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Development of a New Monitoring System for the Evaluation of Hand Hygiene Compliance; Hand Hygiene Activity Recognition Using a Triaxial Accelerometer Network System
www.ajicjournal.org Vol. 37 No. 5
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Project: Professional skills are acquired through education, time and experience. This model has been used to describe nursing residency programs (Benner, P. 1984) and medical residency programs (Accreditation Council for Graduate Education). The level is self determined and would be supported by accomplishments presented in a standard resume or curriculum vita. Results: The five levels of skills acquisition are as follows: d
d
d
d
d
d
Infection Preventionist- Novice would have minimal clinical experience (, 1year) and no formal education OR have a Masters or Doctorate in a healthcare related field and , 6 months clinical experience in infection prevention. Infection Preventionist- Advanced Beginner would have some clinical experience (. 1 year) and some formal education (such as completion of EPI 101) OR have a Masters or Doctorate in a healthcare related field and . 6 months clinical experience in infection prevention. The third level term Competent. The Infection Preventionist-Competent would have more experience (. 2 years) and be certified in Infection Control (CIC) OR have a Masters or Doctorate in a healthcare field, . 6 months experience and be certified in Infection Control (CIC). Infection Preventionist- Proficient would need to meet the qualifications of the Infection Preventionist-Certified, have more clinical experience (. 7 years) and be published in a peer reviewed journal on a topic related to infection prevention and control OR Masters or Doctorate in a healthcare related field and . 5 years clinical experience in infection prevention plus be published in a peer reviewed journal on a topic related to infection prevention and control. Infection Preventionist-Expert would need to meet all previous requirements and have extensive clinical experience (.10 years), maintain certification in Infection Control (CIC) and be published in a peer review journal every five years on a topic related to infection prevention and control OR Masters or Doctorate in a healthcare related field and . 5years clinical experience in infection prevention plus be published in a peer review journal every five years on a topic related to infection prevention and control. In addition to the five levels outlined by Dreyfus, there are scientists, researchers and advocates who move the profession forward, but may not be applying their skills to everyday infection prevention strategies. A sixth category would be added to the Dreyfus model. These individuals or groups would be classified as Infection Preventionist- Champion, and would be recognized by Infection Preventionist- Experts.
Lessons Learned: Creating a five tiered career ladder promotes learning, certification and publication to advance the profession. In addition, it could be tied to promotion and advancement within a healthcare organization, and be recognized through financial compensation. Presentation Number: 18-200
Development of a New Monitoring System for the Evaluation of Hand Hygiene Compliance; Hand Hygiene Activity Recognition Using a Triaxial Accelerometer Network System Toshie Tsuchida, PhD of Nursing, Lecturer; Chisako Takeda, Master Science of Education, Professor; Machiko Ogino, Master Science of Nursing, Tomohiro Tsuchiya, Master Science of Nursing, Assistant, Hyogo University of Health Sciences, Kobe, Japan; Futoshi Naya, Master Science of Engineering; Haruo Noma, Ph.D of Engineering, Senior Researcher; Kiyoshi Kogure, Ph.D of Engineering, Director, Knowledge Science Laboratories, Kyoto, Japan; Hiromi I. Ozaku, Ph.D of Engineering, Senior Researcher, Information Management Office, Tokyo, Japan; Emiko Hama, Bachelor of Engineering, Reseacher, Knowledge Science Laboratories, Kyoto, Japan; Yoshio Takesue, Ph.D of Medicine, Professor; Kaoru Ichiki, Specialist, Infection Control Nurse; Kazuhiko Nakajima, Ph.D of Medicine, Assistant; Mika Ishihara, Bachelor of Pharmacology, Pharmecist, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan Background: There is no consistent way to measure hand hygiene (HH) compliance in clinical settings. As a result, we have been developing a triaxial accelerometer network system to evaluate nursing care activities. Objectives: Aim of this study was to recognize and evaluate HH activity using triaxial accelerometers in order to promote better HH practices by nurses.
E158
American Journal of Infection Control June 2009
Methods: An experimental study was performed with 13 nurses fitted with triaxial accelerometers while they performed routine nursing duties at a university hospital’s Coronary Care Unit (CCU) from 9 AM to noon. Data was collected twice for each subject for a total of 26 trials. We used 4 Bluetooth-based B-packs (wireless, wearable sensor platforms) per subject with triaxial accelerometer sensors, attaching them on the waist, chest, and both upper arms of subjects. The frequency and skill of performance of HH activities was directly observed by researchers monitoring the subjects. HH activity was also observed using a video camera installed above a hand washing sink in the CCU. A sliding window framework was used to analyze data from the sensors and extract features of HH activity recognition. The following features were extracted for each sliding window of data for each of the sensors’ axes: mean & standard deviation of acceleration, energy & frequency-domain entropy, and correlation coefficients between different sensors’ axes data. The ability to distinguish between hand washing and alcohol-based hand rubbing was evaluated with support vector machines and the true positive rate for each HH activity was calculated. Results: In total, 2406 features (Fig.1) were extracted from data for 246 HH activities. The overall accuracy of feature extractions was 92.6% and the kappa was 0.853. Analysis by activity extracted 1224 features from 70 hand washing activities and 1182 features from 176 hand rubbing activities. The recognition accuracy of each HH activity was 92.7% for hand washing and 92.5% for hand rubbing. Conclusions: The recognition accuracy of HH activities using triaxial accelerometers was 93%. Building upon the positive results of this experiment, we will continue evaluating the validity of HH activities detection with subjects involved in nursing care activities. Accurate detection and analysis of nurses’ activities could help improve HH practices by nurses.
