« ZurückWeiter »
HAND WASHING COMPLIANCE
MEASUREMENT AND RECORDING
BACKGROUND OF THE INVENTION 5
This invention relates generally to the field of healthcare, and more particularly to a method and combination for encouraging hand washing and for determining compliance with hand washing requirements in healthcare settings.
Tens of thousands of people die each year from infections 10 they acquire while they were a patient in a hospital. These infections were unrelated to their initial hospital admission. A hospital acquired infection is called a "nosocomial infection."
The CDC (Center for Disease Control & Prevention) in the United States, has reported data that shows that more than 50% of all nosocomial infections can be directly related to the transmission of harmful bacteria by healthcare workers who have not properly washed their hands before and after each patient contact.
The number one reason given for healthcare workers not following proper hand washing guidelines is "not enough time and not enough conveniently located hand washing stations to wash hands as often as required." 25
The problem of insufficient hand washing is becoming worse. Hospitals through staff reductions are requiring healthcare workers to attend to more patients during the healthcare worker's work shift. Additionally, high transmission rates of antibiotic resistant bacteria and viruses require 30 more adherence to the CDC hand washing guidelines. Hospital administrations are searching for products and services that encourage hand washing, and a means to ensure and measure compliance.
The problem of hand washing has been recognized for 35 many years, and various efforts have been made to address it. Obviously, many types of devices and agents have been developed for assisting in the hand washing function. Another aspect of the matter is determining whether or not there has been compliance with hand washing directives. A 40 recent U.S. Pat. No. 6,038,331, issued Mar. 14, 2000, discloses combination and a method for monitoring hand washing. Another is U.S. Pat. No. 5,945,910, issued Aug. 31, 1999 for a method and combination for monitoring and reporting hand washing. Another approach, although not 45 measuring or checking for compliance, is directed to alerting someone of the need to wash their hands. This is addressed in U.S. Pat. No. 4,896,144, issued Jan. 23, 1990 for a hand washing alert. Another patent directed to a method and system for improving hand cleanliness, primarily in a food 50 service environment, is U.S. Pat. No. 5,812,059, issued Sep. 22, 1998. It discloses a method and system for improving hand cleanliness. In this one, an indicator worn by a worker, is activated when the worker leaves a food handling area. The indicator, worn by the worker, is deactivated by a 55 deactivating device associated with a hand cleaning station, and only when it is determined that the worker has used the hand cleaning station before re-entry to the food handling area. The above-mentioned patents are the closest of which I am aware dealing with the matter of monitoring hand 60 washing.
There are some products which have been advertised in connection with monitoring hand washing. A so-called "HACCP" Hand Wash Supervisor, marketed by CFEI at Plas de la Halle, 8910 La Ferte Loupiere, France. Another 65 organization marketing with the brand "HyGenius" advertises "Over 10,000,000 perfect hand washes." Another
monitoring combination is offered by The Clean Hands Company of 10830 Gait Industrial Drive, St. Louis, Mo. 63132. In this system, according to the marketing information, each employee wears an ID badge. A detector at each entrance of a restroom will notify a central computer system when an employee enters, and will wait for the employee to wash their hands before leaving. The employee applies the proper amount of soap, rubs hands together to generate the appropriate lather, and places hands under the camera eye of the instrument in the restroom which, in 5 seconds, will analyze and reveal a "pass" or "fail" reading. An employee can add soap if needed and retest as many times as necessary to pass. Once a "pass" has been achieved, the soap can be rinsed. The "pass/fail" information is fed to a central computer, whereby the employer can determine whether or not an employee is cooperating. Their "web" address is http:H/www.cleanhandsco.com.
The foregoing prior art systems appear to focus on the use of soap, water and sink basins for hand washing. While that is the conventional approach to hand washing, it has been found that, in many circumstances, there is no visually observable evidence of soil on the hands, so they appear clean and not in need of hand washing. In such cases, it may appear that there is no need for hand washing when, in fact, the hands may be seriously contaminated with transient bacteria and/or viruses. Besides, soap and water and a sink are not always conveniently located relative to the treatment site for a patient. In an effort to address this problem, antimicrobial products have been developed and marketed in containers or packages that can be carried by the healthcare worker. These contain an alcohol-based waterless and fast drying gel which can be dispensed on the hands before and after each patient contact, at the patient contact location. But, to my knowledge, there has not been a way to reliably monitor usage of such dispensing containers or packages.
