Study: Hand Hygiene Badge Boosts Compliance, Cuts C. Diff Rates

A special badge worn by healthcare workers helped to significantly increase hand hygiene compliance while at the same time decreasing the incidence of Clostridium difficile (C. diff) among residents in a long-term care facility. But perhaps one of the more compelling findings of the pre-print study in the American Journal of Infection Control is that the badge technology, called BioVigil, was also able to measure compliance by non-clinical staff. As investigators with Spaulding Rehabilitation Network note, non-clinical staff is a “group which is often not the focus of direct observation and provides additional support for the use of HH [hand hygiene] technology.”

In fact, the investigators were so pleased with the results that they say that they’re in the process of expanding the badge technology into other healthcare facilities in their network: an inpatient acute rehabilitation facility and a subacute/skilled nursing facility.

After the badge technology was installed, HH compliance increased from 89.82% to 97.10%, but the “before” badge number was most likely much lower due to the Hawthorne effect, and was probably more like 65%, according to the study.

The study was conducted in a 180-bed long-term acute care hospital. Major diagnostic groups in the hospital included “chronic and actively weaning ventilator dependent patients, pre-and post- transplant patients encompassing heart, lung and liver transplants, oncology patients actively receiving treatment such as IV chemotherapy and proton beam radiation.”

The staff in the study included therapists, nurses, doctors, housekeeping, radiology, respiratory therapists, and food service workers.

The badge is activated when a healthcare worker walks under a beacon at the entrance of a patient’s room. A healthcare worker was considered to be compliant with hand hygiene protocols if she used an alcohol-based rub on her hands within 60 seconds of entering the room. If the person didn’t clean their hands, the badge buzzes and lights a reminder at 15, 30, and 45 seconds. And complete non-compliance was noted. Washing hands at sinks was also monitored; the badge showed how long someone stood before a sink; 15 seconds was considered being compliant with hand hygiene protocols.

During the post-badge year, nearly 3.8 million hand hygiene moments occurred (moments in this study being before touching a patient and after touching a patient). The pre-badge period was from June 2016 to May 2018, and the post-badge period was from July 2018 to July 2020. (June 2018 was used to train staff.)

As far as the C. diff rates, the study says that the “results showed a significant reduction in the incidence of C-difficile (p<0.01) as measured by GDH+/Toxin+ test results pre and post implementation…. The incidence rate was measured on a continuous scale. The result of the two-tailed Mann-Whitney U test was significant based on an alpha value of 0.05, U = 117, z = -2.61, p = .009. The mean rank pre- intervention was 16.25 compared to the mean rank post implmentation of 8.75.”

The investigators argue that the badge could be used to measure outcomes beyond hand hygiene compliance, such as economic outcomes: the money that can be saved with proper hand hygiene through such things as a decrease in the length of stay, fewer sick days for employees and a lessening of penalties incurred for readmission before 30 days. It can also be an aid for contact tracing of those infected with coronavirus disease 2019 (COVID-19).

In addition: “The technology allows the tracking of hand hygiene opportunities to employee work schedules, and correlating the exact hours worked by an employee using badge hours,” the study states. “There are a host of human resource implications which arise as HH technology is adopted as a standard of care. At the extreme, there might be disciplinary action for staff who refuse to participate in utilizing the technology or, while wearing the badge show clear evidence of cross contamination. If adopted on a wide scale, there could be broader quality implications with the potential of penalties imposed by payors for episodes of cross contamination.”