WO2009088929A1 - System and method for promoting hand hygiene - Google Patents

System and method for promoting hand hygiene Download PDF

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Publication number
WO2009088929A1
WO2009088929A1 PCT/US2008/088645 US2008088645W WO2009088929A1 WO 2009088929 A1 WO2009088929 A1 WO 2009088929A1 US 2008088645 W US2008088645 W US 2008088645W WO 2009088929 A1 WO2009088929 A1 WO 2009088929A1
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WO
WIPO (PCT)
Prior art keywords
actuator
hand hygiene
interrupt input
output
detected
Prior art date
Application number
PCT/US2008/088645
Other languages
French (fr)
Inventor
Ari Robicsek
Original Assignee
Northshore University Health System Research Institute
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Northshore University Health System Research Institute filed Critical Northshore University Health System Research Institute
Publication of WO2009088929A1 publication Critical patent/WO2009088929A1/en

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Classifications

    • GPHYSICS
    • G08SIGNALLING
    • G08BSIGNALLING OR CALLING SYSTEMS; ORDER TELEGRAPHS; ALARM SYSTEMS
    • G08B21/00Alarms responsive to a single specified undesired or abnormal condition and not otherwise provided for
    • G08B21/18Status alarms
    • G08B21/24Reminder alarms, e.g. anti-loss alarms

Definitions

  • This disclosure is directed to systems and methods for promoting hand hygiene, and, in particular, to systems and methods for promoting hand hygiene in a patient-caregiver setting.
  • any number of infectious substances may exist in the area in and around a patient, for example, in a patient's hospital room. Some of these infectious substances may occur naturally in the patient's room. Some may be introduced by visitors to the patient's room. Some may be introduced into the room by the patient. [0003] For a healthy person, these substances may present no particular problem. The skin, for example, may provide a barrier to infection. Further, the person's immune system may provide a number of defenses to infection. [0004] For a patient, however, these same infectious substances may present life- threatening dangers. For a patient who has experienced an incising wound or who has undergone surgery, the barrier provided by an intact layer of skin may no longer be available.
  • a hand hygiene system includes a dispenser having an actuator, the actuator having an operative state and a inoperative state, a detector associated with the dispenser, the detector having a detection area, a sensor associated with the actuator, the sensor capable of detecting one of the operative state or the inoperative state of the actuator, an interrupt input having an operative state and an inoperative state, and an output display having an active and an inactive state.
  • the system also includes a controller coupled to the detector to detect if a person has entered the detection area, coupled to the sensor to detect if the operative state of the actuator has been detected, coupled to the interrupt input to detect if interrupt input is in the operative state, and coupled to the output display to place the output display in the active state when neither the operative state of the actuator or the operative state of the interrupt input is detected after the person has entered the detection area.
  • a method of promoting hand hygiene includes detecting presence of a person, detecting whether an actuator associated with a dispenser is operated, and detecting whether an interrupt input is operated. The method also includes activating an output after the presence of person is detected when neither operation of the actuator nor operation of the interrupt input is detected.
  • Fig. IA is a front view of a system for promoting hand hygiene
  • Fig. IB is a front view of an alternative system for promoting hand hygiene
  • Fig. 2 is a front view of a dispensing system for use in the system of Fig. i;
  • FIG. 3 is a block diagram of a monitoring and alarm system for use in the system of Fig. 1;
  • Fig. 4 is a schematic diagram of a patient's room and the system of Fig.
  • FIG. 5 is a flow diagram of a method for promoting hand hygiene using the apparatus of Fig. 1;
  • Fig. 6 is a flow diagram of a variant method for promoting hand hygiene using the apparatus of Fig. 1.
  • the system 20 includes a housing 22, in which is disposed a dispenser 30 (Fig. 2) and a monitoring and alarm system 50 (Fig. 3).
  • the dispenser 30 may include a container 32 that is filled with a hand cleanser.
  • the hand cleanser may be an alcohol-based hand rub, although other hand cleansers may be used as well.
  • the dispenser 30 may also include a delivery system 34 that provides access to the hand cleanser in the container 32.
  • the delivery system 34 may include an actuator 36 (illustrated in dashed line in Fig. 2 and in solid in Fig. IA) and a spout 38. By depressing the actuator 36 (into the page, as illustrated in Figs. IA and 2), a metered amount of hand cleanser may be dispensed via the spout 38. The amount may vary according the variations in the distance traveled by the actuator 36, although in other embodiments the amount of hand cleanser dispensed does not vary according to the distance the actuator 36 travels.
  • the monitoring and alarm system 50 may include a controller 52.
  • the controller 52 may be a microcontroller or microprocessor, for example. While a commercial variant of the present disclosure may utilize dedicated circuits, printed circuit boards and the like, it is also possible to design an operational unit using, for example, the BASIC STAMP microcontroller available from Parallax Inc. of Rocklin, California.
  • the controller 52 may include memory, in the form of read-only memory (ROM) and random access memory (RAM).
  • the memory may be integral with the controller 52, or may be maintained separately from the controller 52.
  • the controller 52 may be programmed using any of a variety of programming languages, including machine languages.
  • the monitoring and alarm system 50 may include a plurality of input and output devices coupled to the controller 52.
  • the input devices may include, for example, an actuator sensor 60, an interrupt input 62, and a detector 64.
  • the input devices may also include an "after-hours" detector 66.
  • the output devices may include, for example, an audible output 70 and a visible output 72.
  • the input and output devices 60, 62, 64, 66, 70, 72 may be each coupled separately to the controller 52 as shown.
  • the input and output devices 60, 62, 64, 66, 70, 72 may be coupled, for example, to one or more buses or data links that are coupled to the controller 52.
  • the controller 52 and one or more of the devices 60, 62, 64, 66, 70, 72 may be coupled to a power supply, which may be in the form of a battery or a connection to a wall socket via an AC/DC converter, for example.
  • the actuator sensor 60 may be mounted on the housing 22, may be coupled in some fashion to the actuator 36, and may be used to detect or determine use of the actuator 36.
  • the actuator 36 operates by depression of the actuator (into the page, as illustrated in Fig. IA)
  • the actuator sensor 60 may be a pressure switch, which provides a signal to the controller 52 in response to the actuator 36 abutting against the switch 60.