While the foregoing comments have been directed to the hospital environment, it can be understood easily that they apply also to other healthcare institutions of various sizes from clinics, down to doctor's offices, down to kiosks, or temporary set-ups in shopping malls for tasks as simple as shots for influenza or cholesterol screenings. While these latter situations might not currently fall under any regulatory organizations' hand washing protocols or compliance requirements, a much larger area is also envisioned. An example is in the case of dealing with disasters, epidemics or other circumstances in which large outdoor areas are dedicated, at least on a temporary basis, to treatment of patients. For certain types of treatment, it may be just as important that hand washing be done as it is in a hospital setting. Moreover, it may be important to monitor compliance on a real-time basis.
The present invention is directed to addressing the problems heretofore involved in connection with encouragement of hand washing, and monitoring compliance with hand washing directives.
SUMMARY OF THE INVENTION
Described briefly, according to one embodiment of the present invention, portable, individualized, filled hand washing agents dispensers are provided from a control station to healthcare workers. Unique worker identification "tag" (ID#), and unique dispenser identification "tag" (ID#) are stored in computer memory. At patient treatment sites of a healthcare facility, wireless signal transmitters are employed, constantly producing a wireless signal. Each dispenser includes a wireless signal receiver, an agents
dispensing actuator and information storage device. The receiver is responsive to reception of wireless signals to insert into the storage device, an event signal. When the worker dispenses the hand wash agents, it is recorded in the storage device to represent a hand washing event. The dispenser is worn externally on the health care worker during the entire work shift. At the end of the shift, the dispenser is returned to the control station which has means to identify the dispenser and determine the amount and type of agents dispensed during the work shift, and store that information for subsequent tabulation and reporting. The control station also relates the unique identification signature tag of the dispenser to the unique identification tag of the worker and the amount and type of agents used and stores that information, as well as the unique transmitter site, date and time information from the event record in the dispenser storage, thus tracking the time, date and location, of each occasion specified for use of the dispenser and whether or not the worker dispensed agents from the worker's assigned dispenser, during the work shift.
According to another embodiment of the present invention, the hand washing agents dispensers also include a radio transmitter capable of transmitting to a satellite component of a global positioning system. The transmitter transmits, on a real-time basis, information from the dispenser identifying the dispenser, the date and time when a dispensing event takes place, and the global positioning system identifies the location of the dispenser when the transmission is made. That information can be monitored on a real-time basis or stored in a management computer for access and use by management to deal promptly, if desired, with any sensed failure or inadequacy of hand washing events associated with a particular dispenser and, thereby, by the healthcare worker to whom the dispenser has been checked out.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a block diagram of an inventive system according to one embodiment of the present invention.
FIG. 2 is a block diagram of the system according to another embodiment of the present invention.
FIG. 3 is a block diagram of the system according to the embodiment shown in FIG. 2.
DESCRIPTION OF THE ILLUSTRATED
For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.
Referring now to FIG. 1 of the drawing, the dashed outline represents a healthcare facility 11. There is a plurality of hand washing agents dispensers 12 used in that facility. One of them is shown in the large block 12A and the rest are designated in the smaller blocks 12B through 12N. Each of the dispensers has its own individual identifier "tag" different from each of the others. Such tag can be, for example, but without limitation, a human readable numerical or alpha-numerical identifier tag, or a bar code tag on the outside of the dispenser and a corresponding identifier tag
stored in memory in the dispenser. Also, there is a set of wireless signal transmitters 13, designated in blocks 13A through 13N located at various patient diagnosis and treatment sites in the facility. Each of the transmitters 13A 5 through 13N is identical to each of the others except that each produces a wireless signal that is unique and different from the wireless signal produced by each of the others. The wireless nature is represented by the antenna 14 and may be of any of a variety of natures from ultrasonic through radio, "blue tooth" and light frequencies, for example, but infrared is considered the preferred choice at the moment. Electrical supply to the transmitters may be the electrical system of the healthcare facility, with battery back-up in each of the transmitters.
The facility 11 also includes one or more control stations
15 16 depending upon the size of the facility. For purposes of present example, and to facilitate description, only one is shown. It includes computer memory 17, a central processing unit 18, a user input station 19, a check-out station 21, and a check-in station 22.
