensers that send notifications on a wireless network when sanitizer is dispensed. RHMNS also provides informative reports about compliance and trends. Validation results based on a proof-of-concept deployment in a hospital bedroom and on a performance evaluation in a university laboratory suggest that it is feasible to have an RTLS-based system that is reliable, accurate, valid and adoptable, that considers the privacy of healthcare providers and that reminds healthcare providers of taking hand hygiene actions when required.