  • Such a switch 60 may be particularly useful if the desire is to monitor not only use of the dispenser 30, but a particular form of use of the dispenser (e.g., adequate application of feree to the actuator 36 to ensure sufficient hand cleanser is dispensed).
  • the actuator sensor 60 may, in the alternative, be a motion sensor that detects motion of the actuator 36, or motion of a hand past the sensor 60 to activate the actuator, regardless of whether the actuator 36 is depressed a great amount, or only a small amount.
  • the actuator sensor 60 may include a roller switch.
  • the sensor 60 may be integrated with the actuator 36.
  • the signal provided to the controller may simply inform the controller 52 that the actuator 36 has been used; in other embodiments, the signal may provide additional information regarding the use of the actuator. Still other variants will be recognized. [0026] As is illustrated in Fig.
  • the interrupt input 62 may also be mounted on the housing 22, and may be used to provide a signal to the controller 52 that the user wishes to deactivate of the alarm function of the monitoring and alarm system 50. Deactivation of the system 20 is permitted for some persons or classes of people because these people are unlikely to come into contact with the patient during the time they are in the patient's room, and thus requiring these people to clean their hands upon entering each patient's room may be unnecessary and/or excessive.
  • a food service worker who is bringing a tray into a patient's room may not have contact with the patient (unlike other caregivers, such as nurses, doctors or therapists), and, according to the guidelines of the healthcare provider (e.g., hospital administration), not be required to clean their hands upon entering each patient's room.
  • the healthcare provider e.g., hospital administration
  • the interrupt input 62 may disposed on the housing 22 in relatively close proximity to the actuator 36. That is, the interrupt input 62 may be disposed so that it is not so close to the actuator 36 as to risk simultaneous activation of the actuator 36 and the input 62, but close enough that selecting between the input 62 and the actuator 36 would not require a great deal of effort to perform. According to alternative embodiments, it may be sufficient to have the input 62 mounted separate from the housing 22, but in close proximity to the housing 22 and, in particular, the actuator 36 (as is illustrated in Fig. IB).
  • the interrupt input 62 may be disposed on the housing 22 in a highly visible location or manner. As illustrated in Fig. IA, the interrupt input 62 is disposed on the front panel 24 of the housing 22, along with the actuator 36 and the visible output 72.
  • the interrupt input 62 which may be in the form of a button or switch, may also vary in coloration relative to the housing 22: the input 62 may be red while the housing 22 may be white. Further, the input 62 may have symbols (e.g., alphanumeric characters) disposed thereon, by embossing, for example.
  • the detector 64 may also be mounted on the housing 22 as illustrated in Fig.
  • the detector 64 may be used to determine if a person (a visitor or caregiver, for example) is proximate or moves proximate to the housing 22, or is proximate or moves proximate to the patient.
  • the detector 64 may also be disposed separate from the housing 22, while remaining coupled to the controller 52.
  • the detector 64 may be mounted close to a doorway, while the other input and output devices are mounted on or near the housing 22, which may be disposed closer to the patient. While the detector 64 is illustrated below the actuator 36, it will be recognized that the detector 64 may be mounted above or to either side of the actuator 36 as well; the illustrated embodiment of Fig. IB is simply one variant.
  • the detector 64 may be a motion detector, such as a passive infrared (PIR) motion detector.
  • the motion detector 64 may have a certain field beyond which the detector may not detect the movement of a person.
  • a limited field (or range) would permit the detector 64 (and housing 22, in the case of the embodiment of Fig. IA) to be disposed in a part of the room where movement of the visitor or caregiver will cause the initiation of the alarm operation of the system 50, while movement of the visitor, caregiver or patient in the remainder of the room will not cause the initiation of the alarm operation of the system.
  • FIG. 4 illustrates one such embodiment, wherein the housing 22 is mounted so as to position the motion detector 64 proximate to a doorway 80, and the field 82 of the detector 64 only extends to an antechamber 84 adjacent the doorway 80, but not to the remainder 86 of the room 88.
  • an infrared transmitter and receiver may be used in place of a PIR motion detector.
  • the "after-hours" detector 66 may optionally be provided to alter or limit the alarm discussed below. That is, the detector 66 may be a light-intensity detector, and may provide a signal that is utilized by the controller 52 in determining the alarm to be provided. For example, if the detector 66 determines that the room lighting is low, such as may be the case during nighttime hours, then the controller 52 may alter the alarm provided to visual only, as opposed to audible and visual as may be provided during daytime hours. Alternatively, the volume of an audible alarm may be decreased during nighttime hours. In the alternative to a light-intensity detector, the detector 66 may operate according to a radio-frequency signal that may be emitted at certain times of the day to deactivate the systems 20.
  • the audible output 70 which may be a speaker, or other such noisemaking or speech-simulating device, may be mounted in the housing 22, and may be used to provide an audible alarm, warning or reminder to the visitor, caregiver and/or patient.
  • the speaker 70 may be disposed behind a grill 26 on the front panel 24 of the housing, as illustrated in Fig. IA. In this manner, the speaker 70 may operate in the manner intended, while access (and consequential damage) may be limited.
  • the visible output 72 may also be mounted on or in the housing 22, and may be used to provide a visible alarm, warning or reminder to the visitor, caregiver and/or patient. As illustrated in Fig. IA, the visible output 72 is an array of light emitting diodes that may be used to form symbols (e.g., alphanumeric characters) that may be combined into messages, such as the "CLEAN YOUR HANDS" message displayed. Alternatively, any number of other visible output devices may be used. For example, a liquid crystal display (LCD) may be used instead, as may a visible output as simple as a single bulb or light emitting device (LED).
  • LCD liquid crystal display
  • LED light emitting device
  • a message may be disposed on a screen of translucent material (e.g., a piece of opaque plastic) and a light may be disposed behind the screen such that when the screen is illuminated, the message becomes apparent or more apparent to the visitor, caregiver and/or patient.
  • a screen of translucent material e.g., a piece of opaque plastic
  • the visible output 72 may be used to convey other information, in addition to providing a visible alarm, warning or reminder, or to convey the visible alarm, warning or reminder in a different form.
  • information regarding the operation of the dispenser 30 may also be displayed on the visible output 72 (e.g., "PUSH PADDLE TO OPERATE”).
  • information about the importance of hand hygiene may be displayed (e.g., "CLEAN HANDS HELP FIGHT INFECTION").
