J. Cahill a, A. Kay a, V. Howard a, B. Mulcahy b, M. Forde b, S. George b, E. Ziampra c, F. Duffy c, G. Lacey d,e, F. Fitzpatrick f.
Objectives: To describe the lived experience of healthcare staff during the Coronavirus Disease 2019 (COVID-19) pandemic relating to the use of personal protective equipment (PPE) and investigate risks associated with PPE use, error mitigation and acceptability of mindfulness incorporation into PPE practice. Methods: A qualitative human factors’ study at two Irish hospitals occurred in late 2020. Data was collected by semi-structured interview and included role description, pre-COVID-19 PPE experience, the impact of COVID-19 on lived experience, risks associated with PPE use, contributory factors to errors, error mitigation strategies and acceptability of incorporating mindfulness into PPE practice. Results: Of 45 participants, 23 of whom were nursing staff (51%), 34 (76%) had previously worn PPE and 25 (56%) used a buddy system. COVID-19 lived experience impacted most on social life/home-work interface (n = 36, 80%). Nineteen staff (42%) described mental health impacts. The most cited risk concerned ‘knowledge of procedures’ (n = 18, 40%). Contributory factors to PPE errors included time (n = 15, 43%) and staffing pressures (n = 10, 29%). Mitigation interventions included training/education (n = 12, 40%). The majority (n = 35, 78%) supported mindfulness integration into PPE practice. Conclusions: PPE training should address healthcare staff lived experiences and consider incorporation of mindfulness and key organisational factors contributing to safety.
Gerard Lacey, Buyiswa Lizzie Sithole, and Anna Vorndran
Infection Control Network Africa (ICAN) is the largest infection prevention and control (IPC) organisation in Africa. It provides IPC education programs and actively supports IPC implementation to reduce healthcare-associated infections (HAIs), such as COVID-19, Ebola, etc. Good quality clinical hand hygiene is the foundation of IPC. Still, it is challenging to teach as it involves a new psychomotor skill and develops new hand hygiene habits appropriate to the clinical setting. In 2019 ICAN Train-The-Trainer (TTT) program began using the SureWash technology platform to support both in-person education and the cascade of training to other staff in the facility. This paper describes the need, the technology platform, program rollout before and during the COVID-19 outbreak, the impact and the lessons learned. We conclude by providing some observations on the future use of technology for infection control training.
Gerard Lacey, Lucyna Gozdzielewska, Kareena McAloney‑Kocaman, Jonathan Ruttle, Sean Cronin, Lesley Price
Hand hygiene is critical for infection control, but studies report poor transfer from training to practice. Hand hygiene training in hospitals typically involves one classroom session per year, but psychomotor skills require repetition and feedback for retention. We describe the design and independent evaluation of a mobile interactive augmented reality training tool for the World Health Organisation (WHO) hand hygiene technique. The design was based on a detailed analysis of the underlying educational theory relating to psychomotor skills learning. During the evaluation forty-seven subjects used AR hand hygiene training over 4 weeks. Hand hygiene proficiency was assessed at weekly intervals, both electronically and via
human inspection. Thirty eight participants (81%) reached proficiency after 24.3 (SD=17.8) two-minute practice sessions. The study demonstrated that interactive mobile applications could empower learners to develop hand hygiene skills independently. Healthcare organizations could improve hand hygiene quality by using self-directed skills-based training combined with regular ward-based assessments.
Objectives: Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. Therefore, this study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines. It assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.
Methods: A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a post-intervention questionnaire.
Results: The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.
Conclusions: This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care–associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.
Gerard Lacey, PhD, MBA, Jiang Zhou, PhD, Xuchun Li, PhD, Christine Craven, SRN, MSc, Chris Gush, BS, MS (Essex)
Background: Poor quality handwashing contributes to the spread of nosocomial infections. Therefore, we investigate the impact of automatic video auditing (AVA) with feedback on the quality and quantity of handwashing in a hospital setting.
Methods: AVA systems were mounted over all handwash sinks in a surgical unit. Phase 1 established baseline handwashing quality and quantity. Phase 2 examined the impact of real-time performance feedback, and phase 3 examined the incremental impact of weekly team performance reports. Finally, phase 4 remeasured the baseline without feedback.
Results: A total of 3,606 handwash events were audited. During phase 2 and 3, compliance with the World Health Organization technique improved from 15.7%-46% (P < .0001), and the average number of handwash events per patient per day increased from 0.91-2.25 (P < .0001). However, performance returned to baseline in phase 4.
Conclusions: AVA with real-time feedback significantly improved the quality and quantity of handwashing. The combination of AVA with electronic monitoring will allow simultaneous auditing of hand hygiene quantity and quality. The impact of cognitive offloading onto the technology may have contributed to the return to baseline at the end of the study, and suggests further research is required in this area.
