A Device to Monitor Hand Sanitation Compliance

Eric Reynolds and Ben Phillips

Abstract

According to research conducted by the World Health Organization, hand-washing

compliance in the healthcare setting can be as low as 20 percent. The purpose of this experiment

was to design a device, wearable by doctors and nursing staff, that could communicate with

sensors in the the doorway and soap dispenser of a room. This device monitors the position of

the doctor and whether a doctor has washed their hands in order to remind a doctor to wash their

hands before exiting a room. With such device, the levels of infection in hospitals could be

controlled simply by having doctors or nurses wash their hands more. The researchers used an

Arduino Uno microcontroller board and RFID transmitter to track and communicate with the

doctor. The doctor wears an RFID tag which blocks a specific frequency emitted by the RFID

transmitter. The act of hand-washing is monitored by a flex sensor, attached inside of a hand-

washing pump Success in this project was defined as the products ability to discern when a

doctor entered the room, and effectively prompt him or her to wash their hands before and after

entering the room. This was tested by putting the device through all possible scenarios 100 times

each. For each of the 4 scenarios the device attained a 100% success rate, never failing to

execute the correct function. The device can be further improved through the implementation of

a long range (3-5m) RFID reader. This improved reader will allow our prototype to function

passively, without any action from the doctor.

Introduction
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In hospitals around the world, sickness is rampant. One would assume that there would

be sickness in a hospital, but there are uncontrolled infections that patients often contract due to

an overall uncleanliness amongst medical staff. The purpose of this experiment was to design a

device, wearable by doctors and nursing staff, that could communicate with sensors in the the

doorway and soap dispenser of a room, in order to remind a doctor to wash their hands before

exiting a room. With such device, the levels of infection in hospitals could be controlled simply

by having doctors or nurses wash their hands more. The researchers hoped to learn whether or

not it was possible to construct a device small enough to be carried that could communicate with

both a sensor at a door that could differentiate between individuals and a sensor on a soap

dispenser that could alert an individual leaving the room if they had not washed their hands.

Success in this project is defined as the products ability to discern different subjects entering

room and warn each of them to wash their hands if they fail to do so. This will be tested by

entering and exiting a defined space 100 times and washing or not washing ones hands based on

a coin flip.

In discussion with several medical professionals, the researchers concluded that a device

that could sense a doctor or nurse entering a room and warn them if they had not washed their

hands would be very beneficial to both doctors and patients alike. There is a direct correlation

between doctors hand washing habits and patient health, especially in regards to infections

usually found in hospitals like Norovirus, Influenza and Staph infections (Luby, 2005). In many

cases, handwashing compliance can be as low as 20 percent, which is dangerous to patient health

(Pittet, 2000). With the introduction of a simple device, that compliance percentage could double

or even triple, lowering a patients chance of infection drastically (Broughall 1984). The idea of

doctors washing their hands constantly is one that many people have, and many people would

be surprised to learn that doctors often neglect to do such a menial task that could decrease
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infection and in some cases save lives. The researchers are hoping that this device could hold

doctors accountable for their patients health, because weve heard from several professionals that

their only system is counting on doctors and nurses to hold eachother accountable. This is a

system that is not working, requiring the development of a system that will work. This is where a

smart system such as the one detailed above would play a huge part in lowering patient infection

rates.

The device is controlled by an arduino unit. It communicates with a pressure sensor

contained inside of a soap dispenser and a receptor mounted in a doorway through RFID

technology (Radio Frequency Identification). The device is wearable by doctors, and sounds a

warning tone when a doctor or nurse attempts to leave the room without washing his/her hands.

When the individual enters a room they are marked in the arduino code as someone who has not

washed their hands. They can move about in the room, but if they attempt to leave without

washing their hands, there is an audible warning that reminds them to wash their hands. An

individual who is in the room marked as a non-hand washer will becomes unmarked when they

wash their hands. The device knows this through its communication with the soap dispenser. An

individual who has become unmarked can leave the room without triggering the audible warning.