20 In the dispensers, there is a supply 26 of hand wash agents and operable by a dispenser button 27 to dispense a predetermined amount (one dose) per button actuation and which is discharged from the dispenser 28. Two examples of supply 26 are a carousel of single dose cartridges or a multidose
25 reservoir. There is a wireless signal receiver 31 capable of receiving the wireless signals transmitted by any of the transmitters 13. In addition to dispensing agents from supply 26, the button 27, when pressed, being coupled to the wireless receiver as designated by line 32, enables the
30 wireless signal receiver to receive a signal from any of the transmitters 13. Upon receiving such signal, the wireless signal receiver transmits that information event on line 33 to memory 34 for storage of the date, time and identification of the site from which the transmitter signal was received,
35 based upon the particular identifying signature in the signal from the transmitter. The memory 34 also stores the identification of the dispenser itself. In addition, there may be an identification strip or other indicia 36 on the dispenser itself, if that is preferred over direct identification from the
40 memory 34, for some particular application.
Having described the general organization of components, a method of operation according to the present invention will now be described.
A healthcare worker inputs data at the user input station
45 19. The preferred procedure is for the worker to enter his or her own personal identification information. This can be done by the use of a keyboard or by use of a bar code on an identification badge or some other unique code device worn on or embedded in the person, or by fingerprint. Other types
50 of identifier input may also be used. Once the personal identifier has been entered, the worker may enter the type of hand wash agents to be used in the dispenser to be checked out to the worker. This information is delivered to the processing unit 18, stored in memory 17, and transmitted to
55 the check-out station 21. The dispenser 12A at the delivery point of the check-out station is then filled with the appropriate hand wash agents, its identification is read from the memory 34 and/or from an external identifier 36, transmitted to the processor 18 and to memory 17. The quantity of
60 agents required to fill the dispenser is measured and transmitted to the processor 18 and stored in memory 17 along with the identification of the last prior user of the particular dispenser. In this way, the amount of agents used during a shift by the worker who last used the dispenser, is made of
65 record in memory 17.
As the worker removes the dispenser from the check-out station, the worker immediately attaches the dispenser to
his/her clothing and/or body outside the clothing in plain sight for the duration of the work shift. Attachment can be a variety of ways. Hook or spring clip are a couple of examples. Then the worker begins making rounds.
When the worker arrives at a patient treatment site, hand 5 washing is expected before contact with the patient. To do this, the worker, holding the dispenser in the palm of one hand, places the dispenser in position to dispense a dose of agents as at outlet 28 in FIG. 1, onto the other hand and pushes a button or other dispensing actuator 27 with the 10 dispenser holding hand. This dispenser delivers a pre-set dosage amount of hand wash agents from storage 26 in the dispenser. At the same time, it activates through line 32, the wireless signal receiver 31, which then is enabled to receive a signal from transmitter 13A and which has a character unique to that particular transmitter at that treatment site. 15 The signal receiver 31 transmits information regarding the identification of the treatment site, the date, and time of actuation, along line 33 to memory 34 in the dispenser. That information is stored in memory 34 along with the identification of that particular dispenser which always is stored 20 and available from that memory 34.
Then the healthcare worker moves on to the next patient treatment site. Such treatment sites can be as near as one bed is to another in a hospital room. But it would have its own separate wireless signal transmitter, such as 13B, for 25 example.
Again, the worker is expected to wash hands before contact with the patient at the second treatment site. Upon actuating the dispenser actuator 27, agents is dispensed onto one hand of the worker and the wireless signal receiver is 30 enabled to receive a signal from the transmitter 13B. The receiver then transmits the identification site of transmitter 13B, the date and time to the memory 34 where that information is stored. This procedure continues as the worker makes the rounds of the healthcare facility. 35
At the end of a shift, the worker returns to the control station and delivers the dispenser into a slot at the check-in station 22. Upon reception in the check-in station, a tag reader records the dispenser's unique identification, and the station records the return date and time, and downloads by way of wireless transmission or direct data port connection, 40 that information along with the dispenser's use data collected in dispenser during the worker's work shift, through the data processing unit 18 to memory 17. The dispenser remains in the control station along with other dispensers returned by other workers, to eventually be re-filled with 45 agents and checked out. Although the FIGS. 1 and 3 block diagrams position the check-out station above the check-in station, the check-in station will be physically above the check-out station, so dispensers returned to the slot in the check-in station will be at the top of a stack, and moved 50 downwardly in the stack as other dispensers are checked out at the bottom of the stack. When this particular dispenser has advanced downwardly to the point where it is in position to be checked out and, after the next worker to use it has entered the required information to enable check-out, this 5J dispenser is filled with the designated hand washing agents. During or following the fill, the amount of agents required to fill it, is measured. That information is transmitted to the data processing unit 18, matched with information stored in memory 17 from the prior user, and stored in memory. In this way, a record is made of the amount of hand washing agents 60 dispensed by a healthcare worker who used this dispenser during a prior work shift. At the same time, this particular dispenser is ready for check-out by the next healthcare worker to use it. Alternatively or additionally, downloading of a dispenser's use data during a given prior user worker's 65 work shift can also be executed at the time the dispenser is being re-filled prior to being checked-out for the next user or
the next shift of the prior user. This can be done at the check-out station as indicated in FIGS. 1 and 3 between blocks 18 and 21.
