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Ignaz Semmelweiss was laughed out of his Viennese hospital when he suggested that physicians should wash their hands in between conducting an autopsy and delivering a baby.
A hundred and fifty years later, we know just how right he was, but hand sanitation compliance rates at hospitals still hover in the 30% to 50% range. This makes it easy for hospital-acquired infections (HAIs) such as MRSA and VRE to run rampant, a (literally) dirty, not-so-little, and not-so-secret reality for American patients.
A Healthbox-backed startup is trying to change that. SwipeSense, founded in 2012 by Northwestern University graduates Mert Iseri and Yuri Malina, is a system designed to improve sanitation practices in hospitals using portable hand sanitizers and wirelessly-collected data on their use.
The organization wants to help stem the tide of avoidable HAIs. Each year, about 100,000 Americans die from infections they contract during their time in the hospital – more than the number of Americans killed by guns, motor vehicles, and leukemia combined. In addition to the direct human toll, HAIs cause patient length-of-stays to increase by 8.0 days in ICUs and 7.4 to 9.4 days in acute care wards, taking up expensive capacity and preventing others from accessing needed hospital beds. They’re also expensive, causing an estimated $4.5 to $5.7 billion in excess costs.
Iseri and Malina were inspired to create SwipeSense by a project they did for Design for America, a student group created to catalyze social change using human-centered design (also founded by Iseri and Malina). It took them to Northwestern Memorial University Hospital in their college town of Evanston, Illinois, where they identified two salient issues with hand sanitation: convenience and compliance.
“It’s obvious it’s not the fault of the nurse or physician…it’s something wrong with the system,” Malina told me in an interview. Even though alcohol foam and soap dispensers are ubiquitous in American hospitals, they often aren’t at the immediate point of care. “Medical staff need to sanitize four or five times per patient encounter,” Malina said, making proper sanitation an arduous, time-consuming, and unrealistic task. “Our philosophy at SwipeSense is that the right thing to do should be the easiest thing to do… We want to make something that people love.”
That meant creating a system which allowed clinicians to “sanitize at the point of care, rather than having to go to the wall four or five times each patient encounter,” said Malina. To do this, they created a small, portable gel dispenser that squirts out the appropriate amount of sanitizer, used mostly by nurses.
Rather than replace the ubiquitous alcohol foam and soap dispensers in hospitals, they chose to fit a small sensor on each, which was cheaper and didn’t require re-training clinicians on where to find them. Physicians, who are much more peripatetic than nurses, clip a small sensor onto their badge to track the use of these dispensers as they round from unit to unit.
Without data, Malina told me, “people aren’t really aware how they’re doing individually.” Hospital administrators who try to track this compliance manually find it a gargantuan undertaking, and because clinicians know they’re being watched, the data is compromised by the Hawthorne Effect.
Which is why it’s crucial that dispenser use data is collected by a wall-mounted hub, allowing unobtrusive data collection in the background. The data is sent to a cloud-based software platform that hospital administrators and unit managers can use to analyze hand sanitation compliance. Access to this data can lead to myriad uses: to stimulate engagement, for example, savvy administrators could pit units against each other in a contest to see which can best maintain high sanitation standards.
Hand sanitation compliance is a ubiquitous, vexing problem for hospitals, and a sustainable solution has proven elusive. SwipeSense isn’t the first organization to attempt to fill this gap, but Malina believes they’re “the only technology in the hand hygiene space really trying to make the lives of the health care workers easier.”
Early results were mixed: In a one-month field trial, units given SwipeSense portable dispensers used 64% more hand gel than they did without it, though engagement was low (use of the dispensers and the online platform were 22.5% and 14%, respectively). When the dispensers were carried by staff, they seemed to sanitize more.
SwipeSense is one of many nascent organizations hoping to stem the tide of avoidable hospital deaths caused by HAIs, ranging from movement-activated cameras that transmit video to India (where it is watched, minute-by-minute, for compliance), to vibrating sensors which “nudge” clinicians to sanitize when entering a patient’s room.
Previously, hospitals’ main incentive to reduce hospital-acquired infections (HAIs) was humanist: saving lives. But they could also be reimbursed for the longer stays that HAIs engendered, a quiet but persistent countervailing force against effective prevention.
Now, hospitals across America face financial penalties for poor performance. The Affordable Care Act included two “sticks” meant to incent hospitals to improve sanitation and reduce the incident of HAIs: Currently, certain HAI-related Medicaid reimbursements are no longer covered, and starting in 2015, the worst-performing quartile of hospitals (compared to the national average) will see a 1% penalty reduction in their Medicare reimbursements.
This makes a compelling business case for hospitals to reduce HAIs, which partially explains the number of nascent hand sanitation startups like SwipeSense. With an average cost per HAI of $13,973, reducing the incidence by even a small amount will have a significant positive effect on hospitals’ bottom lines.
With this in mind, SwipeSense is looking to expand nationally. The organization currently has two clients: Northwestern Memorial University Hospital and Rush University Medical Center, both in the Chicago area. According to Malina, the company is testing whether “being able to link [hand hygiene compliance] to an individual…actually positive impacts hand hygiene levels and hand hygiene behavior…we have the capability to do it, but we’re really trying to figure out what the most effective way of doing this is.”
Recently, SwipeSense was selected as one of 24 candidates for the Wall Street Journal's Startup of the Year contest. This fall, the organization hopes to scale the program to 10 hospitals, a significant undertaking. But sanitation is just the first step. As Malina noted, “having people carry a wearable sensor doesn’t just have to collect hand hygiene data, it really opens the door on the whole lot of interesting information.“ The team is currently brainstorming other uses, but is focused on sanitation for now.
Whether SwipeSense will lead to fewer HAIs is literally the billion-dollar question. What do you think? Is it a paradigm-shifting system, or another also-ran in the quest to improve safety and quality in America’s hospitals?