Abstract:
A system and method for evaluating hand decontamination compliance in a medical care facility includes a plurality of patient stations; a plurality of hand hygiene stations; personnel tags for personnel in the medical care facility; readers at the patient stations and at the hand hygiene stations capable of detecting the presence of personnel tags; and a controller for detecting whether a personnel tag accessed a hand decontamination station before presence at one of the patient stations. In an alternate embodiment, personnel tags of healthcare workers and patients are tracked in space within the facility to indicate contacts between the healthcare workers and the patients and whether the healthcare workers accessed hand hygiene prior to the contact. Hand hygiene stations include hand washing stations and antimicrobial hand rub dispensers.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    This application relates to monitoring of hand washing and decontamination, and in particular monitoring of hand washing and decontamination in a healthcare environment. 
         [0002]    Acquisition of infection by hospital patients is a serious healthcare problem. The Center for Disease Control, the World Health Organization and other health care organizations and agencies encourage health care workers to practice proper hand hygiene to reduce the transmission of pathogens via hands. Recommended procedures include the decontamination of the hands prior to direct patient contact, prior to invasive non-surgical procedures, prior to gloving, after contact with body fluid, mucous membranes, non-intact skin and wound dressings, intact skin and inanimate objects near patients. These procedures apply in hospital settings, doctor&#39;s offices, and anywhere where these personnel come into contact with patients. Furthermore, it is generally recommended that visitors to such patients also practice proper hand washing procedures. In some instances, application of an antimicrobial preparation to the hands is substituted for a hand washing. In any event, the goal is to reduce the microbe load on the healthcare provider&#39;s hands and prevent contamination of either the patients or healthcare providers. 
       SUMMARY OF THE INVENTION 
       [0003]    A system, according to the present invention, provides for evaluating hand hygiene compliance in a medical care facility. The system comprises a plurality of patient stations; a plurality of hand hygiene stations; personnel tags for personnel in the medical care facility; readers at the patient stations and at the hand decontamination stations capable of detecting the presence of personnel tags; and control means for detecting whether a personnel tag accessed a hand decontamination station before presence at one of the patient stations. 
         [0004]    The patient stations typically would comprise beds, but also can include procedure tables, examination tables, dentist chairs and any other location where interactions occur between patients and healthcare workers. 
         [0005]    Preferably, each patient station will have a unique patient station identifier and each personnel tag will have a unique personnel identifier, making possible the tracking of specific patient healthcare worker interactions. Individual hand hygiene stations can also bear unique identifiers. If a hand hygiene station were located too long of a distance from patient station presence there may not be considered sufficient for a subsequent patient interaction a the patient station. 
         [0006]    Hand hygiene stations can include hand washing stations, such as a sink with a soap dispenser, can also include anti-microbial hand rub dispensers. Preferably, they also include an actuation sensor for sensing not just presence but actual use of the hand hygiene station, the actuation sensor being linked to the control means. 
         [0007]    The personnel tags comprise a machine readable sensor such as an RFID tag. Hand hygiene status of a user bearing the personnel tag is preferably stored on the personnel tag itself but can also be stored on a central processor linked to multiple patient stations and one or more hand hygiene stations. The central processor can generate reports of compliance rates. Such reports might be averaged for the facility or specific to individual healthcare workers. They can include the number of patient interactions, the number of patient interactions where proper hand hygiene was practices the number of interactions where proper hand hygiene was not practiced and whether proper hand hygiene was practiced after a patient interaction. 
         [0008]    Preferably, the patient stations incorporate some form of alarm which can provide a warning if a personnel tag having a status other than “clean” approaches the patient station. The warning can be both audible and visual. Preferably, means are provided for defining a perimeter about the patient station within which the personnel tag is considered present at the patient station. 
         [0009]    Preferably, the personnel tags comprise a status indicator to indicate the hand hygiene status of its bearer. Such a status indicator can provides a visual indication of the hand hygiene status and also provide an audible indication of a change in status, or an audible warning of improper patient contact. 
         [0010]    A method according to the present invention provides for evaluating hand hygiene compliance in a medical care facility. The method comprises the steps of: tagging personnel in such facility with a personnel tag; detecting presence of personnel tags at hand hygiene stations within the facility; detecting presence of personnel tags at patient stations; and determining whether a person tagged with a personnel tag has visited a hand hygiene station prior to visiting a patient station. 
         [0011]    The method preferably stores a hand hygiene status of a user, such as “clean” or “potentially contaminated.” This status changes from “clean” after contact with a patient. It will also change from “clean” after a predetermined time regardless of patient contact. 
         [0012]    An alternative system, according to the present invention, provides for evaluating hand hygiene compliance in a medical facility. The system comprises: personnel tags for patients and for healthcare workers within the facility; sensors for determining a location of the personnel tags; and a controller programmed to detect whether a healthcare worker bearing one of the personnel tags accessed a hand hygiene station prior to contacting a patient bearing a separate one of the personnel tags. Hygiene tags can be provided at the hand hygiene stations within the facility. Alternatively, their locations can be programmed in. Tags are beneficial for stations which might be mobile. 