The foregoing sequence of events enables the administration of the healthcare facility to determine the compliance of a healthcare worker with the facility's requirements pertaining to hand washing activity. Of course, the facility administrators can also enter into memory, patient records, compliance procedures and specifications, and have the control station compare a healthcare worker's record with requirements, and produce an output record of worker compliance. If desired, data storage, comparison, charting and the like can be accomplished at some location in or outside the control station or healthcare facility, if desired. It is thought that the preferred arrangement in terms of number and location of control stations, depends upon the size and organization of the healthcare facility for optimum accessibility to workers for check-in and check-out functions at the beginning and end of work shifts. The attaching of the dispenser to the worker in a way that it is clearly and always in sight, and convenient to use, rather than in a pocket, encourages the timely use of it.
One alternate arrangement to further encourage the healthcare worker to wash hands in a timely fashion, is indicated by some dashed lines in the dispenser 12A shown in FIG. 1. According to this method, when the healthcare worker reaches a patient treatment site such as adjacent a hospital bed, for example, the wireless signal receiver responds to the signal transmitter such as 13A and does two things. First of all, it signals the annunciator 41 as indicated along dashed data line 42 and turns it on. This annunciator can be a flashing light or a vibrator or an audible signaler in the dispenser itself. Secondly, the receiver also signals along line 43, the memory 34 to make a record of the date, time and site that the worker entered. Then, upon operation of the dispenser actuator such as 27, it would turn off the annunciator 41 and signal the memory 34 that the dispensing event has occurred. It will be recognized that, in this case, the wireless signal receiver 31 is enabled at all times to receive a signal from any of the transmitters, instead of being turned on only upon activation of the dispenser actuator 27, as in the previously described embodiment. Thus the receiver sets the annunciator to "on," and the dispenser actuator resets it to "off'. However, if the worker fails to use the dispenser actuator 27 in response to annunciation, then the annunciator is terminated by automatic reset within short duration (5-10 seconds, for example) but the fact would still be recorded into memory that a hand washing event was signalled but not executed. Another example of a reset scheme could be that, if the worker fails to use the dispenser at the one site, the annunciator will be automatically and momentarily reset by reception of a wireless signal from the transmitter at the next site visited. Also, as above, the failure of the worker to wash hands at the previous site will be recorded in the dispenser memory. After the momentary reset to "off', the annunciator is set to "on" at the said next site, to alert the user to wash hands.
More often than not, the hand washing agents will be an antimicrobial fluid. But it may be other types and forms of agents. Powders or gels are a couple of examples. They may be dispensed as a stream, mist, cloud or, more likely, a spray. Reports can be generated from the data processing system which will provide the following compliance information:
1) Healthcare worker ID#;
2) Fluid dispenser ID#;
3) Fluid used ID# (type of fluid);
4) Where in location (site) was fluid dispenser used;
5) Time, date fluid dispenser was used at a given location (site);
6) Time, date fluid dispenser was checked-out from control station;
7) Time, date fluid dispenser was returned to control station;
8) Patient contacts during fluid dispenser's use by healthcare worker;
9) Total number of dose applications from fluid dispenser during a given time.
10) Time, date and location sites where hand washing 10 events were signaled for but were not performed.
Hospital administrations will differ in the amount of information they require for compliance reporting relating to healthcare worker hand washing. Some hospitals will only require information regarding: 15
1) How many hand washes a healthcare worker performed during a given work shift; and
2) What fluid dispenser by ID is issued to a healthcare worker at a given time, on a given date.
Some hospitals will issue fluid dispensers to: patients, 20 tech staff, maintenance personnel, administrative personnel, etc., without requirements to measure compliance. In such applications a disposable fluid dispenser would be utilized and the control station will have the primary function of being a delivery device. If a compliance report relating to 25 who used what disposable fluid dispenser on what date/time and how many dose applications were dispensed, then the control stations would record such information. The amount of fluid used would be measured also at the control station by means of weight, optics or electronics, based on the 30 differential readings of the disposable fluid dispenser at the time of delivery to the user and at the time of return upon completion of its use. For a disposable dispenser, the simple procedure would be to weigh the full one before or upon check-out, and weigh it again upon check-in at the check-in 35 station.
