"A system, method and PDU for monitoring hand hygiene compliance" Technical Field:

This invention relates to a system and method for monitoring hand hygiene compliance. Background Art:

The World Health Organisation (WHO) has defined five moments when hand washing should occur when treating a patient. These are (1 ) before touching a patient; (2) before any clean or aseptic procedure; (3) after body fluid exposure risk; (4) after touching a patient; and (5) after touching patient surroundings. Current studies have indicated that healthcare workers are washing their hands according to these five moments less than 50% of the time, leading to increased levels of healthcare acquired infections (HAI's).

Typically, and in accordance with WHO guidelines, hospitals audit hand hygiene compliance to the five moments via manual audits by trained monitors. However this process has come under increasing discredit as healthcare workers change their behaviour when monitored; monitoring only captures a small percentage of the opportunities for hand hygiene; and monitors are unable to capture all five moments of hand hygiene due to the competing need to respect patient privacy. Since manual auditing is not perceived to be appropriate or adequate, there has been an increasing deployment of electronic monitoring systems to monitor hand hygiene. One such system is that described in the applicants own granted European Patent No. EP1982314. These systems provide considerable benefits over manual auditing. However, heretofore these systems can only monitor moments 1 , 4, and 5 outlined above effectively. Although these moments typically are over 80% of the total opportunities, a large proportion, 20%, of the total moments are still not being captured as moments 2 and 3 and not being recorded. Various other systems and methods have been described that attempt to improve monitoring of hand hygiene compliance. For example, US Patent Application Publication No. US2010/0262430 in the name of Gips et al, US Patent Application Publication No. US2010/0328443 in the name of Lynam et al., and US Patent Application Publication No. US2013/0342349 in the name of Cruz all describe methods and systems for monitoring hand hygiene compliance. Furthermore, PCT Patent Application Publication No. WO201 3/106440 in the name of Smith et al and PCT Patent Application Publication No. WO2014/140870 in the name of DEB Group Limited describe methods, systems and dispensing units for use in the improvement of hand hygiene monitoring methods and systems. However, heretofore, none of the available devices has proven entirely satisfactory.

There is a need for a system, method and PDU that embodies the benefits of electronic monitoring systems that captures all five moments of hand hygiene. It is an object of the present invention to provide a system and method that solves at least some of the problems with the existing systems and methods and that provides a useful alternative choice for the consumer.

Summary of Invention:

According to the invention there is provided a method of monitoring compliance with the World Health Organisation (WHO) guidelines on hand washing moments by a health care worker (HCW) in a healthcare facility, the healthcare facility having a plurality of sensors therein designating areas within the healthcare facility as healthcare zones, a plurality of sensors therein designating areas within the healthcare zones as patient zones, the HCW carrying a personal dispensing unit (PDU) of hand washing compound on their person, the PDU being operable to transmit an indication of a dispensing event each time the PDU is used to dispense hand washing compound, the HCW carrying on their person a portable tracking unit, the healthcare facility having a tracking system for tracking the location of the tracking unit in the healthcare facility over time, and a central monitoring unit (CMU) having accessible memory, the CMU receiving the indications of dispensing events by the HCW and the CMU receiving the location of the HCW in the healthcare facility over time from the tracking system, and for each indication of a dispensing event, the method comprising the steps of: (a) the CMU collating the data of the indication of the dispensing event with the location data to determine the location of the HCW when the dispensing event occurred;

(b) the CMU determining whether or not the HCW is in one of the patient zones at the time of the dispensing event;

(c) on the CMU determining that the HCW was inside one of the patient zones at the time of the dispensing event, the CMU classifying the dispensing event as one of a type 2 or a type 3 handwashing event in accordance with the WHO's guidelines on hand washing moments;

(d) on the CMU determining that the HCW was outside one of the patient zones at the time of the dispensing event, the CMU retrieving from memory the historical location of the HCW over a first predetermined time period immediately preceding the dispensing event;

(e) on the CMU detecting that the HCW was previously inside a patient zone within that first predetermined period of time, the CMU classifying the dispensing event as one of a type 4 or a type 5 handwashing event in accordance with the WHO guidelines on hand washing moments; and

(f) the CMU storing in memory a record of each of the dispensing events performed by a HCW in the healthcare facility along with the classification of the hand washing event.

