Assessing factors associated with hand hygiene observance in care situation by the use of a continuous automated RFID based monitoring associated with bedside care tracking PDA and a qualitative analysis of video recording – MHT

Healthcare associated infection (HCAI) is affecting approximately 5 million people each year in Europe with an estimated cost of 13-24 billion €, and an attributable mortality varying from 50.000-135.000 cases. Among the leading cause of HCAI, transmission of pathogenic agent from one patient to another by HCW hand is thought to be of major concern. There is no standard for measuring adherence to hand hygiene practices; however directly observing adherence to hand hygiene recommendations is the methods used in the majority of studies. Direct observational surveys suffer from several limitations; they are time consuming and costly, they do not allow continuous monitoring and they only provide information on a small sample of all hand hygiene opportunities. More importantly, staff members change behavior when know that they are been observed, this been called the “Hawthrone effect’. Factors associated with adherence to hand hygiene have already been investigated, either those depending on HCW behavior and those independent but the results are not consistent and not usable to understand and not usable for improvement of hand hygiene. This is likely related to the fact that until now, no unbiased measurement of hand hygiene was available and observed bias “hawthorn effect” may explain at least in part those discrepant results. Moreover none or few studies have assessed the role of room architecture, patient and related disease, and the health care organization in relation to adherence. Our recently developed monitoring system (MHT) associated with our more recently develop health care tracking portable device ( Patient Smart Reader) would allow to accurately evaluate yet unevaluated factors related to non-adherence to hand hygiene.
Objectives : This study will aim to define quantitative and qualitative factors associated with hand hygiene adherence by merging two type of data, those recorded by an automatize continuous recording system ; MHT with is a HCW hand hygiene tracking monitor and those provided by Patient Smart Reader which is a bedside acts of care tracking portable device . The quantitative variables studied will be; HCW and patient’s characteristics, ergonomics, care organization. In parallels, video recording of routine care will be taken and qualitative data will be recorded by anthropological analysis of HCW explanation on their own behavior while watching their own video recording.
Methods: The study is a pragmatic exploratory study that aims to analyze factors associated with hand hygiene. This needs 4 steps, 2 technical development and 2 experimental medical study detailed in 4 tasks. Improve the experimental prototype of MHT to a “ready to commercialized” portable audit kit (T1). Merge in the same data base variables recorded by PSR and variables recorded by MHT (T2). Collect data from both MHT and PSR and analyze hand hygiene adherence to “WHO my Moment 1, 2, 3 and 4” in complex care ( T3) and record routine care by the mean of video for qualitative analysis and self-evaluation of HCW behavior toward hand hygiene (T4)
Statistical analysis: In response of the bias introduced by the number of path and the compliance ratio of each individuals, we will developed two multilevel logistic models prioritized to reflect the impact of the caregiver on the use of the alcoholic solution.
Expected results: understanding precisely care situation, ergonomic variables, individual behavior link to hand disinfection compliance would support reorganizing care, modifying location of alcohol dispenser, simplifying protocols in order to be more understandable and applicable by HCW with a minimum of constraint to led to only one expected goal that of reducing cost and loosen life due to HAI.