Note: Descriptions are shown in the official language in which they were submitted.
CA 02807337 2013-02-22
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Invention Title
Hand Hygiene Reminder System
FIELD
This device is applicable to the general field of hand hygiene practices and
behaviours
in various settings. A device that will elicit a reminder to practice hand
hygiene through
the use of an alcohol-based hand sanitizer. It ensures that individuals have
dispensed
hand sanitizer from the dispenser before entering a specified setting or room.
The end
result will be that hand hygiene will be practiced as a result of this novel
reminder
system.
CA 02807337 2013-02-22
BACKGROUND AND THE IMPORTANCE OF THE INVENTION/DEVICE
Why is hand hygiene important?
Many sources including the Centre for Disease Control, the World Health
Organization (WHO) and Public Health sectors throughout the country and the
world
have indicated that hand hygiene is the most important and efficient way of
preventing
the spread of infections. This is relevant in all settings and in particular
importance in
the huMan services sectors such as hospitals, food handling establishments and
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schools. This new device can address the low adherence of hand hygiene
practices
encountered in health care settings in particular as well as other human
service settings.
Increase of Health care acquired infections and mortality rates
There is a direct correlation between proper and consistent hand hygiene
practices and reduction in the transmission of infections. The College of
Nurses of
Ontario state that "proper hand hygiene is the single most important infection
prevention
and control practice". Health care associated infections are still a patient
safety issue
and represent significant adverse outcomes in our health care systems (Baker
et al,
2004; Stone et al, 2004). The definition of a health care associated or
hospital acquired
infection (HAI) is that the individual got the infection during the process of
care in a
health care setting (such as a hospital) which was not present or incubating
at the time
of the admission (Ducel, G., et al.; WHO, 2002). This is important because of
the direct
correlation between proper and consistent hand hygiene practices and the
reduction in
the transmission of infections. This is why hand hygiene is one of the five
key initiatives
indicated by the World Alliance for Patient Safety and the first strategy is
to improve
hand hygiene practices (Global Patient Safety Challenge, WHO, 2006).
Another factor is that infections cost the government a lot of money and
significantly increase mortality rates. In Canada there is an estimated
220,000 patients
that get a hospital acquired infection (HA!) such as methicillin-resistant
staphylococcus
aureus or Clostridium difficile which costs the government $40 to $52 million
dollars
(Birnbaum, 2007). Patients with one or more HAI's during the in-patient stay
remain in
the hospital longer and incur costs that are on average three times greater
than
uninfected patients (Plowman et al, 2001). It is also fatal; in Canada, there
are 8000
deaths per year from hospital acquired infections (HAI's) (Zoutman et al,
2003). HAI's
are the 4th leading cause of death in Canada and the vehicle determined most
commonly as the spread are the hands of health care workers (Zoutman, et al,
2003).
This is why our device will help staff and visitors; by reminding them to
clean their hands
with an alcohol-based hand sanitizer.
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Decreasing 'sick time' and infection spread in communities
Since it well evidenced that hand hygiene reduces the transmission of
infections,
our hand hygiene reminder system will decrease the spread of infection in any
setting.
This will thereby decrease sick times for staff in the setting and others who
enter the
same settings! Our reminder system ensures that anyone entering the setting or
the
room with our device installed will have to clean their hands with hand
sanitizer. For
example somebody with a common cold entering a retirement home would have to
clean their hands before making physical contact with their relative. Or
someone with a
cough entering a school would have to clean their hands before being exposed
to the
children and staff in the school. Another example is kitchen staff or cooks;
before
entering or re-entering the kitchen after using the bathroom, they would have
to clean
their hands with the hand sanitizer.
Government mandated in health care settings
The Ministry of Health and Long Term Care of Ontario created a program called
Just Clean your Hands (JCYH) in 2008. JCYH is an evidence-based program to
improve
compliance with hand hygiene best practices in health care settings to prevent
healthcare associated infections and promote patient safety. In 2009, JCYH was
adapted and rolled out for use in long-term care homes, and launched to
retirement
homes in 2011 (http://www.health.gov.on.ca/ en/ms/handhygiene/). In the
program
hospital and other health care settings in Ontario must follow an evidence
based
program of hand hygiene at what they call, the '4 moments of hand hygiene' Our
device
fits exactly in line with this program. Two of the 4 points of when health
care workers
should clean their hands is when they enter the setting and another one is
when they
exit the setting. (diagram to follow). Therefore when the staff person enters
the room the
alarm on the hand sanitizer device will be activated if they do not use hand
sanitizer and
the alarm will deactivate once the person dispenses hand sanitizer from the
dispenser.
