Monitoring Hand Hygiene Behavior

We have developed a low-cost, highly portable, real-time data-collection system that can capture healthcare worker behavior (i.e., hand hygiene) as well as the underlying social network (i.e, healthcare worker interactions over time and space). Our approach, based on our work with wireless sensor motes, automatically and reliably captures individual workers’ hand-washing behavior, including exactly where and when the behavior is performed, as well as proximity with other healthcare workers over time. Our measurement technology is effective, accurate, inexpensive, unobtrusive, and, unlike other systems based on RFID, easy and quick to deploy without the need for expensive infrastructure. Because ours is a technology-based approach, we are not limited by the costs associated with human observers. Because our technology is portable, it can be used outside large tertiary healthcare centers; in fact, our system can be deployed in outpatient clinics, outpatient surgery centers and dialysis centers. And because our technology is inexpensive, we are able to provide complete coverage of the area under study, yielding a much more accurate picture of the social milieu for analysis.

By fitting a mote to a hand sanitizer dispenser, we are able to record the use of the dispenser on both the individual’s mote as well as on the dispenser itself. We are currently able to reliably detect when a person enters a room or approaches a patient without using hand-hygiene rub.

The extended system now consists of four basic elements. As before, badge-like motes are worn by individual healthcare workers, and beacon motes are placed about the hospital unit, including in patient rooms (e.g., affixed to the patient bed frame) so that proximity to patients can be directly inferred. Wall-mounted automated hand-sanitizer dispensers, modified to incorporate a sensor mote, are placed at multiple locations in the unit. In contrast to the other elements, which broadcast identifying message packets at regular intervals, each mote on a hand-hygiene dispenser broadcasts a low-power identifying packet only when sanitizing liquid (generally an alcohol-based gel) is dispensed. Finally, small base stations (ARM-processor-equipped computers, with significantly more processing and storage than the other three elements), serve as both beacons and data aggregation and analysis systems.

From left to right: healthcare workers wear rechargeable badge-like sensor motes; fixed location sensor mote beacons are located, e.g., on patient beds; wall-mounted automated hand-sanitizer dispensers are modified to incorporate motes triggered by use; and base stations serve as beacons (location anchors) and data aggregation points.