By having such a method, it will be possible to determine whether the HCW is inside or outside of a patient zone when they are carrying out a handwashing exercise. Therefore, it will be possible to determine whether or not the HCW is performing a type 2 or a type 3 moment. Furthermore, by monitoring whether or not the HCW has been inside a patient zone within a predetermined period of time prior to the hand washing action, it is possible to determine whether the HCW is performing a type 1 , 4 or 5 moment. It will be appreciated therefore that it is possible for the method to monitor the 5 moments of hand washing as recommended by the WHO.

In one embodiment of the invention there is provided a method comprising the intermediate step of:

(g) on the CMU detecting that the HCW was not previously inside a patient zone within the first predetermined period of time, the CMU classifying the dispensing event as a type 1 handwashing event in accordance with the WHO guidelines on hand washing moments.

In one embodiment of the invention there is provided a method comprising the intermediate steps of: (h) on the CMU determining that the HCW was outside one of the patient zones at the time of the dispensing event, the CMU monitoring the location of the HCW for a second predetermined period of time immediately after the dispensing event; and (i) on the CMU detecting that the HCW enters a patient zone within that second predetermined period of time, the CMU classifying the dispensing event as a type 1 handwashing event in accordance with the WHO guidelines on hand washing moments. In this way, the precise nature of the hand washing event can be determined and recorded correctly. This will facilitate building a more accurate picture of the performance of the HCW and where training or instruction is required. in one embodiment of the invention there is provided a method comprising the step of the HCW, using the PDU , indicating the type of dispensing event occurring and the PDU transmitting the type of dispensing event occurring to the CMU.

This is seen as a particularly preferred embodiment of the invention. By allowing the HCW to indicate the type of dispensing event that they are performing, an even richer picture of the performance of the HCW can be ascertained. In this way, it will be possible to differentiate between type 2 moments and type 3 moments and furthermore it will be possible to differentiate between type 4 moments and type 5 moments. This will be highly advantageous from the point of view that an even more accurate picture of the performance of the HCW will be provided and it will be possible to provide more targeted training or instruction on the strength of the information.

In one embodiment of the invention there is provided a method comprising the step of the CMU storing the type of dispensing event occurring received from the PDU as the classification of the hand washing event.

In one embodiment of the invention there is provided a method comprising the step of the CMU comparing the classification of the hand washing event with the type of dispensing event indication received from the PDU.

In one embodiment of the invention there is provided a method comprising the steps of:

(j) the CMU analysing the location data of the HCW in conjunction with the data of the indication of the dispensing events by the HCW to determine those instances where a dispensing event should have occurred but didn't occur; and

(k) the CMU storing in memory a record of each of the instances where a dispensing event should have occurred but didn't occur for the HCW. In one embodiment of the invention there is provided a system for monitoring compliance with the World Health Organisation (WHO) guidelines on hand washing moments by a health care worker (HCW) in a healthcare facility, the system comprising: a plurality of sensors designating areas within the healthcare facility as healthcare zones; a plurality of sensors designating areas within the healthcare zones as patient zones; a personal dispensing unit (PDU) of hand washing compound to be carried by a HCW, the PDU having a transmitter to transmit an indication of a dispensing event each time the PDU is used to dispense hand washing compound; a portable tracking unit to be carried by the HCW; a tracking system for tracking the location of the tracking unit in the healthcare facility over time and in particular the presence of the tracking unit in the healthcare zones and patient zones and the movement of the HCW into and out of patient zones; and a central monitoring unit (CMU) having accessible memory, the central monitoring unit having a receiver to receive the indications of dispensing events by the HCW and the location data of the HCW in the healthcare facility over time from the tracking system; the CMU having processing means to: collate the dispensing event data with the location data to determine the location of the HCW when the dispensing event occurred; determine whether or not the HCW was in one of the patient zones at the time of the dispensing event; and classify the dispensing event in accordance with the WHO's guidelines on hand washing moments depending on whether the dispensing event occurred prior to, during, or after the HCW was in a patient zone.

