New Smart Watch May Improve Hand Hygiene in Hospitals

Ken Terry

November 10, 2014

A new mobile technology may help solve the longstanding problem of ensuring proper hand hygiene in hospitals to reduce infection rates.

Nurses and physicians in at least one hospital owned by Intermountain Healthcare, a healthcare system based in Salt Lake City, Utah, are wearing specially designed smart watches that show whether they have washed their hands before they walk into patient rooms.

"The watch detects motion and it knows when a wearer goes from room to room," Karl West, Intermountain's chief information security officer, recently told mHealth News. "As soon as I leave a room, I need to be aware that I should be washing my hands. So the watch has a color-based alarm that goes off as I change rooms. Now the watch instead of being green is red, and based on a period of time, we also change that to yellow to give clinicians the indication that they should be washing their hands for sepsis control.

"We've tried many things over the years: policies and procedures, putting signs on the walls. This mobile device sends information that managers can see. It has had a great impact in our hospital. We've tracked a reduction in infection."

Intermountain was unable to provide someone who could answer questions about this infection control device by publication time, but from the context of West's interview, it appears that Intermountain developed the smart watch in its Healthcare Transformation Lab, which focuses on finding new ways to deliver care using the latest technologies. According to mHealth News, the pioneering healthcare organization has 71 mobile or telehealth projects in the works.

Need for "Accountability"

Observers who track patient safety in hospitals say that the Intermountain smart watch is the latest in a series of devices that have been applied to hand hygiene.

Nicole Latimer, senior vice president, clinical performance technologies, for the consulting firm The Advisory Board Co, said she has seen sensors attached to handwashing stations and badge alerts related to handwashing. There are also smart sinks that beep if a clinician does not wash his or hands for the required 20 seconds, she told Medscape Medical News. However, she added, "I haven't seen anything this sophisticated in infection control."

The Intermountain smart watch "is one of a half dozen devices that have come to my attention from venture capitalists and people working in hospitals that are designed to serve as devices and even data collection portals for hand hygiene adherence," said Donald A. Goldmann, MD, chief medical and scientific officer for the Cambridge, Massachusetts–based Institute for Healthcare Improvement, in an interview with Medscape Medical News. Some studies of these devices have shown "impressive" results, he added.

Regarding the claimed effect of the Intermountain smart watch, he said, "It's hardly surprising. If you put in a visible monitor and the data are collected and sent back, performance will certainly improve, especially in the short term."

In the long term, however, "People get inured to these things, and they don't remember that it's there, and sometimes compliance trails off," Dr Goldmann said. "But it won't trail off if it's linked to accountability." Hospital managers and medical directors have to pay attention to the data and confront violators of hospital rules, no matter what their seniority, he explained.

That's very tough in most hospitals, Latimer noted. Often, administrators or medical directors are not "forward about sharing the data with physicians," she said. "And who's going to tell the cardiovascular physician who produces the most income for your health system that he's noncompliant with hand-washing standards?"

There is some evidence that smart sinks are effective in getting people to wash hands longer, Latimer said. But overall, she added, this kind of infection control has a limited efficacy, because the results are shared at the level of the hospital unit, rather than as feedback to individual clinicians.

"The question is, How do we get the individual performance data back to each person so they can react to it? That's where the smart sinks and the badges aren't great."

Dr Goldmann said he's "a little concerned about having a technological fix for just one part of safety or quality improvement. In reality, there are scores of things that need to be done reliably in the care of patients." Hospitals should not have a technological fix for each problem, separately, he said.

Some progress has been made in improving hand hygiene in the past few years, Dr Goldmann said. But real advances in infection control, he added, depend on a culture of safety that hospital leaders insist on.

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