Why is hand hygiene not happening? Behaviour change is unsuccessful
Although hand hygiene has been clearly indicated as evidence based practice,
people are not increasing their hand hygiene practices. The creators of this
patent
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application have particular experience and expertise as registered nurses with
over 20
years in the health care field. We understand the unique needs of changing
health care
practices and behaviors in the busy and intense environment of the human
services
sector.
Sources indicate that although staff have been trained and the public have
been
notified at numerous times about best practices for hand hygiene and
prevention of
infection spread, the practice of hand hygiene has not increased significantly
and the
change in behavior is not consistent or long term. The World Health
Organization
(WHO) indicates that health care providers clean their hands when they are
visibly
soiled or for personal hygiene purposes but not before non-inherent practices
such as
taking a pulse or touching the environment which are also opportunities of
infection
spread. This novel device will help facilitate the behavior change by
reminding the
person to use hand sanitizer. This is similar to the car seatbelt alarm. Prior
to this
implementation the wearing of seatbelts did not make a significant increase.
However
after the alarm was implemented there was a behavior change whereby people did
put
on their seatbelt. So why do we need to remind people to practice hand
hygiene?
Firstly, educating hospital staff about proper hand hygiene is not working. We
(the
invention creators) have worked as clinical instructors in a hospital setting
and were in
charge of teaching proper hand hygiene practices to all staff. Even though the
staff were
able to recite all of the rationales for proper hand hygiene practices they
were still not
practicing it. We were responsible for monitoring hand hygiene practices on a
weekly
basis. We would position ourselves in the hallway where we could watch the
staff enter
and exit patient rooms. The staff could not see us watching. The results were
that less
than 10% of staff were cleaning their hands with hand sanitizer on entry and
on exiting.
Therefore education alone was not helping change behaviour. Similar results of
poor
hand hygiene practices were reported by the WHO and other organizations
However when there was a visual reminder, the hand hygiene rates increased!
For example when we positioned ourselves within the view of the staff, the
staff member
would see us and this would remind him/her to clean their hands every time
they
entered or exited a patient room. The visible reminder of seeing us would
cause the staff
to clean their hands. Therefore hospitals need a reminder method where hand
hygiene
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practices can be at 100%. The sight of seeing their clinical instructor
reminded them to
clean their hands. The end result was that when we were standing there the
staff
cleaned their hands 100% of the time. However, it is not financially feasible
to have
hospital staff stand in the hallway all day to monitor hand hygiene practices
on a regular
basis. Yet along with the rates of infections in hospitals, the government:
Public Health
Ontario requests the rates of hand hygiene practices through the monitoring
done in the
hallway by staff. "Direct observations of hand hygiene are to be completed by
trained
observers using a standardized and validated audit tool" (Public Health
Ontario, 2011).
This means money is needed and used for direct observation of hand hygiene
practices
of staff. Our device can eventually lead to eliminating the need and cost of
direct
observation since our reminder system requires the person to use hand
sanitizer in
order for the alarm to shut off. According to results from December 2012 of
direct
observation most hospitals in Ontario are struggling to decrease the rate of
infections.
"According to Public Health Ontario the observational audits from Just Clean
Your
Hands testing in Ontario showed a baseline general compliance rate of 40%."
(http://www.health.gov.on.ca/ en/ms/handhygiene/).
Why an alarm reminder? The psychology of behaviour
The psychology of behavior change tells us that change will not happen if
attitude
towards the change is negative (Eagly, A.H., & Chaiken, S. 1993). Our reminder
system
is non-threatening and non-punitive therefore changing any negative
connections or
beliefs towards hand hygiene practices. Moreover our reminder system is NOT a
monitoring or detection system and this will help by not creating any negative
feelings or
attitudes that can be then associated towards our device. This in turn will
help increase
hand hygiene practices. Our reminder system is for everyone. Its purpose is to
remind
everyone in the setting to use hand sanitizer to decrease the spread of
infection.
Furthermore, the WHO reports that 91% of patients indicated they felt more
confident
about the health care system knowing there was a hand hygiene program in
place.
However it can be quite uncomfortable and intimidating for a patient to ask
the person
who is caring for them, their health care provider if they cleaned their
hands. "Patients
who see the health care provider performing hand hygiene are reassured that
everything
is being done to protect them from unnecessary infections" (WHO, 2006). Thus
our
CA 02807337 2013-02-22
device will eliminate this stress and also allow the patient to feel a sense
of
empowerment and involvement in the care they are receiving.
The audible alarm informs the person that he/she did not clean their hands.
