Auditing tool improves hand-washing
TORONTO – Toronto Rehab scientists
have developed an easy-to-use electronic tool that helps hand hygiene
auditors efficiently monitor and report hand hygiene compliance rates,
which will ultimately make patients and hospitals safer.
Currently, hand hygiene auditors monitor the hand washing practices of
four healthcare workers at once, recording each of their hand washing
actions – that can be a difficult and complicated task.
“The current standard for auditing hand hygiene compliance is a
paper-based observation tool that requires auditors to make subjective
decisions as to whether hand washing opportunities have been seized or
missed while observing healthcare providers and recording their
actions,” says Dr. Geoff Fernie, vice president of research at Toronto
Rehab and one of the scientists who developed the new auditing tool.
“The potential for error is high.”
HandyAudit eases the process of collecting, recording, analyzing and
reporting hand hygiene compliance practices by taking personal judgement
out of determining hand washing compliance.
“Effective hand washing practices in hospitals and other healthcare
facilities play a key role in improving patient safety and preventing
the spread of potentially deadly hospital-acquired infections,” adds Dr.
Each year in Canada about 8,000 patients – or approximately 22 people a
day – die from hospital-acquired infections. These are infections that
patients acquire while in hospital being treated for some other
condition. The most common include Clostridium difficile (C. difficile),
vancomycin-resistant enterococci (VRE) and methicillin-resistant
Staphylococcus aureus (MRSA). And this flu season, H1N1 can be added to
the list of infections a person can contract in hospital.
The HandyAudit system consists of a personal digital assistant (PDA) and
a web-based application. While observing the activities of several
healthcare providers at a time, hand hygiene auditors use touch screen
technology to simply input actions into the PDA. Auditors record typical
activities performed by healthcare workers in the course of caring for
patients, such as: entering the patient’s room, touching the patient,
cleaning open wounds, using an alcohol gel hand sanitizer or leaving the
patient’s room, etc.
Once the actions are recorded in HandyAudit, data is downloaded from the
PDA to a secure website. The HandyAudit software analyzes these actions
and determines whether hand washing was done at the right time or was
missed. Actions are then calculated into hand hygiene compliance rates.
Hand hygiene compliance calculations are based on the four critical hand
cleansing opportunities as identified in the Ontario Ministry of Health
and Long-Term Care’s hand hygiene compliance program, “Just Clean Your
The software can be tailored to comply with the hand hygiene compliance
requirements in different institutions and jurisdictions across the
world. The World Health Organization, for example, recently released new
guidelines for monitoring hand hygiene compliance.
HandyAudit can also take the same data collected one year and track it
against different or revised guidelines so that trends in hand hygiene
can be seen over several years.
As the person who oversees St. Michael’s Hospital’s day-to-day
monitoring of hand hygiene compliance, infection control physician Dr.
Matthew Muller is very aware of the on-the-ground challenges of
observing and inputting hand hygiene compliance data.
“Keeping your eyes on several healthcare workers at once while
simultaneously interpreting and recording whether or not a person has
washed their hands before and after touching a patient or performing a
medical procedure can be extremely demanding. There is a lot of
potential for errors in inputting and transcribing that information,”
explains Dr. Muller. “Some of these decisions can be difficult to make
in a busy environment because you need to remember or take into account
a complicated sequence of events. This novel technology relieves some of
those demands because it requires you to just enter what you see.”
Dr. Muller adds that current hand hygiene auditing processes are
extremely resource-intensive and using HandyAudit could save hospitals
money and time by reducing auditor training and eliminating the need to
transcribe information from paper to computer.
Beginning April 30, 2009, the Ministry of Health and Long-Term Care
required all Ontario hospitals to publicly report their annual hand
hygiene compliance rates. This data will assist hospitals in evaluating
the effectiveness of their infection prevention and control
interventions and make further improvements to their hand cleaning
“The HandyAudit system is a very consistent, reliable, and
cost-efficient tool that healthcare facilities can easily add to their
arsenal of infection prevention strategies,” says Dr. Fernie. HandyAudit
will soon be piloted in several Ontario hospitals and it is expected to
be commercially available early next year.
HandyAudit was funded, in part, through a grant from the Mississauga
Halton Infection Control Network and the Ontario Centres of Excellence
with support from the Ministry of Health and Long-Term Care.
About Toronto Rehab
Toronto Rehab is at the forefront of one of the most important and
emerging frontiers in healthcare today – rehabilitation science. As a
fully affiliated teaching and research hospital of the University of
Toronto, Toronto Rehab is Canada’s largest academic provider of adult
rehabilitation services, complex continuing care and long–term care.
Toronto Rehab is advancing rehabilitation knowledge and practice through
research and education.
Posted Nov.26, 2009