It was mentioned above, that hand washing and the importance thereof are not limited to individual healthcare facilities. Occasions arise when delivery of healthcare is inside or outside any temporary or permanent building site 40 and where facilities including sinks, water, and antimicrobial supplies are not readily available. Examples are disasters where many people are injured, or there are mass inoculations to address diseases or anticipated outbreaks of disease. FIG. 2 represents schematically, one possible see- 45 nario for large scale inoculation against or treatment for epidemic disease. In this example, a soccer field 61, is reserved for numerous patient treatment stations 62 at which at least one healthcare provider 63 is stationed for treatment of numerous patients. Even though many sick or persons at 50 risk will be treated in each station, it is important that hands be washed between the event of treatment of one patient and that of another. Also, it is desirable that tracking of hand washing events be maintained and, in this instance, on a real-time basis. 55
To avoid the necessity of a permanent establishment and the time required to set up transmitters at individual stations as has been described in the previously described embodiments, in this instance, a geosynchronous satellite 64 is employed in orbit. This satellite is used as the hub of a 60 global positioning system. As in the previously described embodiment, each of the healthcare workers has an antimicrobial dispenser much like that in the previously described embodiment. In this instance, however, instead of or in addition to the infrared receiver, it has a radio transmitter 65 communicating with the satellite 64 which, upon receipt of a signal from the transmitter as indicated schematically
along the wireless signal line 66, responds with the rather precise geographical location of the station from which the signal has been transmitted. The location identification response may be transmitted from the satellite to a monitoring station as indicated along the wireless signal path 67 from the satellite to the monitoring station 68 where the identification of the dispenser and its location information are received in the monitoring station 68, each time a dispensing event occurs. In that way, persons monitoring the activity can be aware on a real-time basis of the dispensing of hand washing agents at each station. Of course, the information can be stored as well in a computer at the monitoring station 68. Because many satellites are used for a variety of functions, and there are space limitations in them, an alternative arrangement would provide for the dispenser to also have a wireless communication path along line 71 from a cellular or other radio transmitter in the dispenser to a corresponding receiver 72 at the monitoring station 68. Accordingly, reception on a real-time basis, and storage for future use, of information identifying the dispenser, the time, date, and place of use at each hand washing agent dispensing event, is available using the global positioning system for location of the event. It will be recognized that this embodiment of the invention provides a capability of monitoring activity in a fairly large geographical area not confined to a single building or a single set of buildings in one geographical location. The dispenser checkout and check-in procedure is essentially the same as described above for the first embodiment, and information regarding location as transmitted to the dispenser from the satellite, is stored in memory in the dispenser so that, if and as the health care worker moves from station-to-station, that information will be stored in the dispenser itself, as well as being stored in a computer at the administration building 68.
Referring now to FIG. 3, the block diagram there shows in more detail than FIG. 2, the dispenser component and central station component of that embodiment of the invention. Each of the dispensers 65A through 65N is similar in many respects to that shown for the first embodiment of the invention. More specifically, it is provided with a clip or other suitable means for attachment to the outside of the healthcare worker. Also, it has a dispenser button 76 operable when actuated to discharge a dose of hand wash agents from the supply 77 into a hand of the user. It also actuates the global positioning system (GPS) transceiver 78 to query the satellite 64 (FIG. 2) as to its location. It receives the response from the satellite and, translating at either the satellite or more likely in the transceiver unit 78, translates the site location to a wireless transceiver 79 for transmitting that information from antenna 81 directly to antenna 72 at the administration building 68. An alternative possibility, if the satellite has the capability to do so, is that it can transmit the site location information directly on the path 67 to antenna 83 at building 68. Transmission between antennas 81 and 72 can be any of a variety of communication channels, wireless telephone of the cellular or other type being just one possibility. In addition to the site location information determined through GPS, the transceiver 79 also transmits the information regarding date, time and the site identification number to the administration building. The transceiver also provides that information to the memory 84 in the dispenser for subsequent downloading into the check-in station 22 of the control station 16. Thus, it can be seen that the control station 16 may be essentially identical to that in the previously described embodiment, whereas the dispensers are somewhat different to adapt them to the global positioning system environment and real-time