Accurate Measurement of Handwash Quality Using Sensor Armbands: Instrument Validation Study

Abstract

Background Hand hygiene is a crucial and cost-effective method to prevent health care–associated infections, and in 2009, the World Health Organization (WHO) issued guidelines to encourage and standardize hand hygiene procedures. However, a common challenge in health care settings is low adherence, leading to low handwashing quality. Recent advances in machine learning and wearable sensing have made it possible to accurately measure handwashing quality for the purposes of training, feedback, or accreditation. Objective We measured the accuracy of a sensor armband (Myo armband) in detecting the steps and duration of the WHO procedures for handwashing and handrubbing. Methods We recruited 20 participants (10 females; mean age 26.5 years, SD 3.3). In a semistructured environment, we collected armband data (acceleration, gyroscope, orientation, and surface electromyography data) and video data from each participant during 15 handrub and 15 handwash sessions. We evaluated the detection accuracy for different armband placements, sensor configurations, user-dependent vs user-independent models, and the use of bootstrapping. Results Using a single armband, the accuracy was 96% (SD 0.01) for the user-dependent model and 82% (SD 0.08) for the user-independent model. This increased when using two armbands to 97% (SD 0.01) and 91% (SD 0.04), respectively. Performance increased when the armband was placed on the forearm (user dependent: 97%, SD 0.01; and user independent: 91%, SD 0.04) and decreased when placed on the arm (user dependent: 96%, SD 0.01; and user independent: 80%, SD 0.06). In terms of bootstrapping, user-dependent models can achieve more than 80% accuracy after six training sessions and 90% with 16 sessions. Finally, we found that the combination of accelerometer and gyroscope minimizes power consumption and cost while maximizing performance. Conclusions A sensor armband can be used to measure hand hygiene quality relatively accurately, in terms of both handwashing and handrubbing. The performance is acceptable using a single armband worn in the upper arm but can substantially improve by placing the armband on the forearm or by using two armbands.

Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers

“…Such a prospective cohort was recently established in Luxembourg (Predi-COVID) to study factors associated with COVID-19 disease severity; this study uses data from the national telesurveillance system that is used for virtually all patients who tested positive for COVID-19 and combines the data with biological sampling, electronic patient-reported outcomes, and innovative digital data collections such as smartphone-based voice recording to identify vocal biomarkers of respiratory syndromes. In another study, Wang et al [ 13 ] described armband sensors that can remotely measure the accuracy of hand hygiene based on WHO procedures.…”

iWash: A smartwatch handwashing quality assessment and reminder system with real-time feedback in the context of infectious disease

“…Moreover, these approaches are not ubiquitous, have installation costs, and do not work when the user is outside his home (e.g, travelling). To overcome these limitations, several smartwatch based automated systems have been developed for assessing the handwashing quality ( Li et al., 2018 ) ( Galluzzi et al., 2015 ) ( Wang et al., 2020 ) as well as reminding the users ( Mondol and Stankovic, 2015 ). These systems utilize the sensing capabilities of the smartwatches, are ubiquitous and very much suitable for the daily life settings given the growing popularity of the consumer-grade smartwatches.…”

“…While the soap or the alcohol applying step on the hands are different, we can see that the key steps for cleaning different portions of the hands (step 2 through until step 7) are the same. So, to cover both of the approaches, the existing handwashing quality assessments systems have focused on whether the steps 2 through 7 were properly performed by the user ( Li et al., 2018 ) ( Wang et al., 2020 ). Moreover, by carefully observing these steps, we can see that the steps 3, 5, 6, and 7 involves an action to be repeated by opposite hands.…”

“…In most of the previous works, the adherence to the WHO handrub and handwash guidelines were measured ( Li et al., 2018 ) ( Galluzzi et al., 2015 ) ( Wang et al., 2020 ) ( Mondol and Stankovic, 2015 ) to assess the quality of hand hygiene. In other words, a handwashing or handrubbing event is assessed as a proper one if the user followed the steps in the guidelines properly.…”

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“…In addition to that, this approach motivates the community to the World Health Organization handwashing guidance to ensure hygiene before eating and after using the toilet. Though, a proper handwashing activity required 20 to 30 seconds and lying in of five major steps that are imperative to be exhibited to the community [5]. Consequently, most of the people proclaim that their hand washes meet the standard, but the studies discovered that the public hand washing necessitates to be amended [4], [6], [7], and [8].…”