By providing such a system, it will be possible to monitor the 5 moments of hand washing as recommended by the WHO. This is achieved without highly disruptive changes to the existing systems architecture so that it may be implemented relatively seamlessly. If desired, the portable tracking device may be part of the PDU. in one embodiment of the invention there is provided a system in which there is provided a plurality of sensors designating areas within the healthcare facility as wash station zones and there is provided means to monitor the usage of the wash station zones by a HCW. In one embodiment of the invention there is provided a system in which the PDU has an input module to receive input by the user of the PDU relating to the type of handwashing event in accordance with the WHO's guidelines on hand washing moments being carried out, the transmitter being configured to also transmit the type of handwashing event entered by the user of the PDU to the remote CMU.

In one embodiment of the invention there is provided a personal dispenser unit (PDU) for use in a hand hygiene monitoring system, the PDU comprising a fluid reservoir for reception of hand washing compound, a dispensing mechanism for dispensing hand washing compound from the fluid reservoir, a sensor to detect actuation of the dispensing mechanism, a transmitter to transmit an indication of a dispensing event to a remote central monitoring unit (CMU) each time the dispensing mechanism is actuated, and an input module to receive input by the user of the PDU relating to the type of handwashing event in accordance with the WHO's guidelines on hand washing moments being carried out, the transmitter being configured to also transmit the type of handwashing event entered by the user of the PDU to the remote CMU .

This is seen as a particularly advantageous aspect of the present invention. By having a PDU that allows the HCW to indicate the type of hand washing event that they are performing at that moment in time, it will be possible to accurately distinguish between type 2 moments and type 3 moments and it will be possible to differentiate between type 4 moments and type 5 moments. This will be highly advantageous from the point of view that a highly accurate picture of the performance of the HCW will be provided and it will be possible to provide more targeted training or instruction on the strength of that information.

In one embodiment of the invention there is provided a PDU in which the input module comprises a dedicated button. By having a dedicated button, the button could be used to distinguish between a type 2 and a type 3 moment or indeed the button could be depressed several times in sequence depending on the type of moment that is being performed. ln one embodiment of the invention there is provided a PDU in which the input module comprises five dedicated buttons, one for each type of hand washing moment in accordance with the WHO's guidelines on hand washing moments. In one embodiment of the invention there is provided a PDU in which the input module comprises a user interface.

Brief Description of the Drawings: The invention will now be more clearly understood from the following description of some embodiments thereof given by way of example only with reference to the accompanying drawings, in which:-

Figure 1 is a diagrammatic representation of the WHO's five moments of hand washing relating to a patient in a system according to the invention;

Figure 2 is a diagrammatic representation of the system according to the invention; and Figure 3 is a diagrammatic representation of a personal dispenser unit (PDU) according to the invention.

Detailed Description of the Drawings: Referring to Figure 1 , there is shown a system, indicated generally by the reference numeral 100, having a healthcare zone 200 and a patient zone 300 inside the healthcare zone. The healthcare zone is delimited by a plurality of sensors (not shown) and the patient zone is also delimited by a sensor (not shown). For simplicity, only one patient zone in the healthcare zone has been shown however it will be understood that typically there will be several patient zones. Furthermore, for simplicity only one healthcare zone has been shown however there may be several healthcare zones in a healthcare facility being monitored simultaneously. The patient 400 is in the patient zone 300. The five moments of hand washing as recommended by the WHO are illustrated graphically by large arrows 1 to 5 inclusive. The five moments when a health care worker (HCW) should wash their hands are: (1 ) before touching a patient (type 1); (2) before any clean or aseptic procedure (type 2); (3) after body fluid exposure risk (type 3); (4) after touching a patient (type 4); and (5) after touching patient surroundings (type 5). Type 1 , 4 and 5 hand washing procedures (moments) should be performed outside of the patient zone. Type 1 is performed outside the patient zone 300 before entering the patient zone whereas type 4 and 5 hand washing moments should be performed outside the patient zone 300 after leaving the patient zone. Type 2 and type 3 should be performed by the HCW inside the patient zone 300.