  • information regarding the interrupt input 62 could be displayed (e.g., "DEPRESS RED BUTTON OR USE DISPENSER TO DEACTIVATE ALARM”).
  • the display could provide the basic alarm, warning or reminder (e.g., "CLEAN YOUR HANDS") in more than one language: in English, Spanish and French, for example.
  • a method 100 of promoting hand hygiene using the system 20 is now discussed relative to Fig. 5.
  • the method 100 is merely one embodiment of a method for using the system 20, and the use of the system 20 is not limited in this regard. Further, the method 100 may be performed using embodiments of the system 20 other than those illustrated, and the method 100 not limited to only those embodiments of the system 20 disclosed herein.
  • the method 100 starts with the detection of a person at block 102.
  • the person may walk through the field 82 of the detector 64 as the person (caregiver, visitor, etc.) enters the patient's room 88.
  • the detector 64 may provide a signal to the controller 52, so that the controller 52 may determine that a person has activated the monitoring and alarm system 50.
  • the method 100 then passes to block 104, wherein a timer is started.
  • the timer may be in form of a timer circuit, or may be a software operation performed by the controller 52.
  • the timer is provided to permit a person passing through the field 82 of the detector 64 a certain amount of time to reach the system 20 after the person has entered the field and activate the actuator 36 or the interrupt input 62 before the alarm operation of the system 50 is activated.
  • the method passes to block 106.
  • the controller 52 determines if the time (measured by the timer set at block 104) has elapsed. If the time has not elapsed, then the method 100 passes to the block 108.
  • the controller 52 monitors the interrupt input 62 to determine if the person who activated the system 50 by passing through the field 82 has used the interrupt input 62. If the interrupt input 62 has been activated, the method 100 may first index a counter at block 110. The method may then stop the timer set at block 104 and start another timer at block 112, which timer may also be in the form of a separate circuit or software operation carried out by the controller 52.
  • the second timer may provide the person who activated the input 62 a sufficient amount of time to clear the field 82 before the system 50 returns the method 100 to block 102.
  • the second timer may provide a sufficient time for the person to perform a limited activity (e.g., place or pickup a food service tray) before the system 50 returns the method 100 to block 102.
  • the timer may be monitored at block 114, with the method returning block 102 once it is determine that the time period (as measured by the second timer) has elapsed.
  • the method 100 proceeds to block 116.
  • the controller 52 determines if the actuator 36 has been used. For example, the controller 52 may monitor the actuator sensor 60 to determine if a signal has been received, indicating use of the actuator 36. If the actuator 36 has been used, then the method 100 may pass to block 112 to permit the person to exit the field 82, and then return to block 102 via block 114. If the actuator 36 has not been used, then the method 100 returns to block 106. [0041] If it is determined that time (measured by the first timer) has elapsed at block 106, then the method 100 passes to block 118.
  • the controller 52 activates the audible and/or visible outputs 70, 72.
  • the controller 52 activates the outputs 70, 72 when the method 100 has determined that neither the interrupt input 62 nor the actuator 36 has been used prior to time elapsing.
  • the controller 52 may activate both outputs 70, 72 simultaneously, or the controller 52 may activate the outputs 70, 72 in sequence.
  • the controller 52 may activate the audible output 70 first to get the attention of the person who activated the system 50, and then activate the visible output 72 to provide the necessary further alarm, warning, reminder, etc.
  • a further embodiment may involve a timer, wherein the controller 52 activates the visible output 72 first and sets the timer, and if the input 62 or the actuator 36 is not used before time elapses, then the controller 52 also activates the audible output 70.
  • the method 100 passes to blocks 108, 116. If the interrupt input 62 (monitored at block 108) or the actuator 36 (monitored at block 114) is activated, then the method proceeds to blocks 110 and/or 112, from thence to block 102 via block 114. If neither the interrupt input 62 nor the actuator 36 is activated, then the method returns to block 106, at which point the determination is made that the time has elapsed, the outputs 70 and/or 72 remain activated, and the method passes back to blocks 108, 116.
  • a further timer may be set once it is determined that the person has not used the interrupt input 62 or the actuator 36 within the allotted time. This timer may reset the system (return the method 100 to block 102) if neither the input 62 nor the actuator 36 is used within a certain time after the alarm operation of the system 50 is activated. Such an optional time may limit "alarm fatigue" from setting in and the caregivers, visitors, patients, etc. from “tuning out” or ignoring the alarm or warning messages.
  • a further variant method 200 for operating a dispenser system is illustrated in Fig. 6. Similar to the method 100, the method 200 involves activation of an output (such as outputs 70, 72) to alert a person to the need for using the hand sanitizer dispenser 30 when neither an actuator sensor (such as sensor 60) nor an interrupt input (such as input 62) has been activated. Additionally, as mentioned as an option in regard to the method 100 above, the method 200 provides that separate time periods may be established, wherein a different output 70, 72 or combination of outputs 70, 72 is activated in each of the time periods. While two such time periods are illustrated, it will be recognized that additional time periods may be possible. For that matter, it is also possible to vary the operation of a single output 70, 72 during each of the time periods, to alert the person in different fashions during different time periods. Such a method 200 may be carried out by the controller 52, for example.
  • the method 200 begins with the determination by the controller 52 that a detector (such as the detector 64) has been activated at block 202.
  • a detector such as the detector 64
  • a counter may be indexed in accordance with the triggering of the detector 64. This counter may be used in comparisons with other counters maintained to determine the number of activations of the actuator 36 of the hand sanitizer dispenser 30 and the number of activations of the interrupt input 62, as discussed below.
  • the method 200 then passes to a block 206, wherein it is determined whether a first period of time has elapsed. If the first period of time has not elapsed, then the method 200 proceeds to blocks 208, 210, 212, and 214. [0047] At block 208, an output is activated. According to an exemplary embodiment of the method 200, the output activated at block 208 is the visible output 72, in the form of a light emitting diode, for example. The visible output 72 may even be toggled on and off during subsequent iterations of block 208.
  • the method 200 may poll the actuator sensor 60 or the interrupt input 62 to determine if the actuator sensor 60 or the interrupt input 62 has been activated at block 210. The method 200 may then determine at blocks 212, 214 whether the actuator sensor 60 or the interrupt input 62 has been activated based on the actions of block 210. It will be recognized that while these actions have been represented as separate blocks 210, 212, 214 in the flowchart of Fig. 6, it is possible for these actions (the polling and determination actions) to be combined. [0049] If it is determined at either block 212 or 214 that either the actuator sensor 60 or the interrupt input 62 has been activated, then the method 200 may branch to a separate set of similar actions.