     
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]      FIG. 1  is a diagram view of a hand hygiene compliance system according to the present invention; 
           [0014]      FIG. 2  is a plan view of a personnel tag according to the present invention; and 
           [0015]      FIG. 3  is a diagram view of an alternative embodiment of a hand hygiene compliance system according to the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0016]      FIG. 1  illustrates a hand hygiene compliance system  10  for a healthcare facility. Persons within the facility such as a doctor  12 , nurse  14  or visitor  16  are each provided with a personnel tag  18 , which preferably incorporates a unique identifying number but may not for privacy reasons. The tag  18  preferably incorporates some form of proximity locator or local communication means. For instance, in a preferred embodiment of the invention, the tag  18  incorporates a Radio Frequency IDentification (RFID) tag  20 . 
         [0017]    Patient contact locations such as hospital bed  22  are provided with a patient location module  23  comprising sensors  24  to detect the approach of persons such as a nurse  14  or the approach of the tag  18 . Multiple sensors  24  and a sensors of different types could be employed. For instance, a passive infrared radiation (IR) sensor  26  which detects the approach of a person can be employed along with an RFID transceiver  28  for reading the RFID tag  20  in the personnel tag  18 . This would allow the RFID transceiver to remain off until the bed  22  is approached, saving energy and reducing electromagnetic noise in the environment. 
         [0018]    Some form of perimeter is preferably defined about a patient station. In a simple form it can be the location of the RFID transceiver  28  on the station with the RFID transceiver having a range equivalent to the desired perimeter. The perimeter is preferably about one or two feet from the patient station. If it is too far it might falsely register a contact and if it is too small it might fail to register a contact. Other means for defining a perimeter such as light beams broken via personnel approaching a patient station may also be employed if a more exactly defined perimeter is desired. 
         [0019]    Other machine readable tagging systems may be employed. RFID tags  20  are particularly suitable for this application as they are inexpensive, can be read at a distance and some types can have data written to them and updated. 
         [0020]    The patient contact location is not limited to beds, but might also include procedure tables, examination tables, dental chairs, gurneys and any location at which a health care worker is likely to come into contact with a patient. These locations may be mobile, such as gurneys. 
         [0021]    Hand hygiene stations  30  (such as an antimicrobial hand rub dispenser  32  or hand wash station  34  such as a sink with running water and a supply of soap or detergent for hand washing) are provided with hand hygiene station modules  31  having an RFID transceiver  36 . U.S. Pat. No. 5,997,893 to Jampani et al., incorporated herein by reference, discloses a particularly suitable anti-microbial hand rub formulation. 
         [0022]    Preferably, the RFID transceivers  28  and  36  are all tied through some form of communication to a central data processing station  40 . That communication could take the form of a hard-wired connection or some other form such as radio frequency communication. In an institution having an 802.11b or 802.11g or similar type of WiFi based networking or communication system the RFI transceivers  28  and  36  could communicate to the central processing station  40  through such network. A dedicated communication system could also be employed. Passive IR personnel detectors  38  can be employed at the hand hygiene stations  30  as well. 
         [0023]    Hand hygiene stations  30 , especially hand rub dispensers  32  can be mobile. They can be mounted on wheels or carried on a person such as is disclosed in U.S. Pat. No. 5,927,548 to Villaveces, incorporated herein by reference. 
         [0024]    In its basic operation, the hand hygiene compliance system  10  employs the RFID transceivers  28  and  36  along with the personnel tags  18  to help ensure that a person who approaches a patient location has either washed their hands or applied an antimicrobial hand rub to reduce the chance of infecting a patient. This can be implemented in many different fashions. One simple implementation would detect the person&#39;s presence at a hand hygiene station  30  and then signal either to the RFID tag  20  or to the central processor  40 , or to both, that the person&#39;s status was now “clean.” Then when that person approached a hospital bed  22  the RFID transceiver  28  associated therewith would read the RFID tag  20  in the personnel tag  18 . If the status was directly encoded within the RFID tag  20  it would be read directly by the RFID transceiver  28 , otherwise a unique ID associated with that RFID tag  20  would be queried back to the central processor  40  which would return the status “clean.” 
         [0025]    Preferably, the patient location module  23  incorporates a display  42  of some fashion with an audio output device  44 . The display  32  could be as simple as one or more color-coded lights, preferably labeled, or more complex such as an LCD panel. Therefore, when the person approached the patient bed  22  the display  42  would indicate such as by a green light or display of the status “clean” that the person had attended to hand hygiene prior to visiting that hospital bed  22 . 
         [0026]    If the status is not “clean” but is rather “potentially contaminated” then the patient location module  23  will indicate a warning. Preferably, the warning would include either a warning light or a warning message on the display  42  and an audio alert such as a buzzer or more preferably voice instructions to attend to hand hygiene. 