Referring to Figure 2, there is shown a diagrammatic representation of the system 100 according to the invention in a healthcare setting. The healthcare zone is illustrated as a patient's room 200 however it will be appreciated that this is not limiting and the healthcare zone could be a multi-patient room, a ward, a department or indeed an entire healthcare facility. Within the healthcare zone there is a patient zone 300. Again , only one patient zone is illustrated in the healthcare zone however there could be several patient zones 300 inside the healthcare zone 200. The healthcare zone 200 has an entrance 500 with a wash station 550 outside the entrance, and a sink area 600 with a wash station 650 inside the healthcare zone. The wash stations 550 and 650 are in this instance anti-bacterial fluid dispensers. Each of the wash stations 550, 650 has a sensor (not shown) capable of detecting the presence of a HCW in the vicinity of the wash station and is capable of determining whether the HCW used the wash station.

The sensor in the wash station could, for example, be capable of detecting an RFID tag worn by the HCW or an RFI D tag or the like formed as part of an antibacterial fluid dispenser worn by the HCW. Alternatively, the sensor could detect the presence of the HCW by reading a barcode, QR code or other code mounted on the HCWs person, such as, but not limited to, on an identity badge worn by the HCW. It will be understood that there are a number of disparate ways in which the sensors in the wash stations could detect the presence of the HCW. A HCW 700 is shown inside the healthcare zone but outside the patient zone. The HCW has on their person a personal dispensing unit (PDU) 750 for dispensing anti-bacterial or like hand wash substance and they carry that PDU on their person throughout their shift. The patient zone 300 comprises a sensor 350 which is operable to detect the presence of a HCW in the patient zone 300. Finally, the system further comprises a central monitoring unit (CMU) (800). The CMU is in communication either directly or indirectly with the sensors in the hand wash stations 550, 650, the sensor 350 in the patient zone 300 and the PDU 750. Each time the HCW operates one of the PDU or the wash stations 550, 650, a notification is transmitted to the CMU that the HCW performed a hand washing exercise.

It will be understood that in this way, the use of a wash station 550 (in addition to or instead of the use of the PDU) can also be included in the evaluation of the HCW performance and the type of dispensing event that they are performing. If desired , the wash station may be provided with a plurality of buttons designating the type (i.e. type 1 , 2, 3, 4 or 5) of moment being performed for receiving an indication by the user of the type of moment being performed.

The position of the HCW in the healthcare facility is tracked over time (using for example a tracking device inside the PDU in association with a plurality of sensors distributed throughout the healthcare facility - tracking systems are described in, for example, EP1982314, the entire disclosure of which is incorporated herein by way of reference) as they move through the healthcare facility and the position data is provided to the CMU . The CMU can thereafter collate the position data with the dispensing data to map where the HCW is when they performed a hand washing exercise. Furthermore, the CMU can determine whether the dispensing occurred inside the patient zone (type 2 or type 3 moment) or outside the patient zone (type 1 , type 4 or type 5 moment) and if the dispensing was outside the patient zone, whether it was before (type 1 moment) or after (type 4 or type 5 moment) the HCW was in the patient zone. The detection of the different moments by the system and method will be further outlined below:

Moment 1 : As a healthcare worker approaches the patient zone, the system determines if the healthcare worker has washed their hands before entering the zone. If the HCW has washed their hands, they are compliant to moment 1 , If they have not they are not compliant to moment , This can be achieved by monitoring the instances of hand washing in conjunction with the location data of the HCW or in another embodiment the HCW could register the hand wash as a moment 1 hand wash via the input device / sensor switch on the PDU (or indeed via an appropriate switch on a wash station).

Moment 2: If the healthcare worker washes their hands using the personal dispenser and registers the hand wash as a moment 2 hand wash via the input device / sensor switch on the PDU, they are credited with a moment 2 hand wash. If this hand wash occurs outside the patient zone the hand wash can also be credited as a moment 1 , 4, or 5 hand wash depending on the protocols of the hospital. In another embodiment, if the healthcare worker washes their hands within the patient zone using the personal dispenser they are automatically credited with a moment 2 hand wash .

Moment 3: If the healthcare worker washes their hands within the patient zone using the personal dispenser they may be credited with a moment 3 hand wash. In another embodiment they could register the hand wash as a moment 3 hand wash via the input device / sensor switch of the PDU.

