Thursday, December 22, 2011

Hand Hygiene Surveillance a la George Orwell- Video Surveillance

It seems like a cannot stray too far from the subject of hand hygiene as of late. Apologies to those that find it boring. Here is a related article published in Clinical Infectious Diseases


The investigators evaluated healthcare worker hand hygiene with the use of remote video surveillance with and without feedback. The study was conducted in an 17-bed intensive care unit from June 2008 through June 2010. 


Cameras were placed with views of every sink and hand sanitizer dispenser to record hand hygiene of healthcare workers. Individual patients were not visualized. Sensors in doorways identified when a healthcare worker entered/exited a patient room.  Trained, remote video auditors utilized for review of the surveillance data.  Hand hygiene was measured during a 16-week period of remote video auditing without feedback and a 91-week period with feedback of data. Performance feedback was continuously displayed on electronic boards mounted within the hallways, and summary reports were delivered to supervisors by electronic mail.
During the 16-week prefeedback period, hand hygiene rates were shockingly less than 10% (3933/60 542) and in the 16-week postfeedback period it was 81.6% (59 627/73 080). The increase was maintained through 75 weeks at 87.9% (262 826/298 860).


Hand hygiene surveillance by video audit works. The process is not cheap and has associated start up (technology) costs, training of video auditors and, likely, ongoing auditor validation for quality assurance. Of course, conservatives and libertarians will bemoan such Orwellian surveillance tactics. However, as video surveillance is not punitive, respects patient privacy (patients are not visualized),  and is done for the sake of patient safety, their argument is flimsy, at best.


Newer technologies for hand hygiene surveillance seem promising. I have blogged about this before.

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