         [0027]    After leaving the patient bed  22 , the RFID tag  20  would now have the status “potentially contaminated”. The status “potentially contaminated” would also apply when there had not been previous contact with a hand hygiene station  30 . Status would be changed back to “clean” upon visitation of a hand hygiene station  30 . The “clean” status would be effective for a specified period of time assuming there is no further contact with patient locations. In more elaborate implementations of the invention sensors such as the RFID transceiver  28  could be placed in other locations within a facility which could be possible sources of contamination and contact therewith would change a status from “clean” to “potentially contaminated”. 
         [0028]    Methods are potentially included to allow a personnel tag  18  to move away from a patient bed  22  and return to that same bed  22  without having the status register as “potentially contaminated.” This would allow, for instance, a nurse  14  to move about a patient&#39;s room without having the status change, or at least the status as respect to that particular patient bed  22 . Preferably a time limit would be implemented so that even if the nurse  14  re-approaches the bed  22  after that time limit the status registers as “potentially contaminated.” 
         [0029]    Other implementations and data storage can be included within the invention. For instance, compliance rates for various personnel can be tracked. The tracking can be performed on the RFID tag  20  itself or at the central processor  40 . Reports can be generated and used to help personnel improve their compliance. Such reports might include the number of times such personnel approached a patient location with a status other than “clean” within a given time period. It could also track which patients were approached and be compared against patient records to track transmission of infections within the institution. Penalties or bonus can be awarded personnel based upon compliance. 
         [0030]    If a doctor  12  or nurse  14  approach a patient bed  22  in a condition other than “clean” the system  10  preferably checks whether such person then proceeds to a hand hygiene station  30  or continues with patient contact. An exception in this area may be flagged with a higher priority by the system  10 , and can be identified by comparing time present at the bed  22 , time to the next appearance at a hand hygiene station  30  and possibly whether such personnel then return to the same bed  22 . For instance, spending more than five or ten seconds at the bed  22  in a state other than “clean” might constitute an egregious violation. 
         [0031]    Compliance at a hand hygiene station  30  can either be assumed by presence, assumed by presence for a given amount of time or verified with a sensor  46  at the hand hygiene station  30  such as a sensor  30  which reads when soap is dispensed at a hand wash station  34  or a sensor  30  which reads when an antimicrobial hand gel has been dispensed at a hand rub dispenser  32 . Such sensors  46  would be important when the hand hygiene station  30  comprises a portable antimicrobial hand rub dispenser  32  worn on the body of the user. 
         [0032]    Hand hygiene procedures typically require a certain length of scrubbing at hand wash stations  34  and the time of water running after dispensing of the soap might also be measured. A proximity sensor, especially one already used to turn on water flow, might also be polled to see if hands are in the stream of the water. Many faucets already incorporate such sensors. 
         [0033]    The personnel tags  18  can further incorporate audio and visual displays. For instance it might bear a light which changes color or separate lights  50  and  52  for each status and a beeper  54  which emits a tone upon a change in status (see  FIG. 2 ). In such instance they preferably incorporated powered RFID tags  56  which have improved communication ranges over passive RFID tags and a common power source could power all of the features of such tags  18 . 
         [0034]    Turning also to  FIG. 3 , an alternative embodiment of a hand hygiene compliance system  58  would employ multiple detectors  60  throughout a facility which would read and located personnel tags  62 . In such a system  58 , a person&#39;s exact location within a facility would be tracked. Patients also would have personnel tags  62 . With such a system proximity between personnel tags  62  could be tracked. 
         [0035]    If a personnel tag  62  assigned to a doctor  12 , nurse  14  or visitor  16  approached a personnel tag  62  assigned to a patient in a status other than “clean” a violation could be registered. Preferably such a tag  62  would incorporate its own warning system such as the audio and visual displays of the tag  18  shown in  FIG. 2 . Therefore contact away from traditional patient locations such as beds  22  could be tracked. Rather than a transceiver, a hand hygiene station  30  would have its own tag  64 , or its location could just be programmed into a central processing controller  66 . Proximity to the hand hygiene station  30  would change status to “clean.” The more elaborate procedures mentioned before could also be employed. 
         [0036]    In either system the readiness of the hand hygiene station  30  could be tracked. If it is a hand wash station  34  the level of hand soap in a dispenser could be tracked with a level sensor  68 . If it is a hand rub dispenser  32  the amount of hand rub could be similarly watched with a level sensor  68 , preferably in communication with the central processing controller  40  or  66 . Rather than a level sensor  68 , if a dispenser  32  were to dispense an accurate amount with each actuation the number of actuations as monitored by the actuation sensor  46  could be counted. Upon emptying a message to refill the dispenser  32  could be generated to appropriate personnel. Shelf life could similarly be monitored, and even incorporate a temperature sensor (not shown) to adjust for temperature effects upon shelf life. Upon expiration of shelf life a warning could be generated to appropriate personnel. 
         [0037]    The invention has been described with reference to the preferred embodiments. Obviously, modifications and alterations will occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.