Moments 4 and 5: As a healthcare worker leaves a patient zone, the system determines if the healthcare worker washes their hands. If they do wash their hands they are compliant with moment 4 and moment 5. If they do not wash their hands they are not compliant with moment 4 and 5. In another embodiment they could register the hand wash as a moment 4 or moment 5 hand wash via the input device / sensor switch of the PDU.

Referring to Figure 3, there is shown a graphical representation of the PDU 750 according to the invention. The PDU comprises a fluid reservoir and a dispensing mechanism for dispensing hand washing compound from the fluid reservoir. The hand washing compound could be could be alcohol gel, alcohol foam, antimicrobial water- based compound or the like. The PDU further comprises a transmitter (not shown) for transmitting an indication of a dispensing event to the CMU. The PDU differs from the previous PDUs in that the PDU has an input device, in this case a button 751 , operable to indicate the type of dispensing event being performed by the HCW. For example, if the HCW is performing a type 2 moment inside the patient zone, they may depress the button twice in quick succession. If the HCW is performing a type 3 moment inside the patient zone, they may depress the button three times in quick succession. The transmitter in the PDU is further operable to transmit this data back to the CMU so that the CMU can store in memory the type of dispensing event that was performed by the HCW.

The input device is provided by a single button however a plurality of buttons could be provided if desired. Indeed , five buttons could be provided, one for each of the five moments. The input device is a button however it could be in a different form such as a switch, a user interface with menu, a touch-activated user interface, a motion sensor, a voice activated sensor or the like. For example, the type of moment being performed could be indicated using an accelerometer and tilt functionality in the sensor. A quick sideways motion prior to dispensing could indicate a type 2 dispensing operation whereas a quick vertical motion could indicate a type 3 moment. Alternatively, the device could be sensitive to impact so that if the side of the PDU is tapped a certain number of times, this could indicate a certain type of dispensing operation being performed. A microphone inside the sensor would allow the user to talk into the microphone to identify the type of event or to tap the microphone a predetermined number of times to indicate the type of event. What is important is that the input device can receive from the HCW an indication of the type of dispensing event being performed. The transmitter is a wireless transmitter and it will be understood that it could be provided by a transceiver and indeed the PDU could be provided with a separate receiver if desired. The transmitter/transceiver will be capable of sending back data to the CMU including a location signal, a dispensing signal, an input device signal and a unique identifier of the PDU. This data can be stored in CMU memory for subsequent analysis.

The system and method according to the invention will monitor the moments and keep a record of the moments for a given HCW. The system and method, by tracking the moments and the position of the HCW over time as well as the type of moments, will be able to evaluate the performance of the HCW and whether they are putting patients at risk by their failure to adhere to one or more of the WHO recommended five moments of hand washing. The system and method can also determine those instances when a HCW should have performed a hand washing operation but failed to do so and this can be provided as feedback to the HCW in due course or, if the PDU has a receiver, as an alert to the HCW. This alert is effectively in real time and can be useful to obviate the likelihood of HAIs.

One aspect of the present invention is the manner in which the system can track the location of the HCW throughout the medical facility. It will be understood that this could be achieved using a wireless network. The wireless network will preferably be a low powered wireless network that will not be power hungry, thereby facilitating the use of standalone units that are battery operated or plugged into low powered communications network cabling. This will reduce the servicing requirement of the network devices. The location of the HCW could be determined by triangulating the signal from a PDU worn by the HCW from two or more other network units including, if desired, measuring the signal strength from one or more units to determine the location of the PDU and by extension the HCW in the medical facility. Other systems to determine the location of the HCW in the facility are readily envisaged and what is important is the ability of the system to detect, with a good degree of accuracy, the location of the HCW at a given moment in time.

Throughout the specification and in the claims, reference is made to first and second predetermined time periods or predetermined periods of time. Typically, these will be of the order of a few seconds, for example, less than 10 or so seconds but could be up to the order of 30 seconds or more if desired. The predetermined periods may be set by the operator of the system and method once it has been determined the time periods that represent best practice. In this specification the terms "comprise, comprises, comprised and comprising" and the terms "include, includes, included and including" are all deemed totally interchangeable and should be afforded the widest possible interpretation.

The invention is in no way limited by the embodiments hereinbefore described but may be varied in both construction and detail within the scope of the claims.