A song on best infection prevention practices

Ron uses his singing talent to teaching others about good infection prevention practices.

Interview with iScrub Lite developer Chris Hlady

iScrub Lite, a free iPhone/iPad app for recording hand hygiene observations, is making a lot of buzz in the infection prevention community since its launch over a year ago. I recently chatted with one of the app’s developers, Chris Hlady, to learn the story behind iScrub Lite.

EP: Could you describe what iScrub Lite does?

CH: iScrub Lite is an iPhone/iPad app for hand hygiene observers to record their observations. Hand hygiene observers are often infection preventionists, they measure hand hygiene compliance by watching healthcare workers (HCWs) go in and out of patient rooms and see if the HCWs are properly washing their hands both before entering and after leaving a patient’s room.

EP: Where did the idea for iScrub come from?

CH: It’s been over 2 years since the original conception, so I may not recall all the details. Basically when Apple first announced the App Store, I felt that it was going to become a very important platform. I began working on a game for the iPhone in order to learn how the platform worked. My advisor, Dr. Phil Polgreen, who is an epidemiologist at the University of Iowa, was very interested in hand hygiene and he gave me the idea for an app for hand hygiene.

We demoed a prototype at the local Iowa APIC conference in 2009 and got positive feedback from the nurses there. That experience encouraged us to move forward with the concept.

EP: What were some key considerations in the design process?

CH: We wanted the app to be simple and very easy to use. We saw that many hospitals were using paper forms to record their observations, and their processes sometimes required multiple forms.

We wanted to create a standard that improves the existing process.

Another goal for iScrub Lite was to cut down the feedback period. We found that in many cases observations were not communicated until weeks or even months later. We wanted to create a tool that lets nurses get results sooner and enables faster communication to HCWs.

EP: How many iScrub users are there?

CH: 3,000 users have downloaded iScrub Lite in the last 6 months.

EP: What kind of feedback have you been getting?

CH: We have been getting a lot of feedback. A lot of people are asking for iScrub Lite for the Blackberry and Android. We also get a lot of inquiries for iScrub Pro.

EP: What’s going to be in the Pro version?

CH: In the Pro version our main goal is to make it easier for nurses to make observations on a large scale. We also want to make reporting easier so that it will enable benchmarking. For example, a hospital can benchmark compliance among units in the same hospital or against other hospitals.

EP: What was the most surprising thing you learned during the making of iScrub Lite?

CH: How many different ways hospitals are doing hand hygiene observation. There are a lot of inconsistencies and disagreements over hand hygiene policies and practices.

Chris Hlady is a graduate student in the Department of Computer Science at the University of Iowa. Fellow graduate students and CompEpi research group members Donald Curtis and Jason Fries are also developers on the iScrub team.

Germ fighting superheros roam New York City streets

The Association of Professionals for Infection Control (APIC) teamed up with Alliance for Consumer Education (ACE) to launch a new hand hygiene education using two superheros. Ace Clean and Iron Man demonstrated proper hand washing techniques in New York City's Times Square on October 1st.

Video link for the superheros is here

Conversations on hand hygiene

I had the opportunity to speak with a number of IPs at APIC. One of the topics that routinely came up was hand hygiene. During the poster session, I spoke with Brenda Grant from Stamford Hospital, who was presenting on the hand hygiene initiative at her hospital. By using a multi-faceted approach that included patient and health worker education and independent monitors, Stamford was able to achieve a higher hand hygiene compliance rate than when compliance was enforced by infection control staff alone. However, a challenge she and many other IPs face is to correlate compliance to reduction in HAIs.

I also had a lively discussion with Paula Ghazarian from Via Christi Hospital-Wichita on a different aspect of the issue. One of Paula's concerns is the definition of "hand hygiene opportunity." It's catchy to say "foam in, foam out," which implies that hand hygiene should be done every time someone enters and exits a patient room. Everyone thought this approach would improve compliance, but healthcare workers who are going from room to room replenishing supplies or delivering meals are challenged to comply with it. For example, healthcare workers who are taking contaminated equipment from the patient's room to the soiled utility room (while still wearing their soiled gloves) point out that they cannot complete hand hygiene until they have dropped off the equipment. As a result, people start to make exceptions - which are logical, but which have the effect of undermining the message.

What's the hand hygiene challenge at your hospital?

Emerging technologies in infection control

Infection Control Today published an article detailing several emerging HAI prevention technologies this week. All were interesting, but a few really stood out to me:

1. HandGiene - This company developed an automated hand hygiene technology that uses RFID, wireless, web-based data collection and reporting software to provide real-time monitoring for handwashing activities of healthcare personnel. Given that many believe that more than 50% of all HAIs could be eliminated by handwashing, HandGiene has great potential to help hospitals reduce HAIs through higher hand hygiene compliance rates.

2. Activeion - Activeion's flagship product, the Ionator, uses a process called "irreversible electroporation" to kill germs and bacteria in tap water. The process does not require the use of chemicals and therefore is very environmentally friendly. The company has a cool video that shows how the process works.

3. Agion - I came across this company a couple of years ago. The company makes disinfectants using silver. One of their products, AgionSilverClene24, provides an attractive alternative to traditional surface disinfectants because it keeps surfaces clean longer and is effective against tougher bugs such as MRSA, VRE, HIV, and Influenza.

Finally, I attended the MIT 100K Business Plan Competition Final last month and this year's second place winner is a company called Novophage. They have engineered a bacteriophage that slows the evolution of antibiotic resistance in bacteria and thereby delays the onset of antibiotic resistance. The bacteriophages could be used in conjunction with traditional antibiotics to improve efficacy.