More than 100 hospital sites in Canada and abroad are now using HandyAudit®, an electronic tool created by Toronto Rehab-University Health Network (UHN) to provide objective, accurate and consistent hand hygiene measurements.
“There’s been a surge of interest,” says Dr. Geoff Fernie, Institute Director, Research, Toronto Rehab-UHN, who invented the concept jointly with Dr. César Márquez Chin and Michael Tsang just three years ago. “HandyAudit is now used in the majority of academic hospitals in Ontario alone.”
Why the interest in HandyAudit? The electronic tool is designed to improve on the paper-based observation system that many hospitals use. The paper system requires one hand hygiene auditor to simultaneously monitor hand washing practices of several health care workers, and to decide when they have made an error.
HandyAudit saves time and reduces subjectivity. While observing the activities of several care providers at once, auditors simply record actions using a touch screen. Typical actions recorded include touching a patient, handling medications, cleaning wounds or using an alcohol gel hand sanitizer. The software analyzes these actions and automatically calculates hand hygiene compliance rates.
Data collected using HandyAudit provides deep insights into hand hygiene behaviour. “Rather than simply recording the number of errors, HandyAudit captures the sequence of events leading up to any errors,” says Dr. Fernie. “This is information hospitals can use to change behaviours that may be enabling the spread of infections.”
About 8,000 patients die in Canada every year from infections they acquire while in hospital. It’s believed that half of those deaths could be prevented through proper hand hygiene.
To date, HandyAudit has collected data on more than 82,000 health care workers, and recorded over 160,000 indications ― including missed opportunities for hand hygiene.
An exciting development, says Dr. Fernie, is the creation of a community of hand hygiene auditors who are discussing their experiences with HandyAudit and sharing ideas for improving hand hygiene.
Hospitals are using data collected with HandyAudit to compare compliance at different sites in a consistent manner, and to calculate rates for each observer, nursing unit or even for different health-care worker categories.
The same data can be instantly analyzed for compliance with different rules sets, including the World Health Organization’s hand hygiene protocol, making it possible to compare across provinces and internationally.
“This is a powerful tool that allows institutions to be more effective in monitoring how they are doing, in introducing corrective actions when they need to, and targeting educational programs,” says Dr. Fernie.
HandyAudit turns out to be a research tool as well
Toronto Rehab-UHN scientists are using data generated by the device to answer pressing questions, such as what drives health practitioners to wash their hands.
In the U.S., the actions of more than 4,000 health care workers have been monitored with HandyAudit as part of a multi-state study. Researchers want to know if there’s a correlation between the type of mask worn by health workers and transmission of influenza and other respiratory illnesses in hospitals.
“The ability to customize HandyAudit to also record mask behaviour was very useful,” says Jenna Los, Research Program Manager, Department of Hospital Epidemiology and Infection Control, at Johns Hopkins Hospital. “And HandyAudit can do so many calculations in real time, making data collection a lot easier and faster.”
Savings and efficiencies
A key moment in HandyAudit’s development came in 2010 when it was selected by the Council of Academic Hospitals of Ontario (CAHO) for rapid implementation as part of the Adopting Research to Improve Care (ARTIC) program. An evaluation of HandyAudit’s use at 16 CAHO hospitals over a six-month period found “significant administrative efficiencies.” Hospitals using it as their primary auditing tool, and who actively audit, saw significant savings when compared to the previous auditing system.
“With the old paper forms, somebody had to transcribe recorded actions from paper into a database. It was time-consuming and there was always the potential for error,” says Dr. Matthew Muller, Medical Director, Infection Prevention and Control, at St. Michael’s Hospital in Toronto.
“HandyAudit eliminates several steps and gets rid of transcription errors. It helps generate reports in a timely manner,” says Dr. Muller, who helped with HandyAudit’s development.
A Toronto Rehab start-up company, HandyMetrics Corporation, is steadily advancing sales. Because it can calculate rates in other jurisdictions, HandyAudit is attracting wide interest. It has been adopted for research and education at several hospital sites in the U.S. and South America. The software is being translated into French and Italian.
“HandyAudit makes sense on all levels, from improving patient safety and quality of care to reducing costs associated with infection, transcription and analysis,” says Michael Tsang, Managing Director of HandyMetrics, which has seven staff members.
HandyAudit’s development was funded in part through a grant from the Mississauga Halton Infection Control Network and the Ontario Centres of Excellence with support from the Ontario Ministry of Health and Long-Term Care, National Research Council of Canada – Industrial Research Assistance Program, MaRS, and VentureLab.
For more, see www.handyaudit.com
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