Where: Princeton Baptist Medical Center, a 323-bed acute care hospital in Birmingham, Ala.
The issue: Reducing health care-associated infections by improving the hand hygiene of health care workers.
Like most hospitals, Princeton Baptist struggled with prevention of health care-associated infections. When clinician leaders looked for a strategy to reduce these occurrences, hand hygiene appeared as an obvious target. “We're always on a quest to move to the next level and of course we all know that hand hygiene is [one of] the basics,” said Paula Davenport, RN, director of surgical services.
The program's goal may have been basic, but Princeton Baptist's method of accomplishing it was more unusual. They collaborated with Proventix, a technology company that had recently developed a method of monitoring hand hygiene compliance. “They had some technology that could potentially, if they partnered with us, help us track our results and even decrease infections,” Ms. Davenport said. “We said, ‘Great.’”
How it works
The technology, called nGage™, involves radio-frequency identification (RFID) badges for all hospital staff and physicians. At every soap or hand sanitizer dispenser, there's a device which registers the presence of the RFID badge whenever its wearer cleans his or her hands. The system then can track overall compliance with hand hygiene, as well as individual use.
The device monitor also has a screen, on which general or personalized messages can appear. “We started out with basic messages saying, ‘Good morning, thank you for washing your hands,’” said Ms. Davenport. “Then we moved up and put stats out about flu season. Employees as well as visitors can read these messages—anybody who engages the soap or hand sanitizer.”
The next step will be individual messaging, for example, comparison data on hygiene compliance in other units. “People in health care professions are very competitive and everybody wants to be on top. If you can tell them that one unit is doing better than another, it draws engagement and compliance,” said Ms. Davenport.
Implementation of the system appears to have increased compliance with hand hygiene recommendations. The system was piloted on the post-surgical unit in 2010 and the rate of health care-associated infections there was 22% lower between February and August 2010 compared to the same period a year earlier. That's significantly greater than the 5% reduction that Proventix CEO Harvey Nix calculates a hospital would need to recoup the cost of the system.
Based on the results, Princeton Baptist expanded the technology from the post-surgical unit to other parts of the hospital. “We've been on multiple floors and we're staying on average across those floors in the mid 20% range [of infection reductions]. There was enough savings on two floors to cover the cost of the system across the whole hospital,” said Mr. Nix.
When the system was first installed, program leaders worried that it would be seen as an intrusive, watchdog measure. Avoidance of any punitive measures and gradual implementation were the keys to avoiding that problem, Mr. Nix said. “Start with a floor and work through an adoption plan to gain health care worker adoption and feedback and testimonials—’Wow, this was easy…’ Other floors start asking for it.”
The program's effect on infection rates also increased buy-in, according to Gloria Deitz, RN, nurse manager on the pilot unit. “They began to see that when the numbers of their hand hygiene ‘engages' went up, the infection rate went lower. We proved the point that hand hygiene is really important,” she said.
By the end of 2011, all of Princeton Baptist is projected to be using the nGage™ system. Program leaders will also look at expanding their use of the device's communication feature.
“We're just getting to the point of integrating two-way communication on it, so that they're able to use the screen to provide feedback and get feedback about the patient that they are about to take care of,” said Mr. Nix. For example, a device could be set to warn anyone washing his hands outside a particular patient's room that the patient is under isolation precautions.
Future capabilities for the system may also include the option for handwashers to provide feedback on the value of a message and wireless monitoring of issues other than hand hygiene, such as bed positioning or pressure sore prevention, Mr. Nix said.