  • a counter is indexed at block 216, the output 72 is deactivated at block 218, and a timer is activated at block 220 to pause the operation of the system 20 for a period of time to permit the person to pass through the field of the detector 64.
  • a counter is indexed at block 222, the output 72 is deactivated at block 224, and a timer is activated at block 226.
  • the method 200 proceeds to block 230.
  • the controller 52 determines at block 230 if a second time period has elapsed, and if not, the method 200 continues to a block 232.
  • a different output or combination of outputs is activated to alert the user to the fact that a first time period has elapsed.
  • the controller 52 may vary the operation of the output 72 activated at block 208.
  • the controller 52 may varying period of the toggling of the visible output 72 at block 232, as well as activating an audible output 70.
  • the audible output 70 may be toggled on and off as well, or may be maintained at a steady tone or tones or at a variable tone or tones, for example.
  • the controller 52 may index a counter to keep track of the fact that the first time period has elapsed without an activation of the actuator sensor 60 or the interrupt input 62.
  • the method 200 is similar to that illustrated in the preceding stage: the actuator sensor 60 and interrupt inputs 62 are monitored at block 234, determinations are made at blocks 236, 238 if either the sensor 60 or the input 62 is operative, with indexing of counters, deactivation of outputs 70, 72, and activation of timers following in blocks 240, 242, 244, 246, 248, 250.
  • the method 200 may return to monitoring of the detector 64 after the system pause. Additionally, if the controller 52 determines that the first and second time periods have elapsed with neither the sensor 60 nor the input 62 having been activated, then the method 200 may also deactivate the outputs 70, 72, and return to monitoring of the detector 64. [0055]
  • the system 20 and methods 100, 200 may provide a number of advantages, all of which need not be realized in a single embodiment to obtain the benefit of the subject matter disclosed herein. For example, the system 20 may provide an interrupt input to permit persons not coming in contact with the patient to limit the number of times the alarm is sounded.
  • the interrupt input may be disposed sufficiently close to the actuator to make the decision to make utilization of the dispenser no more complex than activation of the interrupt input. Further, a count may be maintained of the use of the interrupt input to determine if the interrupt input is being used excessively relative to a particular unit time. Moreover, these counts may be compared on a locational-basis to determine relative statistics for rooms in different wards, for example. Further, where a count is maintained of the times that the detector is activated, this count may be compared with the counts for the operation of the actuator and the counts for the operation of the interrupt input to determine if the system is being disregarded in whole or in part.

Abstract

A hand hygiene system includes a dispenser having an actuator with operative and inoperative states, a detector associated with the dispenser and having a detection area, a sensor associated with the actuator and capable of detecting operative and inoperative states of the actuator, an interrupt input having operative and inoperative states, and an output display having active and inactive states. The system also includes a controller coupled to the detector to detect if a person has entered the detection area, to the sensor to detect if the operative state of the actuator has been detected, to the interrupt input to detect if interrupt input is in the operative state, and to the output display to place the output display in the active state when neither the operative state of the actuator or the operative state of the interrupt input is detected after the person has entered the detection area.

Description

SYSTEM AND METHOD FOR PROMOTING HAND HYGIENE
Background
[0001] This disclosure is directed to systems and methods for promoting hand hygiene, and, in particular, to systems and methods for promoting hand hygiene in a patient-caregiver setting.
[0002] Any number of infectious substances may exist in the area in and around a patient, for example, in a patient's hospital room. Some of these infectious substances may occur naturally in the patient's room. Some may be introduced by visitors to the patient's room. Some may be introduced into the room by the patient. [0003] For a healthy person, these substances may present no particular problem. The skin, for example, may provide a barrier to infection. Further, the person's immune system may provide a number of defenses to infection. [0004] For a patient, however, these same infectious substances may present life- threatening dangers. For a patient who has experienced an incising wound or who has undergone surgery, the barrier provided by an intact layer of skin may no longer be available. Other patients may have damaged or suppressed immune responses, either because of a particular disease or a particular mode of treatment. Moreover, the patient may find it more difficult to deal with an infection when the patient's health is already compromised by other factors, such as injury or illness. [0005] One simple response to the dangers of infection is good hand hygiene. It was recognized nearly three hundred years ago that by cleansing one's hands before contacting a patient, the patient's risk for certain infections may be greatly reduced. For example, the caregiver or visitor may wash his or her hands with soap and warm water. Alternatively, the caregiver or visitor may use a hand cleanser instead of soap and water. For example, the caregiver or visitor may use an alcohol-based hand rub (ABHD).
[0006] While the importance of hand hygiene has been recognized, it is not always possible to achieve the kind of compliance with hand hygiene practices that one would like. The reasons as to why compliance may not reach desired levels are numerous and varied. The form of hand hygiene offered (soap and water, for example) may discourage compliance in that the equipment may not be easily accessible to the caregiver or visitor when dealing with the patient, or may be viewed as too harsh on the skin if repeated frequently. In the case of visitors, the person may lack a proper understanding of the importance of good hand hygiene, or the hand hygiene method provided. Human nature being what it is, the caregiver or visitor may simply forget to use good hand hygiene, or any hand hygiene at all. [0007] As a consequence, a number of different systems and methods have been devised to encourage, assist, and even document hand hygiene practices. Some of these systems provide an alarm that is activated if the user does not operate the system at all, or operates the system improperly. The representation is made by the proponents of such systems that the alarm will assist in modifying hand hygiene practices, and turn bad behavior into good behavior.
[0008] Unfortunately, human nature and design features may combine to overcome the intended effect of these systems. If the system is not sufficiently selective in activating the alarm, then people may fail to respond, or "tune out," the alarm. For example, if the alarm can be activated when a caregiver would not be required to practice hand hygiene, this may be a problem. Also, if the alarm may be activated even if the caregiver does practice hand hygiene, this may be a problem. Moreover, if the system provides an override to deactivate the alarm, the caregiver may deactivate the alarm instead of practicing good hand hygiene.
