"Don't you know you have to sing 'Happy Birthday' twice to get the germs off?"
— Boris Yellnikoff, "Whatever Works" (2009)
TRINITY HEALTH
It's a sure bet that messages about public health concerns have gone mainstream when Hollywood directors like Woody Allen include them as laugh lines in romantic comedies.
But there's nothing funny about the fact that, according to the Centers for Disease Control and Prevention, hospital-acquired infections cause, or contribute to, 99,000 deaths a year in the United States — and $30 billion in additional health care costs.
That's why Saint Agnes Medical Center, in Fresno, Calif., was interested in participating in a pilot program to test the effectiveness of an electronic hand hygiene monitoring system.
"We are always focused on hand hygiene as an important cornerstone for infection prevention measures, especially with the prevalence of bacteria like MRSA (methicillin-resistant Staphylococcus aureus) and C-Diff (clostridium difficile)," says Christi Paradise, infection control coordinator at Saint Agnes. "Until recently, though, we were limited, like everyone else, to motion-activated soap dispensers in hospital hallways and patient rooms."
In June, 2010, Paradise attended a meeting of the Association for Professionals in Infection Control and Epidemiology, where she was able to compare new electronic technology, some of which emitted beacons or activated vibrating devices, to track the number of times health care workers wash their hands.
With the help of $7,000 in funding from a Blue Shield Foundation, she decided to install "nGage," made by Proventix, an Alabama-based technology firm, in 16 rooms of Saint Agnes' telemetry unit on a six-month trial basis in 2011.
"The system appealed to me because of its potential for broader use," she says. "Besides tracking hand hygiene, it incorporates ways to communicate rounding information from one person to another and tag equipment as well."
With nGage, when a nurse walks into a patient's room, she/he swipes a radio frequency badge, which is worn around the neck, in front of a sanitizer/soap dispenser. The nurse then has 20 seconds to wash her/his hands thoroughly before the unit displays a light-emitting diode message and transmits information to a central server.
"At first there was a little kickback from staff about wearing the name tag, but now most people like it for a variety of reasons," says Kristi Mattson-Cruz, a registered nurse and practice coordinator for the telemetry unit. "For one thing, it's a fantastic teaching tool to stress the importance of hand washing to patients. It also uses a solution that is less irritating to the skin while still being an effective cleanser."
And while the system provides personal feedback to staff members about their hand washing practice, its LED messages also provide positive reinforcement in the guise of general information — everything from NCAA playoff scores to weather forecasts — to help keep interest high.
Of course, hospital administrators are more interested in the feedback it provides on staff hand hygiene habits. "Instead of relying on perhaps 30 random observations per unit per month, we are now getting 3,000 to 4,000 observations per month," says Paradise. "That gives us the ability to correct any bad habits and remind individuals about good hand washing techniques."
Saint Agnes was so pleased with the results of using nGage — infection rates were 21 percent lower on the telemetry unit than in 2010 — that it is now leasing the electronic hand hygiene monitoring devices for all 28 rooms on the unit.
"We are the only medical center in California currently using these, and one of only 41 nationally," says Paradise. "As technology improves, though, I'm sure they will become a more commonplace strategy to help with infection prevention."