Small sensors monitor employee motions in every one of the inpatient rooms at Franklin Woods Community Hospital in Johnson City, Tenn. But they’re tracking just one, arguably mundane, aspect of clinical workflow: hand hygiene.
Hand hygiene, as defined by the Centers for Disease Control and Prevention, involves clinicians and other healthcare staff cleaning their hands before and after patient contact, as well as at select points of patient care. That’s to prevent the spread of hospital-acquired infections, said Jamie Swift, corporate director of infection prevention at Ballad Health, the hospital’s parent company.
“It’s the backbone of infection prevention,” she said.
There are financial, as well as clinical, implications, as HAIs are expensive to treat. The average cost for a central line-associated bloodstream infection is $45,814, and Clostridium difficile infections can cost $11,285 per case, according to study results published in JAMA Internal Medicine.
To tackle HAIs upstream, Ballad in late 2017 began a phased rollout of a system from startup SwipeSense to better monitor how frequently staffers clean their hands, starting with Franklin Woods. That included providing each employee with a badge that goes behind their name tag, installing location hubs to track when staff wearing those badges enter and exit a room, and replacing the drip trays under each soap and alcohol gel dispenser with a new one, outfitted with a sensor.
The system compiles data on hand-hygiene compliance at the employee, unit and facility level by tracking whether an employee cleans their hands within 60 seconds of entering a room. Infection preventionists, nurse managers and hospital leadership have access to a dashboard that draws out insights from this data, including identifying over- and underperformers in each unit.
Since 2017, three more of Ballad’s hospitals have installed the system, with plans to implement it at two more facilities in the next few months. SwipeSense charges organizations a subscription fee for the system based on their bed count, said Vince Panozzo, SwipeSense’s vice president of revenue.
To help make the effort feel positive, rather than punitive, Swift said nurse managers at the health system developed “fun initiatives” using the data, such as hosting pizza parties for units with the best compliance and creating monthly competitions between units.
The first year after installing the system, Franklin Woods reported only one infection, Swift said. It’s difficult to quantify how much of that can be attributed to the sensors and employee monitoring, as that’s just one piece of an infection-prevention strategy. But identifying barriers to hand-hygiene compliance is a first step—and a common challenge—for any hospitals looking to reduce HAIs.
Before implementing SwipeSense, the four Ballad hospitals that now use the system averaged roughly 100 to 200 instances a month per facility of monitoring whether or not someone washed their hands; Ballad relied on a mix of infection preventionists and so-called “secret shoppers,” or staff who agreed to secretly record observations. That figure climbed to 100,000 to 400,000 with the automated systems.
Regardless of whether a health system monitors hand-hygiene compliance with an electronic system or with manual documentation, Klaus Nether, executive director of high reliability product delivery at the Joint Commission Center for Transforming Healthcare, said data is only as helpful as how it’s used. It’s crucial for organizations to really drill down into the analytics to figure out the “why?”—the root causes of staffers not cleaning their hands. Those root causes tend to differ from one organization to the next, and even between units at the same facility. “It isn’t as simple as the solution or best practice that we implement here is now going to work” elsewhere, he said.
That’s part of what Ballad does with the system’s data on individual employees. When nurse managers approach consistent underperformers, it’s meant to be a conversation on barriers to hand-hygiene compliance. Those might include a lack of alcohol gel in certain areas, or whether the employee’s hands are full when they enter a room. Findings on underperformers are not used in a disciplinary way, Swift said. It’s “not in any way punitive at this time,” she said.
There are dozens of possible reasons for why people don’t clean their hands when entering a room, and hospital leaders should talk with staff to figure out what’s driving the issue—and then target a solution.
“You have to take the time to really understand it, because it is more complex than just reminding someone to wash their hands,” Nether said.