Evaluating Automated Hand Tracking Hygiene Technologies in an Inpatient Pediatric Care Setting
Abstract
Introduction: Children's Hospital of The King's Daughter's (CHKD) contracted a vendor in June 2023 to install a Bluetooth-enabled system of sensors throughout the hospital to monitor hand hygiene (HH) compliance in an effort to reduce health care associated infections (HAI). The system is locally branded "Wonder Washers". Wonder Washers functions on an individual wearing a SmartBadge on their upper torso that communicates with location sensors, sensors in automated hand sanitizer and soap dispensers, and "gateways" that off-load HH data to the vendor's database for display. In this study, automated HH data from pediatric residents was analyzed from July 2023-July 2024. Additionally, HH data from medical students on clinical rotations was analyzed each week during June-July 2024.
Methods: Pediatric residents and medical students were selected as populations of the study due to their widespread areas of activity and comparison subgroups (i.e. resident year groups, medical student cohorts). This allowed analysis of discrepancies between individuals, resident classes, and inpatient units not entirely attributable to personal HH practices. User data was obtained from the vendor's online dashboard and compiled into respective subpopulations. The user data was then reconciled against observer verified HH opportunities and compliance on rounds to generate an "opportunity error rate" and "compliance error rate" for the system.
Results: The most impactful factors for the system's efficacy were simply badge wearing and proper badge placement. 63% of residents recorded a badging event in July 2023, however that figure had decreased to 28% by June 2024. During July 2024, the opportunity error and compliance error rates were found to be 31.9% and 53.6%, respectively.
Conclusion: Badge wearing compliance presented the single largest limitation in determining the efficacy of the automated HH tracking system. Large error rates fed pessimism on the system's utility, which fed lower badge wearing compliance rates, which lowered data collection, which further distorted the system's error rates. While automated HH tracking system theoretically gave users the power of information about their own HH practices, additional improvements in system efficacy are necessary to promote buy-in to the system.