Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors. Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system. The effect of changing the prompt duration on hand hygiene performance was determined by a cluster-randomized trial on 3 nursing units with 1 acting as control. Sustainability of performance and participation was observed on 4 nursing units over a year. All staff were eligible to participate. Between June 2015 and December 2016, a total of 459,376 hand hygiene opportunities and 330,740 handwashing events from 511 staff members were recorded. Dispenser activation counts were significantly influenced by use of the system (χ2[3] = 75.76; P < .0001). Hand hygiene performance dropped from 62.61% to 24.94% (odds ratio, 0.36; 95% confidence interval, 0.34-0.38) when the prompting feature was removed. Staff participation had a negative trajectory of -0.72% (P < .001), whereas change in average performance was -0.18% (P < .001) per week for the year. Use of electronic monitoring with real-time prompts of 20 seconds' duration nearly doubles handwashing activity and causes handwashing to occur sooner after entering a patient room. These improvements are sustainable over a year.

The built environment continues to become increasingly accessible to people with disabilities, yet there remains a lack of focus on how these individuals are evacuated in emergencies. The objective of this scoping review was to survey the academic literature to identify solutions for safely evacuating individuals with functional limitations from the indoor built environment (i.e., buildings). Journal articles and conference proceedings published in the year 2002 onwards were included. Two pairs of reviewers independently evaluated 3562 articles from ten databases and identified 99 articles. The results were categorized into six main evacuation solution types: notification, wayfinding, egress, building design, strategy, and training programs. Our findings highlight the importance of tailoring solutions to the needs of individuals with different functional limitations. Future work should focus on expanding the number of solutions available for (1) emergencies beyond fires (e.g., natural disasters); (2) unique building types that may require specialized engineering considerations; and (3) a greater variety of impairments (e.g., seeing, hearing, cognitive). We also emphasize the need for more interdisciplinary work and the importance of including rescuers and rescuees in emergency preparedness discussions. These collaborations will ensure that building designs, organizational procedures, and evacuation aids complement each other to maximize safety. To our knowledge, this is the first scoping review to identify solutions for evacuating individuals with functional limitations from buildings. These findings may help inform future recommendations for new evacuation guidelines around the world.

Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare-acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels. An electronic monitoring system was deployed 3times at 6-month intervals on a musculoskeletal rehabilitation nursing unit in Toronto. Each deployment lasted 4 consecutive weeks. Each wall-mounted soap and hand rub dispenser was outfitted with an activation counter to assess the impact of system deployments on overall handwashing activity. System deployments took place in October 2016, April 2017, and October 2017. A total of 76,130 opportunities were recorded, with an aggregate hand hygiene performance of 67.43%. A total of 515,156 dispenser activations were recorded. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Participation was high at the beginning of each deployment and declined during each deployment but was restored to a high level with the start of the next deployment. Intermittent deployment of an electronic monitoring intervention counteracts potential declines in participation rates sometimes seen with continuous system use. However, adoption of this strategy requires the acceptance of lower periods of performance between each deployment.

Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

Electronic Monitoring of Individual Healthcare Workers’ Hand Hygiene Event Rate - Volume 35 Issue 9 - Matthew P. Muller, Alexander I. Levchenko, Stanley Ing, Steven M. Pong, Geoff R. Fernie