This was tested by a human subject entering a room one hundred times and, based off a coin flip,

either engaging the soap dispenser of neglecting to. The result was the sounding of the audible

alarm in the case of neglecting to engage the dispenser or the lack of an audible alarm in the case

of engaging the soap dispenser. The human would know to wash his or her hands and would be

prompted to push the soap dispenser. Additionally, the prototype could be expanded to

communicate with the door. Locking the door for doctors who have not washed their hands, and

unlocking the door for people who have washed their hands. The arduino prototype could also

be used to record statistics about how committed a doctor is to the handwashing process. A
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tally of repeat offenders could be recorded, and certain doctors would see improvement in their

sanitation techniques over time.

The Arduino component of our Radio Frequency Identification (RFID) is the method by

which the prototype determines the location of a health professional. RFID (RF Identification)

is a means of storing and retrieving data through electromagnetic transmission to an RF

compatible integrated circuit (Lionel, 2004). RFID tags are inexpensive, and can be used for

many different applications. This technology is relatively new, and can be seen in many

applications in todays society. The two main types of RFID that are used today are active and

passive RFID. In Active RFID, the tags are powered by electricity, while in Passive RFID the

tags are not charged. The advantages to using Passive RFID are its relatively cheap price, and

wide variety of applications. These applications include: footraces, monitoring cow location,

monitoring clothes in retail stores, as an entry pass, and in package tracking (Birdsong, Hank).

The arduino pack that is worn by the doctor contains a passive RFID tag, and communicates

with the circuit, or receptor, that is placed near a doorway. Each of these receptors have a

communicating radius of about 3 ft (doorway width), and each of the chips interacts differently

with the receptors. This project used 13.56 Hz High Frequency (HF) and Near Field

Communication (NFC) tags to monitor the location of the doctors in the experimenting

conditions.

The poor sanitation found in public healthcare institutions is astounding. Ever since

Louis Pasteur, humans have been informed about the effects of sanitation, germs, and overall

cleanliness on a persons health. The white walls, sanitized benches, and slick tiles of a

traditional hospital are not always as clean as they appear. According to a study conducted by

Pittet in 1999 testing the average compliance with hand hygiene, in the Intensive Care Unit

(ICU) only 38 percent of doctors, on average, sanitized their hands. This statistic increased to
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48% in respect to all wards, but either way these numbers are astonishing (Pittet, 2002). To think

that one out of every two practicing doctors do not properly follow hand hygiene protocols is

shocking, and must be stopped. The arduino prototype aims to accurately monitor the hand-

hygiene methods of health professionals, and raise the percentage of compliant health

professionals to 100%. This sanitation goal will then directly increase the health and safety

standards of the patients, and reduce the risk of disease in medical environments.

Materials and Methods

Some of the materials used were: an Arduino UNO, Consolidated Electronic Wire, Flex

Sensor, Sparkfun RFID USB Reader, ID-20LA RFID Scanner, 4 LEDs (Red, Blue, Green,

Yellow), RFID Card #82003B7F27E1, Piezo Buzzer. These materials were used to construct the

Arduino device.

The alarming lack of handwashing compliance in hospitals prompted the design of a

device that can remind doctors to sanitize regularly. The researchers decided that this problem

required an intelligent solution that could adapt to the many different scenarios that the doctors

office presents. An Arduino Uno was used as the basic framework for the device, and was

programmed to effectively ensure the sanitation of health professionals. The presence of the

doctor was determined by an RFID scanner and card system. This system operates similarly to a

badge, hovering the card over the scanning device prompts an action from the Arduino. A

specific card number was assigned to each individual in the hospital, with number

82003B7F27E1 used for testing in this scenario. The device communicated information to the

reader through four LEDs. Each color LED (Flashing Red with Buzzer, Blue, Green, Yellow)

tells the doctor a specific set of information (figure 3). The Flashing Red LED and Buzzer is a

warning prompting the doctor to immediately wash his or her hands, the Yellow LED cautions
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the doctor that they must wash their hands before proceeding, the Blue LED signifies that the

room is in an empty state, and the Green LED assures the doctor that he or she has washed their

hands two times and is clear to go. A flex sensor was used to simulate the pumping of a soap

dispenser or hand sanitizer. Both the flex sensor and the RFID transmitter-chip system

communicated together through the Arduino code to trigger the right LED at the right time.