Figure 1. Features of hand washing activities extracted from data from four triaxial accelerometers. Presentation Number: 18-201
Direct Observation in the Operating Room: First Step to Best Practices Laura Bardowski, RN, BSN; Anna O’Donnell, RN, BSN, Infection Control Coordinator; Teresa Zembower, MD, MPH, Hospital Epidemiologist; Mary Alice Lavin, BSN, MJ, CIC, Manager, Infection Control & Prevention; Maureen Bolon, MD, MS, Medical Director, Infection Control & Prevention, Northwestern Memorial Hospital, Chicago, IL Issue: Most surgical site infections (SSIs) result from intraoperative microbial contamination. Casual observations by the Infection Control Department (IC) of lapses in practice in the surgical suite combined with data demonstrating an increase in colorectal SSIs prompted an IC investigation. Project: IC observed 19 surgical procedures. Sampling was performed in order to ensure adequate variety. A tool was developed to collect information related to antibiotic prophylaxis, skin preparation, hand antisepsis, sterile field, attire, traffic patterns and the environment. Practices were evaluated for adherence to standards established by national guidelines, regulatory agencies, and local policies. Results: Surgeries observed were cardiac, colon, breast, gallbladder, peripheral vascular bypass, laminectomy, spinal fusion/refusion, craniotomy, cesarean section, abdominal hysterectomy, hip arthroplasty, and knee arthroplasty. Antibiotic choice and timing did not consistently meet guidelines. The preferred product for skin preparation, 2% chlorohexidine gluconate (CHG) and alcohol, was not consistently used according to manufacturer recommendations: application, duration and dry time were inadequate. Similarly, hand antisepsis using 1% CHG/
E157
Project: Professional skills are acquired through education, time and experience. This model has been used to describe nursing residency programs (Benner, P. 1984) and medical residency programs (Accreditation Council for Graduate Education). The level is self determined and would be supported by accomplishments presented in a standard resume or curriculum vita. Results: The five levels of skills acquisition are as follows: d
d
d
d
d
d
Infection Preventionist- Novice would have minimal clinical experience (, 1year) and no formal education OR have a Masters or Doctorate in a healthcare related field and , 6 months clinical experience in infection prevention. Infection Preventionist- Advanced Beginner would have some clinical experience (. 1 year) and some formal education (such as completion of EPI 101) OR have a Masters or Doctorate in a healthcare related field and . 6 months clinical experience in infection prevention. The third level term Competent. The Infection Preventionist-Competent would have more experience (. 2 years) and be certified in Infection Control (CIC) OR have a Masters or Doctorate in a healthcare field, . 6 months experience and be certified in Infection Control (CIC). Infection Preventionist- Proficient would need to meet the qualifications of the Infection Preventionist-Certified, have more clinical experience (. 7 years) and be published in a peer reviewed journal on a topic related to infection prevention and control OR Masters or Doctorate in a healthcare related field and . 5 years clinical experience in infection prevention plus be published in a peer reviewed journal on a topic related to infection prevention and control. Infection Preventionist-Expert would need to meet all previous requirements and have extensive clinical experience (.10 years), maintain certification in Infection Control (CIC) and be published in a peer review journal every five years on a topic related to infection prevention and control OR Masters or Doctorate in a healthcare related field and . 5years clinical experience in infection prevention plus be published in a peer review journal every five years on a topic related to infection prevention and control. In addition to the five levels outlined by Dreyfus, there are scientists, researchers and advocates who move the profession forward, but may not be applying their skills to everyday infection prevention strategies. A sixth category would be added to the Dreyfus model. These individuals or groups would be classified as Infection Preventionist- Champion, and would be recognized by Infection Preventionist- Experts.