Summary
[0009] According to an aspect of the present disclosure, a hand hygiene system includes a dispenser having an actuator, the actuator having an operative state and a inoperative state, a detector associated with the dispenser, the detector having a detection area, a sensor associated with the actuator, the sensor capable of detecting one of the operative state or the inoperative state of the actuator, an interrupt input having an operative state and an inoperative state, and an output display having an active and an inactive state. The system also includes a controller coupled to the detector to detect if a person has entered the detection area, coupled to the sensor to detect if the operative state of the actuator has been detected, coupled to the interrupt input to detect if interrupt input is in the operative state, and coupled to the output display to place the output display in the active state when neither the operative state of the actuator or the operative state of the interrupt input is detected after the person has entered the detection area. [0010] According to another aspect of the present disclosure, a method of promoting hand hygiene includes detecting presence of a person, detecting whether an actuator associated with a dispenser is operated, and detecting whether an interrupt input is operated. The method also includes activating an output after the presence of person is detected when neither operation of the actuator nor operation of the interrupt input is detected.
Brief Description of the Drawings
[0011] Fig. IA is a front view of a system for promoting hand hygiene; [0012] Fig. IB is a front view of an alternative system for promoting hand hygiene; [0013] Fig. 2 is a front view of a dispensing system for use in the system of Fig. i;
[0014] Fig. 3 is a block diagram of a monitoring and alarm system for use in the system of Fig. 1;
[0015] Fig. 4 is a schematic diagram of a patient's room and the system of Fig.
IA disposed in the room;
[0016] Fig. 5 is a flow diagram of a method for promoting hand hygiene using the apparatus of Fig. 1;
[0017] Fig. 6 is a flow diagram of a variant method for promoting hand hygiene using the apparatus of Fig. 1.
Detailed Description of Various Embodiments
[0018] Although the following text sets forth a detailed description of different embodiments of the invention, it should be understood that the legal scope of the invention is defined by the words of the claims set forth at the end of this patent. The detailed description is to be construed as exemplary only and does not describe every possible embodiment of the invention since describing every possible embodiment would be impractical, if not impossible. Numerous alternative embodiments could be implemented, using either current technology or technology developed after the filing date of this patent, which would still fall within the scope of the claims defining the invention.
[0019] It should also be understood that, unless a term is expressly defined in this patent using the sentence "As used herein, the term ' ' is hereby defined to mean..." or a similar sentence, there is no intent to limit the meaning of that term, either expressly or by implication, beyond its plain or ordinary meaning, and such term should not be interpreted to be limited in scope based on any statement made in any section of this patent (other than the language of the claims). To the extent that any term recited in the claims at the end of this patent is referred to in this patent in a manner consistent with a single meaning, that is done for sake of clarity only so as to not confuse the reader, and it is not intended that such claim term be limited, by implication or otherwise, to that single meaning. Finally, unless a claim element is defined by reciting the word "means" and a function without the recital of any structure, it is not intended that the scope of any claim element be interpreted based on the application of 35 U.S. C. §112, sixth paragraph.
[0020] Referring first to Fig. IA, a system 20 for promoting hand hygiene is illustrated. The system 20 includes a housing 22, in which is disposed a dispenser 30 (Fig. 2) and a monitoring and alarm system 50 (Fig. 3).
[0021] As illustrated in Fig. 2, the dispenser 30 may include a container 32 that is filled with a hand cleanser. For example, the hand cleanser may be an alcohol-based hand rub, although other hand cleansers may be used as well. The dispenser 30 may also include a delivery system 34 that provides access to the hand cleanser in the container 32. According to certain embodiments, the delivery system 34 may include an actuator 36 (illustrated in dashed line in Fig. 2 and in solid in Fig. IA) and a spout 38. By depressing the actuator 36 (into the page, as illustrated in Figs. IA and 2), a metered amount of hand cleanser may be dispensed via the spout 38. The amount may vary according the variations in the distance traveled by the actuator 36, although in other embodiments the amount of hand cleanser dispensed does not vary according to the distance the actuator 36 travels.
[0022] As illustrated in Fig. 3, the monitoring and alarm system 50 may include a controller 52. The controller 52 may be a microcontroller or microprocessor, for example. While a commercial variant of the present disclosure may utilize dedicated circuits, printed circuit boards and the like, it is also possible to design an operational unit using, for example, the BASIC STAMP microcontroller available from Parallax Inc. of Rocklin, California. The controller 52 may include memory, in the form of read-only memory (ROM) and random access memory (RAM). The memory may be integral with the controller 52, or may be maintained separately from the controller 52. The controller 52 may be programmed using any of a variety of programming languages, including machine languages.
[0023] As is also illustrated in Fig. 3, the monitoring and alarm system 50 may include a plurality of input and output devices coupled to the controller 52. The input devices may include, for example, an actuator sensor 60, an interrupt input 62, and a detector 64. Optionally, the input devices may also include an "after-hours" detector 66. Similarly, the output devices may include, for example, an audible output 70 and a visible output 72. The input and output devices 60, 62, 64, 66, 70, 72 may be each coupled separately to the controller 52 as shown. Alternatively, the input and output devices 60, 62, 64, 66, 70, 72 may be coupled, for example, to one or more buses or data links that are coupled to the controller 52. It will also be recognized, that while not illustrated, the controller 52 and one or more of the devices 60, 62, 64, 66, 70, 72 may be coupled to a power supply, which may be in the form of a battery or a connection to a wall socket via an AC/DC converter, for example. [0024] In regard to the input devices, the actuator sensor 60 may be mounted on the housing 22, may be coupled in some fashion to the actuator 36, and may be used to detect or determine use of the actuator 36. For example, if the actuator 36 operates by depression of the actuator (into the page, as illustrated in Fig. IA), the actuator sensor 60 may be a pressure switch, which provides a signal to the controller 52 in response to the actuator 36 abutting against the switch 60. Such a switch 60 may be particularly useful if the desire is to monitor not only use of the dispenser 30, but a particular form of use of the dispenser (e.g., adequate application of feree to the actuator 36 to ensure sufficient hand cleanser is dispensed).
