A New Performance Metric to Estimate the Risk of Exposure to Infection in a Health Care Setting: Descriptive Study

Abstract

Background Despite several measures to monitor and improve hand hygiene (HH) in health care settings, health care-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems. Objective This study proposes a novel parameter for quantifying the HAI exposure risk of individual patients by considering temporal and spatial features of health care workers’ HH adherence. Methods Patient exposure risk is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the health care professional, and the time duration that the health care professional spends inside and outside the patient’s room without performing HH. The patient exposure risk is compared to the entrance compliance rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances into the room. The compliance rate is conventionally used to measure HH performance. The ECR and the patient exposure risk are analyzed using the data collected from an inpatient nursing unit for 12 weeks. Results The analysis of data collected from 59 nurses and more than 25,600 records at a musculoskeletal rehabilitation unit at the Toronto Rehabilitation Institute, KITE, showed that there is no strong linear relation between the ECR and patient exposure risk (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in the patient exposure risk. Therefore, there might be scenarios that these 2 parameters are correlated; however, in several cases, the ECR contrasted with the reported patient exposure risk. Generally, the patients in rooms with a significantly high ECR can be potentially exposed to a considerable risk of infection. By contrast, small ECRs do not necessarily result in a high patient exposure risk. The results clearly explained the important role of the factors incorporated in patient exposure risk for quantifying the risk of infection for the patients. Conclusions Patient exposure risk might provide a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records.

Development and Evaluation of BLE‐Based Room‐Level Localization to Improve Hand Hygiene Performance Estimation

“…As mentioned above, current electronic monitoring systems are not capable of positioning the caregiver inside the room. The localization of healthcare workers inside the patient's room can enhance the current calculation of HH performance (compliance rate) as well as the new parameter called patient exposure risk (PER) introduced in [ 10 ]. The authors in [ 45 ] used a motion capture system to derive the location and orientation of the caregiver inside the room and showed that the caregiving activities are well related to their location in the nursing environment.…”

“…Although these systems provide additional valuable information regarding healthcare workers' HH adherence, they are still not able to correctly identify all 4 HH moments. The location of the healthcare worker inside the patient room can help in quantifying the exposure risk to infection for both the patients and the caregivers [ 10 ]. In general, electronic monitoring systems with some level of position-sensing capabilities can be divided into two groups.…”