Sing the birthday song? recites the alphabet? 20 seconds are there? What can be done to guarantee hand washing is effective?
The transmission of germs in healthcare settings and elsewhere can be stopped by maintaining proper hand hygiene habits. However, when it comes to basic hand hygiene, patients, healthcare professionals, and the general public have historically been resistant to change.
Increasing the now-ubiquitous presence of alcohol-based hand sanitizer dispensers and signs, providing training, addressing organisational culture, and establishing accountability have all been part of efforts to enhance hand hygiene in hospitals, clinics, and doctor’s offices. While there are still few ways to assess continuing hand hygiene practises, opponents contend that focusing on compliance rather than quality misses the point and undermines the ultimate objective of enhancing patient care through the eradication of germs.
Now, a new study on the usage of a novel new technique to find unwashed patches on hands using a portable thermal imaging camera connected to an iPhone has been published in the American Journal of Infection Control. The use of a forward-looking infrared (FLIR) thermal camera to evaluate the hand hygiene technique among 12 staff members who volunteered to participate in the study within the Infection Prevention Department at Yale New Haven Hospital in Connecticut is described by authors John M. Boyce, MD, of M Boyce Consulting, and Richard A. Martinello, MD, of the Yale School of Medicine.
The method depends on using alcohol-based hand sanitizer, which causes evaporation and causes a brief dip in skin temperature. The colour palette of the generated photographs was adjusted by researchers using the smartphone app for the thermal camera, which was mounted on a tripod. The quality of hand hygiene habits among 12 participants was evaluated by measuring skin temperature all over the hands before and after using an alcohol-based hand sanitizer.
Mid-palm, tip of third finger, and tip of thumb temperatures were measured using thermal imaging at three sites on the user’s dominant hand at four different intervals: before using hand sanitizer, immediately after hands felt dry, one minute later, and two minutes later. In order to determine whether they were connected to the temperature drop, researchers also looked into the relationship between the quantity of gel used and hand size.
The resulting photographs revealed that the handheld infrared technology was capable of detecting a considerable temperature drop in the skin for all areas on the hand from before to after sanitizer was applied, as evidenced by a striking shift in colour. This in turn suggested a suitable level of sensitivity for assessing the efficacy of hand hygiene procedures.
Images also showed that one study participant with large hands had hand sanitizer coverage that did not extend to their fingertips, suggesting a potential use for the device to determine the proper dosage of sanitizer.
“Thermal imaging is not a technology that is familiar to most people involved in infection prevention and control, but it presents several potential advantages over observations of hand hygiene technique,” says Boyce, who was a co-author of the CDC Guideline for Hand Hygiene in Health-Care Settings and a contributor to the World Health Organization Guidelines on Hand Hygiene in Health Care.
The thermal camera has the advantage of simplicity, requiring only the handheld apparatus, unlike past research that attempted to quantify hand hygiene method using ultraviolet powder or liquid.
Once it has been set up simply on a smartphone, the thermal camera is compact, portable, and simple to operate.
“This technology might potentially be used in a variety of scenarios, including teaching, testing, and evaluating staff competence,” adds Martinello of the Yale School of Medicine in an interview.
The thermal imaging technique, however, will be most helpful as a teaching and assessment tool when baseline photos can be compared with photographs after cleaning, according to Boyce and Martinello, who cautioned that due to changes in body temperature, it may not always be accurate. More study is required to evaluate various hand sanitizer kinds (gel, foam), brands, quantities, and with a wider range of hand sizes.
The idea of using thermal imaging to examine the quality of hand washing is praised by Emily Landon, MD, executive medical director for infection prevention and control at UChicago Medicine, as being “very imaginative and highly original – exactly what we need in infection control.”
She claims in an interview that “Infection control frequently entails pleading with people to take up the fight against unnoticeable issues and requesting that they alter their behaviour without providing any tangible results. This method makes it obvious. In order to collect and monitor data, we already utilise [Apple] mobile devices, so linking something to an iPhone is a simple and accessible process. The concept is workable because it’s economical, available, transportable, and simple to use… I’m eager!”