[0025] Variation is possible relative to the sensor 60. For example, the actuator sensor 60 may, in the alternative, be a motion sensor that detects motion of the actuator 36, or motion of a hand past the sensor 60 to activate the actuator, regardless of whether the actuator 36 is depressed a great amount, or only a small amount. Alternatively, the actuator sensor 60 may include a roller switch. According to other embodiments, the sensor 60 may be integrated with the actuator 36. According to certain embodiments, the signal provided to the controller may simply inform the controller 52 that the actuator 36 has been used; in other embodiments, the signal may provide additional information regarding the use of the actuator. Still other variants will be recognized. [0026] As is illustrated in Fig. IA, the interrupt input 62 may also be mounted on the housing 22, and may be used to provide a signal to the controller 52 that the user wishes to deactivate of the alarm function of the monitoring and alarm system 50. Deactivation of the system 20 is permitted for some persons or classes of people because these people are unlikely to come into contact with the patient during the time they are in the patient's room, and thus requiring these people to clean their hands upon entering each patient's room may be unnecessary and/or excessive. For example, a food service worker who is bringing a tray into a patient's room may not have contact with the patient (unlike other caregivers, such as nurses, doctors or therapists), and, according to the guidelines of the healthcare provider (e.g., hospital administration), not be required to clean their hands upon entering each patient's room.
[0027] As is illustrated in Fig. IA, the interrupt input 62 may disposed on the housing 22 in relatively close proximity to the actuator 36. That is, the interrupt input 62 may be disposed so that it is not so close to the actuator 36 as to risk simultaneous activation of the actuator 36 and the input 62, but close enough that selecting between the input 62 and the actuator 36 would not require a great deal of effort to perform. According to alternative embodiments, it may be sufficient to have the input 62 mounted separate from the housing 22, but in close proximity to the housing 22 and, in particular, the actuator 36 (as is illustrated in Fig. IB).
[0028] The interrupt input 62 may be disposed on the housing 22 in a highly visible location or manner. As illustrated in Fig. IA, the interrupt input 62 is disposed on the front panel 24 of the housing 22, along with the actuator 36 and the visible output 72. The interrupt input 62, which may be in the form of a button or switch, may also vary in coloration relative to the housing 22: the input 62 may be red while the housing 22 may be white. Further, the input 62 may have symbols (e.g., alphanumeric characters) disposed thereon, by embossing, for example. [0029] The detector 64 may also be mounted on the housing 22 as illustrated in Fig. IA, and may be used to determine if a person (a visitor or caregiver, for example) is proximate or moves proximate to the housing 22, or is proximate or moves proximate to the patient. As shown in Fig. IB, the detector 64 may also be disposed separate from the housing 22, while remaining coupled to the controller 52. For example, the detector 64 may be mounted close to a doorway, while the other input and output devices are mounted on or near the housing 22, which may be disposed closer to the patient. While the detector 64 is illustrated below the actuator 36, it will be recognized that the detector 64 may be mounted above or to either side of the actuator 36 as well; the illustrated embodiment of Fig. IB is simply one variant. [0030] In certain embodiments, the detector 64 may be a motion detector, such as a passive infrared (PIR) motion detector. The motion detector 64 may have a certain field beyond which the detector may not detect the movement of a person. A limited field (or range) would permit the detector 64 (and housing 22, in the case of the embodiment of Fig. IA) to be disposed in a part of the room where movement of the visitor or caregiver will cause the initiation of the alarm operation of the system 50, while movement of the visitor, caregiver or patient in the remainder of the room will not cause the initiation of the alarm operation of the system. Fig. 4 illustrates one such embodiment, wherein the housing 22 is mounted so as to position the motion detector 64 proximate to a doorway 80, and the field 82 of the detector 64 only extends to an antechamber 84 adjacent the doorway 80, but not to the remainder 86 of the room 88. As an alternative, an infrared transmitter and receiver may be used in place of a PIR motion detector.
[0031] The "after-hours" detector 66 may optionally be provided to alter or limit the alarm discussed below. That is, the detector 66 may be a light-intensity detector, and may provide a signal that is utilized by the controller 52 in determining the alarm to be provided. For example, if the detector 66 determines that the room lighting is low, such as may be the case during nighttime hours, then the controller 52 may alter the alarm provided to visual only, as opposed to audible and visual as may be provided during daytime hours. Alternatively, the volume of an audible alarm may be decreased during nighttime hours. In the alternative to a light-intensity detector, the detector 66 may operate according to a radio-frequency signal that may be emitted at certain times of the day to deactivate the systems 20.
[0032] In regard to the output devices, the audible output 70, which may be a speaker, or other such noisemaking or speech-simulating device, may be mounted in the housing 22, and may be used to provide an audible alarm, warning or reminder to the visitor, caregiver and/or patient. For example, the speaker 70 may be disposed behind a grill 26 on the front panel 24 of the housing, as illustrated in Fig. IA. In this manner, the speaker 70 may operate in the manner intended, while access (and consequential damage) may be limited.
[0033] The visible output 72 may also be mounted on or in the housing 22, and may be used to provide a visible alarm, warning or reminder to the visitor, caregiver and/or patient. As illustrated in Fig. IA, the visible output 72 is an array of light emitting diodes that may be used to form symbols (e.g., alphanumeric characters) that may be combined into messages, such as the "CLEAN YOUR HANDS" message displayed. Alternatively, any number of other visible output devices may be used. For example, a liquid crystal display (LCD) may be used instead, as may a visible output as simple as a single bulb or light emitting device (LED). As another alternative, a message may be disposed on a screen of translucent material (e.g., a piece of opaque plastic) and a light may be disposed behind the screen such that when the screen is illuminated, the message becomes apparent or more apparent to the visitor, caregiver and/or patient.
[0034] Dependent upon the visible output 72 used, the visible output 72 may be used to convey other information, in addition to providing a visible alarm, warning or reminder, or to convey the visible alarm, warning or reminder in a different form. As one such example, after displaying the alarm, warning or reminder (e.g., "CLEAN YOUR HANDS," as shown), information regarding the operation of the dispenser 30 may also be displayed on the visible output 72 (e.g., "PUSH PADDLE TO OPERATE"). Alternatively, information about the importance of hand hygiene may be displayed (e.g., "CLEAN HANDS HELP FIGHT INFECTION"). As a further alternative, information regarding the interrupt input 62 could be displayed (e.g., "DEPRESS RED BUTTON OR USE DISPENSER TO DEACTIVATE ALARM"). As a still further alternative, the display could provide the basic alarm, warning or reminder (e.g., "CLEAN YOUR HANDS") in more than one language: in English, Spanish and French, for example.