Results

The Arduino handwashing prototype was tested using a pass or fail test over four

scenarios. Each scenario was determined based upon the parameters set up by the device. The

Arduino warns the doctor both when he or she enters and leaves the room. This allows four main

scenarios that the arduino must take into account (figure 4) The four scenarios are: Scenario 1 -

The doctor washes hands after entry and before leaving without warning, Scenario 2 - The doctor

forgets and must be reminded both upon entry and before leaving the room, Scenario 3 - The

doctor does not have to be reminded upon entry but must be reminded upon exit, and Scenario 4

- the doctor has to be reminded upon entry but does not before leaving. Each scenario was tested

for pass or fail 100 times, and for each scenario the arduino passed 100 percent of the time

(figure 2). The results gathered from the tests were analyzed using the Adjusted-Wald Method

(figure 1). The Adjusted-Wald Method returned a best estimate of 0.9902. This means that there

was a 99.02 percent chance that the results achieved through the four scenarios was correct.

Using a confidence level of 5 percent, these Adjusted-Wald Method results prove that the success

of the Arduino prototype was not simply by chance.

Further Studies
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The researchers intent was to create a passive system that utilized RFID, not one that

involved a card scan. If this passive system were to be utilized, it would use a tag that the doctor

would wear that would not need to be scanned. The health professional would not be aware of

the handwashing monitor upon entering the room. Only when warned would the doctor have to

interact with the hand washing device. The devices effectiveness would be greatly increased,

and subversions of the system would be incredibly difficult. This technology would function

similarly to an RFID mat placed at the end of road races. These mats do not require any action

from the runner except crossing for and RFID tracking chip. Unfortunately this technology was

unavailable during the testing window due to budgetary restrictions.

To make the device more effective, it could be expanded to communicate with the door as

well as the soap dispenser; locking the door for doctors who have not washed their hands, and

unlocking the door for people who have washed their hands. This would ensure complete

handwashing compliance from health professionals. The arduino could also be used to record

statistics about how committed a doctor is to the handwashing process. A tally of repeat

offenders could be recorded, and certain doctors would see improvement in their sanitation

techniques over time. With these statistics hospitals could determine which doctors need more

attention and reminders and take action. An incentive system could also be instituted inspire the

doctors. With this device there is a lot of room for expansion that could make the device more

user friendly while also lowering the rate of infection in hospitals.

Conclusion

Through this experiment the researchers were able to successfully create a device to

monitor and regulate hand washing habits. Several elements were utilized in the final product: an

RFID reader, a flex sensor, and an arduino unit. Together these elements work in conjunction to
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provide an intelligent method of holding doctors responsible for their hand washing habits.

Although the researchers had to adapt their original design to account for several obstacles

encountered along the way, they were indeed able to create the device they set out to build.

While there was no definite hypothesis, the researchers did create, design, and build a device that

offers a solution to the problem at hand. The devices 100 pass percentage over 400 trials is a

testament to its ability to monitor the hand washing problem. The Arduino prototype is an

effective and intelligent device that can improve handwashing compliance.

This device is applicable to solve hand washing problems in nearly every medical setting

as well as other settings where hand washing is necessary. The device could be employed not

only in hospitals, but in office buildings and restaurant bathrooms. The researchers believe that

with the addition of an aesthetically pleasing housing, this device could be implemented in any

setting. A cheap, marketable product is the ultimate end goal for this device. Further testing

with the device in an actual hospital would provide a more accurate look at the devices

effectiveness, but it is the conclusion of the researchers that the device would have a significant

positive effect in both raising the percentage of doctors who wash their hands and in lowering the

rate of infection.

Bibliography

Birdsong, Hank. "Passive RFID." Birdsong Supply Company. N.p., n.d. Web. 1 Nov.

2016.

Broughall, J., Marshman, C., Jackson, B., & Bird, P. (1984, June 25). An automatic

monitoring system for measuring handwashing frequency in hospital wards. Journal of

Hospital Infection. Retrieved November 1, 2016.

Lionel, M. (2004). LANDMARC: Indoor Location Sensing Using Active RFID. Wireless

Networks, 10(6). Retrieved November 1, 2016.

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Luby, S. P. (2005, July 16). Effect of handwashing on child health: A randomised

controlled trial. The Lancer. Retrieved November 1, 2016.

Pittet, D. (2000, June). Improving Compliance With Hand Hygiene in Hospitals.

Chicago Journals. Retrieved November 1, 2016.

Appendix

Figure 1: Adjusted

Wald Method Results

Figure 2: Pass Percentage between Scenarios

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Figure 3: LED Schematic

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Figure 4: Scenario Outline