Toronto (Nov. 17, 2009) - 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 even safer.

Currently, hand hygiene auditors monitor the hand washing practices of four health care 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 health care 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 health care facilities play a key role in improving patient safety and preventing the spread of potentially deadly hospital–acquired infections," adds Dr. Fernie.

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 health care providers at a time, hand hygiene auditors use touch screen technology to simply input actions into the PDA. Auditors record typical activities performed by health care 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 Hands."

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 health care 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 practices.

"The HandyAudit system is a very consistent, reliable, and cost–efficient tool that health care 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.

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