[0035] Having thus described the system 20 in detail relative to the embodiments shown, a method 100 of promoting hand hygiene using the system 20 is now discussed relative to Fig. 5. The method 100 is merely one embodiment of a method for using the system 20, and the use of the system 20 is not limited in this regard. Further, the method 100 may be performed using embodiments of the system 20 other than those illustrated, and the method 100 not limited to only those embodiments of the system 20 disclosed herein.
[0036] The method 100 starts with the detection of a person at block 102. In particular, the person may walk through the field 82 of the detector 64 as the person (caregiver, visitor, etc.) enters the patient's room 88. In response, the detector 64 may provide a signal to the controller 52, so that the controller 52 may determine that a person has activated the monitoring and alarm system 50.
[0037] The method 100 then passes to block 104, wherein a timer is started. The timer may be in form of a timer circuit, or may be a software operation performed by the controller 52. The timer is provided to permit a person passing through the field 82 of the detector 64 a certain amount of time to reach the system 20 after the person has entered the field and activate the actuator 36 or the interrupt input 62 before the alarm operation of the system 50 is activated.
[0038] After the timer is activated, the method passes to block 106. At block 106, the controller 52 determines if the time (measured by the timer set at block 104) has elapsed. If the time has not elapsed, then the method 100 passes to the block 108. [0039] At block 108, the controller 52 monitors the interrupt input 62 to determine if the person who activated the system 50 by passing through the field 82 has used the interrupt input 62. If the interrupt input 62 has been activated, the method 100 may first index a counter at block 110. The method may then stop the timer set at block 104 and start another timer at block 112, which timer may also be in the form of a separate circuit or software operation carried out by the controller 52. The second timer may provide the person who activated the input 62 a sufficient amount of time to clear the field 82 before the system 50 returns the method 100 to block 102. Alternatively, the second timer may provide a sufficient time for the person to perform a limited activity (e.g., place or pickup a food service tray) before the system 50 returns the method 100 to block 102. The timer may be monitored at block 114, with the method returning block 102 once it is determine that the time period (as measured by the second timer) has elapsed.
[0040] Alternatively, if the interrupt input 62 has not been activated, then the method 100 proceeds to block 116. At block 116, the controller 52 determines if the actuator 36 has been used. For example, the controller 52 may monitor the actuator sensor 60 to determine if a signal has been received, indicating use of the actuator 36. If the actuator 36 has been used, then the method 100 may pass to block 112 to permit the person to exit the field 82, and then return to block 102 via block 114. If the actuator 36 has not been used, then the method 100 returns to block 106. [0041] If it is determined that time (measured by the first timer) has elapsed at block 106, then the method 100 passes to block 118. At block 118, the controller 52 activates the audible and/or visible outputs 70, 72. The controller 52 activates the outputs 70, 72 when the method 100 has determined that neither the interrupt input 62 nor the actuator 36 has been used prior to time elapsing. The controller 52 may activate both outputs 70, 72 simultaneously, or the controller 52 may activate the outputs 70, 72 in sequence. For example, the controller 52 may activate the audible output 70 first to get the attention of the person who activated the system 50, and then activate the visible output 72 to provide the necessary further alarm, warning, reminder, etc. A further embodiment may involve a timer, wherein the controller 52 activates the visible output 72 first and sets the timer, and if the input 62 or the actuator 36 is not used before time elapses, then the controller 52 also activates the audible output 70.
[0042] From the block 118, the method 100 passes to blocks 108, 116. If the interrupt input 62 (monitored at block 108) or the actuator 36 (monitored at block 114) is activated, then the method proceeds to blocks 110 and/or 112, from thence to block 102 via block 114. If neither the interrupt input 62 nor the actuator 36 is activated, then the method returns to block 106, at which point the determination is made that the time has elapsed, the outputs 70 and/or 72 remain activated, and the method passes back to blocks 108, 116.
[0043] As a further alternative to the embodiment of the method 100 illustrated in Fig. 5, a further timer may be set once it is determined that the person has not used the interrupt input 62 or the actuator 36 within the allotted time. This timer may reset the system (return the method 100 to block 102) if neither the input 62 nor the actuator 36 is used within a certain time after the alarm operation of the system 50 is activated. Such an optional time may limit "alarm fatigue" from setting in and the caregivers, visitors, patients, etc. from "tuning out" or ignoring the alarm or warning messages.
[0044] A further variant method 200 for operating a dispenser system, such as the system 20 illustrated in Figs. 1-3, is illustrated in Fig. 6. Similar to the method 100, the method 200 involves activation of an output (such as outputs 70, 72) to alert a person to the need for using the hand sanitizer dispenser 30 when neither an actuator sensor (such as sensor 60) nor an interrupt input (such as input 62) has been activated. Additionally, as mentioned as an option in regard to the method 100 above, the method 200 provides that separate time periods may be established, wherein a different output 70, 72 or combination of outputs 70, 72 is activated in each of the time periods. While two such time periods are illustrated, it will be recognized that additional time periods may be possible. For that matter, it is also possible to vary the operation of a single output 70, 72 during each of the time periods, to alert the person in different fashions during different time periods. Such a method 200 may be carried out by the controller 52, for example.
[0045] As was the case with the flowchart used to illustrate the method 100, the method 200 begins with the determination by the controller 52 that a detector (such as the detector 64) has been activated at block 202. At block 204, a counter may be indexed in accordance with the triggering of the detector 64. This counter may be used in comparisons with other counters maintained to determine the number of activations of the actuator 36 of the hand sanitizer dispenser 30 and the number of activations of the interrupt input 62, as discussed below.
