Dartmouth-Hitchcock Medical Center Presents Breakthrough Hand Hygiene Device Study at the American Society of Anesthesiologists 2008 Annual Meeting

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A study abstract by Dartmouth-Hitchcock Medical Center presented at the annual American Society of Anesthesiologists conference reveals a promising new approach to healthcare hand hygiene and hospital infection rate reductions using new personal sanitizer dispensers with electronic measures.

Given further study, this device and system has the potential to create a new best-practice model for clinical hand hygiene which could ultimately save 45,000 U.S. lives each year

- A study abstract by Dartmouth-Hitchcock Medical Center (DHMC) of Lebanon, NH presented at the annual American Society of Anesthesiologists (ASA) conference in Orlando, Florida reveals a promising new approach to healthcare hand hygiene and hospital infection rate reductions. Tracking before-and-after infection rates in a 26-bed intensive care unit (ICU), researchers found that by introducing the use of personal sanitizer dispensers by healthcare providers, significant improvements in hand hygiene adherence corresponded to reductions in healthcare acquired infections (HAIs).

The study documented improvements in both catheter related blood stream infections (CRBSI) and ventilator-associated pneumonia (VAP). "During the before study period CRBSI rates were 4.6/1000 line days compared with 1.7/1000 line days in the after group, a 63% reduction. Similarly, a reduction in VAP by 72% has been observed from 7/1000 ventilator days to 2/1000 ventilator days in the after group."

Experts agree hand hygiene is the number one preventative measure against healthcare acquired infections which in the U.S. each year infect over 2 million hospital patients of which 90,000 die with a cost to the U.S. healthcare system of over $4.5 billion. New super-bugs such as MRSA and VRE have increased the threat to patients as percentage of antibiotic resist hospital infections are rapidly increasing: over 59% of staphylococcus aureus cases in ICUs are now MRSA; over 28% of ICU enterococcus cases are VRE.

The new personal sanitizer dispensers are from Sprixx of Santa Barbara, CA. The dispensers are clipped to the clothing of healthcare providers, and are designed to be operated with one hand on-the-go anytime, anywhere. The Sprixx GJ Personal Dispenser takes a 58 ml replacement cartridge that dispenses an alcohol sanitizer gel "at the point of care" as recommended by the Centers for Disease Control and Prevention (CDC). The dispensers have four attachment options for clothing including: lanyard, belt clip, pocket clip, and scrub clip.

"Given further study, this device and system has the potential to create a new best-practice model for clinical hand hygiene which could ultimately save 45,000 U.S. lives each year," explains Assistant Professor of Anesthesiology Matthew D. Koff MD M.S. An attending physician in the DHMC ICU, Dr. Koff went on to say, "having the ability to respond to every hand hygiene opportunity as a second-nature habit during busy times without interrupting workflow is vital to patient safety given the demands on today's healthcare providers. This device meets that clinical requirement and it translates into improved infection rate reductions."

The ASA DHMC abstract using the personal sanitizer dispensers in the ICU was preceded by a study in the OR. A study abstract presented at the 2008 National Patient Safety Foundation (NPSF) 2008 Annual Patient Safety Congress demonstrated how anesthesiologists using a Sprixx GJ personal sanitizer dispensers for intraoperative hand hygiene in the operating room "increased hourly hand hygiene decontamination events 27 fold" and as a result "patients in the treatment (device) group were 5.3 times less likely to have contaminated intravenous tubing." Dr. Koff and associates are in the process of publishing their findings.

The Sprixx personal dispensers are part of a multi-component system designed to not only provide better sanitizer delivery technology but comprehensive logistical and cultural support. "Hospitals are extremely complex environments and the demands on healthcare providers are extreme," explains Sprixx Vice President of Research and Development, Ron Cagle. "It's not always enough just to ask providers to wash their hands; we have to give them the tools and systems to truly make it possible."

The personal dispensers include the ability to record time stamp records every time the dispenser is used. The results are downloaded using a USB cable that connects a computer to the dispensers. The Sprixx Hand Hygiene System's (SHHS) uses the electronic performance data to empower frontline healthcare providers to improve their hand hygiene. The key measure is Average Hourly Episodes (AHE) which is calculated by Total Hand Hygiene Episodes/Hours (decimal). Different positions have varied AHE goals for their shift to fit their duties and hand hygiene frequency requirements. The system generates a poster that graphs the AHEs for each provider's shift yet only identifies providers by a reference number. A handout is generated for each provider that graphs her/his hourly hand hygiene episodes for each working hour of the shift. This allows providers to see their individual performance from within the context of the group and group goals. Shared purpose and group governance are then the primary force for positive change. A reference on page 21 of the CDC guidelines helps establish Average Hourly Episodes as a valid measure as well as an initial range of expectations; "nurses in pediatric wards had an average of eight opportunities for hand hygiene per hour of patient care compared with an average of 20 for nurses in intensive-care units."

The system is compliant with the hand hygiene recommendations made by the Centers for Disease Control & Prevention (CDC), the World Health Organization Patient Safety Challenge, and the Institute for Healthcare Improvement (IHI). It is built and implemented using the best-practices methods of our day: the Geneva Hand Hygiene Model, IHI Improvement Process, Six Sigma principles, and the Outcome Driven Innovation Method.

The DHMC study, initiated in December 2007, will continue over the course of a year to account for seasonal variations and capture a more statistically significant data-set. Publication of further abstracts and articles are planned.

With over 43,000 active members and founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. For more information about the ASA, visit http://www.asahq.org.

Dartmouth-Hitchcock Medical Center (DHMC), internationally renowned, nationally ranked, and regionally respected, integrates high-quality patient care, advanced medical education, and translational research to provide a full spectrum of health care. DHMC is located on a 225-acre campus in the heart of the Upper Connecticut River Valley, in Lebanon, New Hampshire. For more information about DHMC, visit http://www.dhmc.org.

Sprixx is a DBA of Harbor Medical, Inc., of Santa Barbara, CA. Sprixx holds an exclusive patent license for body-worn, single-hand operated sanitizer dispensing and is the developer of the Sprixx Hand Hygiene System. For more information on Sprixx, phone 805-570-5312, visit http://www.sprixx.com, or email rcagle @ sprixx.com.


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