The audible
alarm is incentive for the person to clean their hands with hand sanitizer in
order to
deactivate the alarm or prevent it from sounding in the first place. If they
do not place
get hand sanitizer from the our dispenser an audible alarm will sound and keep
sounding until the person takes hand sanitizer from the dispenser which will
then
deactivate the alarm. Thus the alarm will also alert everyone that this person
has not
cleaned their hands upon entering a patient care room and it will alert
everyone once the
person has used the hand sanitizer because using it will deactivate the alarm.
This will
promote a culture of change setting in a non-threatening, and non-punitive way
for staff
and anyone entering the setting.
Overall, our hand hygiene reminder system will enable staff to change their
behavior because other staff and patients will hear the alarm sound too if
they did not
adhere to cleaning their hands. There will be an automatic timer which can be
used to
lower the volume on the alarm for nights when the patients are sleeping. This
system is
ideal for hospital settings because it does not target just staff but everyone
entering the
patient's room. Our system is a transparent way of promoting hand hygiene
practice
without monitoring and detection and without punitive consequences. Infections
are
caused by all people not just by staff (Global Patient Safety Challenge, WHO,
2006).
Our hand hygiene reminder also helps patients in their own care and gives them
the
ability to know that everyone cleaned their hands when entering their room and
thus
decreasing the chance that they get an infection. "Patients who see the health
care
provider performing hand hygiene are reassured that everything is being done
to protect
them from unnecessary infections." (Public Health Ontario).
Why use hand sanitizer as a hand hygiene practice? Rationale of using Hand
sanitizer
The WHO as well as many governments have stated that hand rubbing with
alcohol-based hand sanitizers can be used instead of hand washing when the
hands are
not visibly soiled or have been in contact with human fluids and or
secretions. The WHO
also documented that hand washing takes more time than hand-rubbing with hand
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sanitizer. Hand washing takes up to 1.5 minutes for the entire procedure and
hand
rubbing with an alcohol-based hand sanitizer takes 15 seconds. Due to the
level of
intensity and fast paced activity in a health care setting using a hand
sanitizer is
advantageous for staff to use when they can:
"To make it possible for health care providers to clean their hands at the
right time, an
alcohol - based hand rub must be provided at the point-of-care, where busy
health care
providers can clean their hands without leaving the patient" (WHO, 2006).
"It is necessary to understand the complexity of clinical and patient care. In
an average
day health care workers do a range of tasks. Some essential yet simple tasks
like
helping patients become comfortable in bed can result in thousands of
microorganisms
being transferred onto the hands of health care workers. Taking a pulse or
blood
pressure results in transfer of equally large numbers of microorganisms. A
quick squirt of
alcohol-based hand rub and the process of rubbing this on the hands until they
are dry
will destroy almost all of these potentially harmful microorganisms in a short
time (15-30
seconds). An absence of hand hygiene at this point would mean that whichever
patient
the health care worker touches next would receive these microorganisms if hand
hygiene is not performed" (http://www.oahpp.ca/services/jcyh/faq.html).
At the same time when people from the community enter a setting they are also
carrying
with them organisms that can spread infection. Our device does not
discriminate who is
staff and who are visitors, attendees or guests thereby enforcing hand hygiene
practices
for everyone and thereby keeping everyone safer by decreasing the risk of
fatal infection
transmission and spread.
Applicable to Other settings and facilities
We propose that our invention and patent is to be applied to any and all
settings that
require or ask for a hand sanitizer dispenser.
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CA 02807337 2013-02-22
SUMMARY OF THE INVENTION
The device will be an alcohol-based hand sanitizer dispenser with a motion
sensor and an alarm built in. The motion sensor is activated once an
individual walks
past the sensor which then activates the alarm IF the person who walked past
it does
not dispense hand sanitizer within the preset time. For example it can be set
at two
seconds. If the individual does not dispense hand sanitizer from the dispenser
within two
seconds the audible alarm will be set off and continue. It will be a beeping
sound. The
alarm will be deactivated once the individual gets hand sanitizer from the
dispenser. If
the individual takes hand sanitizer from the dispenser before the time lag
then the alarm
will be deactivated in this way as well. This is NOT a hand hygiene monitoring
or
detection system. Its purpose is to remind everyone in the setting that hand
hygiene
should be practiced with the use of an alcohol-based hand sanitizer and also
to elicit
behavior change of the staff working and the people visiting the setting. Our
system is a
transparent way of promoting hand hygiene practice without monitoring and
detection
and without punitive consequences. We propose this patent to be applied to any
and all
settings whereby hand sanitizers can and will be requested to be used.
Our hand hygiene reminder is for everyone, including all staff, patients and
visitors.
The hand hygiene reminder system will be installed at entrance points or
anywhere the
setting or organization requests it to be place. It is versatile; it can be
installed and
placed in outdoor and indoor settings.
Inventors: Archna Patel and Antonia Colarossi
Figures and diagrams will follow shortly
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