Lessons Learned: Creating a five tiered career ladder promotes learning, certification and publication to advance the profession. In addition, it could be tied to promotion and advancement within a healthcare organization, and be recognized through financial compensation. Presentation Number: 18-200
Development of a New Monitoring System for the Evaluation of Hand Hygiene Compliance; Hand Hygiene Activity Recognition Using a Triaxial Accelerometer Network System Toshie Tsuchida, PhD of Nursing, Lecturer; Chisako Takeda, Master Science of Education, Professor; Machiko Ogino, Master Science of Nursing, Tomohiro Tsuchiya, Master Science of Nursing, Assistant, Hyogo University of Health Sciences, Kobe, Japan; Futoshi Naya, Master Science of Engineering; Haruo Noma, Ph.D of Engineering, Senior Researcher; Kiyoshi Kogure, Ph.D of Engineering, Director, Knowledge Science Laboratories, Kyoto, Japan; Hiromi I. Ozaku, Ph.D of Engineering, Senior Researcher, Information Management Office, Tokyo, Japan; Emiko Hama, Bachelor of Engineering, Reseacher, Knowledge Science Laboratories, Kyoto, Japan; Yoshio Takesue, Ph.D of Medicine, Professor; Kaoru Ichiki, Specialist, Infection Control Nurse; Kazuhiko Nakajima, Ph.D of Medicine, Assistant; Mika Ishihara, Bachelor of Pharmacology, Pharmecist, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan Background: There is no consistent way to measure hand hygiene (HH) compliance in clinical settings. As a result, we have been developing a triaxial accelerometer network system to evaluate nursing care activities. Objectives: Aim of this study was to recognize and evaluate HH activity using triaxial accelerometers in order to promote better HH practices by nurses.
E158
American Journal of Infection Control June 2009
Methods: An experimental study was performed with 13 nurses fitted with triaxial accelerometers while they performed routine nursing duties at a university hospital’s Coronary Care Unit (CCU) from 9 AM to noon. Data was collected twice for each subject for a total of 26 trials. We used 4 Bluetooth-based B-packs (wireless, wearable sensor platforms) per subject with triaxial accelerometer sensors, attaching them on the waist, chest, and both upper arms of subjects. The frequency and skill of performance of HH activities was directly observed by researchers monitoring the subjects. HH activity was also observed using a video camera installed above a hand washing sink in the CCU. A sliding window framework was used to analyze data from the sensors and extract features of HH activity recognition. The following features were extracted for each sliding window of data for each of the sensors’ axes: mean & standard deviation of acceleration, energy & frequency-domain entropy, and correlation coefficients between different sensors’ axes data. The ability to distinguish between hand washing and alcohol-based hand rubbing was evaluated with support vector machines and the true positive rate for each HH activity was calculated. Results: In total, 2406 features (Fig.1) were extracted from data for 246 HH activities. The overall accuracy of feature extractions was 92.6% and the kappa was 0.853. Analysis by activity extracted 1224 features from 70 hand washing activities and 1182 features from 176 hand rubbing activities. The recognition accuracy of each HH activity was 92.7% for hand washing and 92.5% for hand rubbing. Conclusions: The recognition accuracy of HH activities using triaxial accelerometers was 93%. Building upon the positive results of this experiment, we will continue evaluating the validity of HH activities detection with subjects involved in nursing care activities. Accurate detection and analysis of nurses’ activities could help improve HH practices by nurses.
Figure 1. Features of hand washing activities extracted from data from four triaxial accelerometers. Presentation Number: 18-201
Direct Observation in the Operating Room: First Step to Best Practices Laura Bardowski, RN, BSN; Anna O’Donnell, RN, BSN, Infection Control Coordinator; Teresa Zembower, MD, MPH, Hospital Epidemiologist; Mary Alice Lavin, BSN, MJ, CIC, Manager, Infection Control & Prevention; Maureen Bolon, MD, MS, Medical Director, Infection Control & Prevention, Northwestern Memorial Hospital, Chicago, IL Issue: Most surgical site infections (SSIs) result from intraoperative microbial contamination. Casual observations by the Infection Control Department (IC) of lapses in practice in the surgical suite combined with data demonstrating an increase in colorectal SSIs prompted an IC investigation. Project: IC observed 19 surgical procedures. Sampling was performed in order to ensure adequate variety. A tool was developed to collect information related to antibiotic prophylaxis, skin preparation, hand antisepsis, sterile field, attire, traffic patterns and the environment. Practices were evaluated for adherence to standards established by national guidelines, regulatory agencies, and local policies. Results: Surgeries observed were cardiac, colon, breast, gallbladder, peripheral vascular bypass, laminectomy, spinal fusion/refusion, craniotomy, cesarean section, abdominal hysterectomy, hip arthroplasty, and knee arthroplasty. Antibiotic choice and timing did not consistently meet guidelines. The preferred product for skin preparation, 2% chlorohexidine gluconate (CHG) and alcohol, was not consistently used according to manufacturer recommendations: application, duration and dry time were inadequate. Similarly, hand antisepsis using 1% CHG/