[0046] The method 200 then passes to a block 206, wherein it is determined whether a first period of time has elapsed. If the first period of time has not elapsed, then the method 200 proceeds to blocks 208, 210, 212, and 214. [0047] At block 208, an output is activated. According to an exemplary embodiment of the method 200, the output activated at block 208 is the visible output 72, in the form of a light emitting diode, for example. The visible output 72 may even be toggled on and off during subsequent iterations of block 208. [0048] After activating the output 72, the method 200 may poll the actuator sensor 60 or the interrupt input 62 to determine if the actuator sensor 60 or the interrupt input 62 has been activated at block 210. The method 200 may then determine at blocks 212, 214 whether the actuator sensor 60 or the interrupt input 62 has been activated based on the actions of block 210. It will be recognized that while these actions have been represented as separate blocks 210, 212, 214 in the flowchart of Fig. 6, it is possible for these actions (the polling and determination actions) to be combined. [0049] If it is determined at either block 212 or 214 that either the actuator sensor 60 or the interrupt input 62 has been activated, then the method 200 may branch to a separate set of similar actions. For example, if it is determined at block 212 that the actuator sensor 60 has been activated, a counter is indexed at block 216, the output 72 is deactivated at block 218, and a timer is activated at block 220 to pause the operation of the system 20 for a period of time to permit the person to pass through the field of the detector 64. In a similar fashion, if it is determined at block 214 that the interrupt input 62 has been activated, a counter is indexed at block 222, the output 72 is deactivated at block 224, and a timer is activated at block 226. [0050] Assuming that the controller 52 does not determine that the actuator sensor 60 or the interrupt input 62 has been activated before it determines that the first time period has elapsed at block 206, the method 200 proceeds to block 230. The controller 52 determines at block 230 if a second time period has elapsed, and if not, the method 200 continues to a block 232.
[0051] At block 232, a different output or combination of outputs is activated to alert the user to the fact that a first time period has elapsed. For example, the controller 52 may vary the operation of the output 72 activated at block 208. According to an exemplary embodiment, the controller 52 may varying period of the toggling of the visible output 72 at block 232, as well as activating an audible output 70. The audible output 70 may be toggled on and off as well, or may be maintained at a steady tone or tones or at a variable tone or tones, for example. [0052] Optionally, at the same time, or before or after block 232, the controller 52 may index a counter to keep track of the fact that the first time period has elapsed without an activation of the actuator sensor 60 or the interrupt input 62. [0053] From this point, the method 200 is similar to that illustrated in the preceding stage: the actuator sensor 60 and interrupt inputs 62 are monitored at block 234, determinations are made at blocks 236, 238 if either the sensor 60 or the input 62 is operative, with indexing of counters, deactivation of outputs 70, 72, and activation of timers following in blocks 240, 242, 244, 246, 248, 250.
[0054] If the sensor 60 or the input 62 are determined to have been activated at any point in the first and second time periods, the method 200 may return to monitoring of the detector 64 after the system pause. Additionally, if the controller 52 determines that the first and second time periods have elapsed with neither the sensor 60 nor the input 62 having been activated, then the method 200 may also deactivate the outputs 70, 72, and return to monitoring of the detector 64. [0055] The system 20 and methods 100, 200 may provide a number of advantages, all of which need not be realized in a single embodiment to obtain the benefit of the subject matter disclosed herein. For example, the system 20 may provide an interrupt input to permit persons not coming in contact with the patient to limit the number of times the alarm is sounded. However, the interrupt input may be disposed sufficiently close to the actuator to make the decision to make utilization of the dispenser no more complex than activation of the interrupt input. Further, a count may be maintained of the use of the interrupt input to determine if the interrupt input is being used excessively relative to a particular unit time. Moreover, these counts may be compared on a locational-basis to determine relative statistics for rooms in different wards, for example. Further, where a count is maintained of the times that the detector is activated, this count may be compared with the counts for the operation of the actuator and the counts for the operation of the interrupt input to determine if the system is being disregarded in whole or in part.

Claims

We claim:
1. A hand hygiene system comprising: a dispenser having an actuator, the actuator having an operative state and an inoperative state; a detector associated with the dispenser, the detector having a detection area; a sensor associated with the actuator, the sensor capable of detecting one of the operative state or the inoperative state of the actuator; an interrupt input having an operative state and an inoperative state; an output display having an active and an inactive state; and a controller coupled to the detector to detect if a person has entered the detection area, coupled to the sensor to detect if the operative state of the actuator has been detected, coupled to the interrupt input to detect if interrupt input is in the operative state, and coupled to the output display to place the output display in the active state when neither the operative state of the actuator or the operative state of the interrupt input is detected after the person has entered the detection area.
2. The hand hygiene system according to claim 1, wherein the controller places the output display in the active state if neither the operative state of the actuator nor the operative state of the interrupt input is detected a certain amount of time after the person has entered the detection area.
3. The hand hygiene system according to claim 1, wherein the controller places the output display in the inactive state if either the operative state of the actuator or the operative state of the interrupt input is detected after the output display is placed in the active state.
4. The hand hygiene system according to claim 1, wherein the controller indexes a count by one if operation of the interrupt input is detected.
5. The hand hygiene system according to claim 1, wherein the dispenser comprises a housing, and the interrupt input is disposed on the housing.
6. The hand hygiene system according to claim 1, wherein the interrupt input is mounted separate, but in close proximity to, the actuator.
7. The hand hygiene system according to claim 1, wherein the detector comprises a motion detector.
8. The hand hygiene system according to claim 1, wherein the sensor comprises a pressure sensor.
9. The hand hygiene system according to claim 1, wherein the output display comprises an audible output.
10. The hand hygiene system according to claim 9, wherein the output display comprises a visible output.
11. The hand hygiene system according to claim 10, wherein the controller causes the output display to provide a warning or reminder.
12. The hand hygiene system according to claim 11, wherein the controller causes the output display to provide instructions to operate the dispenser.
13. The hand hygiene system according to claim 10, wherein the visible output is an array of light emitting diodes.
14. A method of promoting hand hygiene comprising: detecting presence of a person; detecting whether an actuator associated with a dispenser is operated; detecting whether an interrupt input is operated; and activating an output after the presence of person is detected when neither operation of the actuator nor operation of the interrupt input is detected.
15. The method of promoting hand hygiene according to claim 14, wherein activating the output comprises activating the output a certain amount of time after the presence of a person is detected if neither operation of the actuator nor operation of the interrupt input is detected.
16. The method of promoting hand hygiene according to claim 14, comprising indexing a count if operation of the interrupt input is detected.
17. The method of promoting hand hygiene according to claim 14, wherein activating the output includes providing an audible alarm.
18 The method of promoting hand hygiene according to claim 17, wherein activating the output includes providing a visible alarm.
19. The method of promoting hand hygiene according to claim 18, wherein the providing of a visible alarm includes providing instructions on operation of the dispenser.
20. The method of promoting hand hygiene according to claim 14, comprising deactivating the output if either operation of the actuator or operation of the interrupt input is detected.
PCT/US2008/088645 2007-12-31 2008-12-31 System and method for promoting hand hygiene WO2009088929A1 (en)

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