I recently caught up with Seth Freedman, President of IntelligentM, a med tech startup that has developed a really simple yet powerful system to reduce the rate of hospital-acquired infections. IntelligentM‘s system is relatively inexpensive and easy to deploy, simple to use and provides immediate feedback to hospital administrators and individual staff on how they can improve their process to reduce the incidence of hospital-acquired infections.
As most anyone involved in medical care in an inpatient setting certainly knows, hospital-acquired (or “nosocomial”) infections are a leading cause of morbidity and mortality. The Centers for Disease Control and Prevention (CDC) has been tracking nosocomial infections since 1970, first under the National Nosocomial Infections Surveillance (NNIS) system and then under its successor, the National Healthcare Safety Network (NHSN). According to a study on the CDC website, the total cost of treating all healthcare-associated infections in the United States is $35 to $45 Billion, and up to 70% of those infections are preventable. The most expensive type of infection to treat was Surgical Site Infections (SSIs), costing $34,670 per infection, followed by Central Line-Associated Blood Stream Infections (CLABSIs) at $29,156 per infection, Ventillator-Associated Pneumonias (VAPs) at $28,508 per infection and Clostridium Dificile Infections (CDIs) at $9,124 per infection.
As of October 2008, the Centers for Medicare and Medicaid Services (CMS) does not reimburse hospitals for secondary diagnoses that were not present on admission. This makes it even more imperative for healthcare facilities to aggressively implement policies and procedures to reduce the incidence of nosocomial infection.
A World Health Organization (WHO) report from 2007 lists 15 published studies showing that proper hand antisepsis is an extremely effective measure for reducing hospital-acquired infections, yet it notes that “unacceptably low compliance with hand hygiene is universal in healthcare.” The report concludes that healthcare authorities should “Promote hand hygiene adherence as a health care facility priority; this requires leadership and administrative support and financial resources.” One of the report’s five recommended steps to achieve hand hygiene adherence is “Measurement of hand hygiene compliance through observational monitoring and feedback of performance to health-care workers.”
Up until now, it was very difficult for hospitals to effectively monitor hand hygiene compliance unobtrusively, resulting in skewed data due to the Hawthorne effect. In other words, clinical staff would improve their hand hygiene when they knew they were being monitored, but would revert to their old habits when not being monitored. In the past year several innovative startups have appeared to try to harness mobile technology to solve this problem. Of these, IntelligentM stands out because their system doesn’t require the hospital to replace all of their existing hand sanitizer dispensers with specialized devices. All they need to do is stick a 20 cent RFID label called an RFID SmartTag™(above) onto the existing sanitizer dispensers. IntelligentM‘s system is also the only one that can detect when a clinician is about to perform a task that has high risk of causing infection (such as placing a central line) and actively prompt the clinician to sanitize their hands before starting the procedure.
The IntelligentM system is incredibly simple, and that’s what makes it so effective. When a clinician arrives to start their shift, they take a fully-charged SmartBand™ wrist band from the charger, swipe it across an RFID label on their employee ID and put it on their wrist. The SmartBand is now linked to that employee for the duration of their shift. The SmartBand contains an RFID reader, Bluetooth Low Energy (BLE) transceiver and accelerometer all in one small, unobtrusive package. When the clinician enters a patient room, the wristband senses this by detecting the BLE SmartTag™ affixed to the doorway of the patient room. If the clinician doesn’t sanitize their hands within a specified amount of time (usually 10 seconds but this is customizable), the wrist band starts to vibrate and won’t stop until the clinician actually sanitizes their hands.
How does the SmartBand know if the clinician has sanitized their hands? When the clinician places their hands under the hand sanitizer dispenser, the RFID reader in the SmartBand detects the RFID SmartTag label on the dispenser. However, it doesn’t stop there. The accelerometers in the SmartBand monitor the clinician’s hand-rubbing technique to make sure that they have sanitized thoroughly. When the clinician has sanitized properly, the SmartBand vibrates once to indicate this to the clinician, but if the clinician doesn’t sanitize for long enough, or rub their hands using proper technique, the SmartBand vibrates three times.
As an added protection against the most common and costly types of infection, the IntelligentM system offers RFID SmartTags that can be placed on the packaging of central line kits so that when the clinician picks up the kit the SmartBand detects they are about to place a central line and will vibrate to remind them to sanitize their hands if they haven’t done so recently. RFID SmartTags are cheap and can be placed anywhere or on any item.
When the clinician is done with their shift, they return the SmartBand to the charging station. The SmartBand detects this and uploads all the data it collected during that shift to a central server (either hosted by IntelligentM or managed by the hospital itself). The server produces useful statistics for hospital administrators to detect trouble spots and areas for improvement. It can also email a “hand hygiene report card” to each clinician with advice on how to improve their hand hygiene.
Perhaps the biggest advantage of the IntelligentM system is that it’s incredibly easy to install. As mentioned, you do not need to replace existing sanitizer dispensers, you just peel and stick inexpensive RFID SmartTags to existing dispensers. The BLE SmartTags that are used to detect when the clinician has entered or exited a patient room are simply affixed with an adhesive strip to the doorway, and consume so little power that they can run for two years on two AA batteries. As a result, there is no need for any wiring, drilling or screwing.
Hospital-acquired infections cause 90,000 deaths per year in the United States. They are the fifth-leading cause of death in the United States, after heart disease, cancer, respiratory illness and stroke. However, unlike the top four, there are relatively inexpensive and highly effective interventions that can significantly reduce this number. Of these, improving hand hygiene compliance is one of the cheapest and most effective. Hospitals and healthcare facilities should be evaluating technologies like IntelligentM to take advantage of this relatively low-hanging fruit.
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