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Toronto General Hospital Uses RTLS to Reduce Infection Transmission
The facility is testing a real-time location system to track hand-washing, the cleaning of equipment and the visits to patients by staff.
Feb 28, 2012—University Health Network (UHN), which operates three hospitals in Toronto, is testing a real-time location system (RTLS) intended to prevent the transmission and spread of new infections, as well as control any existing infections, by tracking equipment, patients and employees. The solution is currently being tested within three units of UHN's Toronto General Hospital, with plans to permanently deploy it if the technology provides data leading to a reduction of infections. Unlike some RTLS solutions that track individual staff members and their movements around a facility and at hand-washing stations, however, this system—provided by Infonaut, utilizing Sonitor tags and receivers—is intended to track behaviors that could lead to infections, while simultaneously protecting workers' privacy, by not revealing the identity of individuals who are wearing the Sonitor badges.
The solution has been installed on two of the hospital's floors, in the transplant, transplant step-down and intensive care units (approximately 25 percent of the facility's ICU patients originate in the transplant unit). Equipment—including pumps, wheelchairs and mattresses—are tagged with Sonitor tags, while workers volunteering to participate wear ID badges, and patients who have completed transplant surgery, or who have been admitted into the ICU, wear Sonitor wristbands. Infonaut's Hospital Watch Live software platform, installed on a server at the hospital, tracks the movements of people and equipment based on tag reads, says Niall Wallace, Infonaut's CEO, with an accuracy of less than 12 inches. The software then provides reports indicating if and when those individuals and assets have been in contact with each other, as well as if and when a hygiene procedure has been missed, such as the cleaning of a piece of equipment, or the washing of hands prior to a patient visit. That information is then provided to the hospital unit's management—without naming individual staff members, but rather reporting the overall behavior of a group (such as nurses) within that unit.
The solution was developed by Infonaut in collaboration with George Brown College, Wallace says, and has been tested by the college's faculty and students at several locations during the past two years, including in the school's simulated hospital environment. The system follows the model of the Positive Deviance Initiative, a program intended to encourage the creation of solutions to complex problems (in this case, how to increase the rate of hygiene compliance, such as hand-washing, and how to reduce the rate of infection without violating staff privacy). The Toronto-area health-care community is especially concerned about the hazards of hospital-borne infections, Wallace says, following a severe acute respiratory syndrome (SARS) epidemic that left one percent of the city's hospital staff quarantined. Better data regarding who had been exposed to the virus could have reduced the need for quarantines, the technology providers speculate, and identified more specifically who was at risk.
Toronto General Hospital chose to test the system initially within its organ-transplant units and ICU, says Dr. Michael Gardam, University Health Network's director of infection prevention and control. The project was awarded $180,000 in funding from the College and Community Innovation Program (supported by the National Sciences and Engineering Research Council of Canada) and the Ontario Ministry of Economic Development and Innovation. By using the system, Gardam hopes that he can gain visibility into how well hygiene compliance is being met, both in terms of staff hand-washing and the cleaning of equipment, and to be able to contact individuals in the event that they may possibly have been exposed to infection. By tagging certain assets and biomedical devices, the system enables infection-control practitioners to identify which of these devices may be part of the chain of infection, according to Dick Tabbutt, Sonitor's chairman.
The deployment consists of 600 wireless battery-powered tag readers (receivers) and 16 gateways, all mounted on walls. The gateways forward data to the server, and also act as tag readers. Four hundred of these receivers are installed at the hospital's GOJO sanitizer dispensers, while the remaining receivers are installed at patients' beds, as well as in hallways and select equipment rooms.
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