Background: In 2009, the World Health Organization recommended the use of a ‘multifaceted, multi-modal hand hygiene strategy’ (Five Moments for Hand Hygiene) to improve hand hygiene compliance among healthcare workers. As part of this initiative, a training programme was implemented using an automated gaming technology training and audit tool. They were used to educate staff on hand hygiene technique in an acute healthcare setting.
Aim: To determine whether using this automated training programme and audit tool as part of a multi-modal strategy would improve hand hygiene compliance and technique in an acute healthcare setting.
Methods: A time-series quasi-experimental design was chosen to measure compliance with the Five Moments for Hand Hygiene and handwashing technique. The study was performed from November 2009 to April 2012. An adenosine triphosphate monitoring system was used to measure handwashing technique, and SureWash (Glanta Ltd, Dublin, Ireland), an automated auditing and training unit, was used to provide assistance with staff training and education.
Findings: Hand hygiene technique and compliance improved signiﬁcantly over the study period (P < 0.0001). Conclusion: Incorporation of new automated teaching technology into a hand hygiene programme can encourage staff participation in learning. Also, it can ultimately improve hand hygiene compliance and technique in the acute healthcare setting.
Gerard LACEY, Michael Corr, Helga Morrow, Ann McQUEEN, Fiona CAMERON and Chris CONNOLLY
Hand hygiene is recognized by the CDC as the most effective method of preventing Hospital Acquired Infections (HAIs) which cost the US healthcare system $14 Billion. However, training and promotion of hand hygiene in healthcare settings is an on-going challenge. Therefore, this paper describes a hand hygiene improvement campaign in Edinburgh Royal Infirmary (Scotland, UK) using the SureWash gesture recognition system (SureWash, IRL). The campaign consisted of two phases of three-months each; the first phase involved technology evaluation and familiarization in a variety of settings within the hospital. The second phase involved rotation between two units with specific changes to the incentives for completing the training. There were 2,010 individual training sessions with over 30% outside of office hours. Individuals completed an average of 2.72 training sessions each and 90% of staff passed the assessment. Most noteworthy, senior staff noted a change in hand hygiene culture following the campaign and the good-natured competition between staff to demonstrate hand hygiene competence using the SureWash serious game. However, while the new technology did facilitate the culture change its successful implementation was dependent on a set of incentives for staff and a structured implementation plan.
Anarta Ghosh PhD, Stefan Ameling MSc, Jiang Zhou PhD, Gerard Lacey PhD, Eilish Creamer PhD, Anthony Dolan MSc, Orla Sherlock PhD, Hilary Humphreys MD
A novel artiﬁcial intelligence (AI) system (SureWash; GLANTA, Dublin, Ireland) was placed on a ward with 45 staff members for two 6-day periods to automatically assess hand hygiene technique and the potential effectiveness of the automated training system. Two human reviewers assessed videos from 50 hand hygiene events with an interrater reliability (IIR) of 88% (44/50). The IIR was 88% (44/ 50) for the human reviewers and 80% (40/50) for the software. This study also investigated the poses missed and the impact of feedback on participation (þ113%), duration (þ11%), and technique (þ2.23%). Our ﬁndings showed signiﬁcant correlation between the human raters and the computer. Therefore, this demonstrated for the ﬁrst time in a clinical setting the potential use of this type of AI technology in hand hygiene training.
Artificial intelligence (AI) offers huge potential in infection prevention and control (IPC). Hence, we explore its potential IPC benefits in epidemiology, laboratory infection diagnosis, and hand hygiene.
Advantages for IPC include speed, consistency, and capability of handling infinitely large data sets. However, many challenges remain; improving the availability of high-quality representative data sets and consideration of biases within preexisting databases are important challenges for future developments. AI in itself will not improve IPC; this requires culture and behavior change. Most studies to date assess performance retrospectively so there is a need for prospective evaluation in the real-life, often chaotic, clinical setting. Close collaboration with IPC experts to interpret outputs and ensure clinical relevance is essential.
Gary Thirkell RN, Joanne Chambers RN,Wayne Gilbart RN, Kerrill Thornhill BEng, James Arbogast PhD, Gerard Lacey PhD
Digital tools for hand hygiene do not share data, limiting their potential to support multimodal programs. The Christie NHS Foundation Trust, United Kingdom, worked with GOJO (in the United States), MEG (in Ireland), and SureWash (in Ireland) to integrate their systems and pilot their combined use in a clinical setting.
Andrew J. Stewardson1, Anne Iten, Veronique Camus, Angele Gayet-Ageron, Darren Caulfield, Gerard Lacey, Didier Pittet.
Hand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. The study assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device’s diagnostic capacity.