Promoting hand hygiene in a chemotherapy day center: the role of a robot

Abstract

Background: Hand hygiene is a critical component of infection prevention in healthcare settings. Innovative strategies are required to enhance hand hygiene practices among patients and healthcare workers (HCWs).

Methods: This study was conducted at the Chemotherapy Day Center of Queen Mary Hospital, Hong Kong. It comprised three phases: phase 1 involved observational audits of hand hygiene practices among patients and HCWs by infection control nurse (ICN); phase 2 included the installation of 53 pressure sensors on alcohol-based hand rub (AHR) bottles at designated sites to monitor usage; phase 3 introduced the robot named Temi Medic to promote hand hygiene through video broadcasts at strategic locations in the center. The mean counts of pressure sensor-equipped AHR per 100 attendances per day (hereafter referred to as the mean count) across phases 2 and 3 were analyzed.

Results: A total of 2580 patient attended the center from April to September 2023. The ICN observed a significant increase in hand hygiene practices among patients at the entrance and reception area, rising from phase 1 (0.2%, 1/583) and phase 2 (0.5%, 3/656) to phase 3 (5.0%, 33/654) (p < 0.001). Meanwhile, the overall hand hygiene compliance among HCWs was 74.1% (1341/1810) throughout the study period. From phase 2 to phase 3, the mean counts of 7 AHR bottles designated for patient use (P1-P7) significantly increased (35 ± 17 vs. 64 ± 24, p < 0.001), as did the 33 AHR bottles shared by both patients and HCWs (207 ± 104 vs. 267 ± 113, p = 0.027). In contrast, there was no significant change in the mean count among the 13 AHR bottles designated for HCWs (H1-H13). The mean count of H1-H13 was significantly higher than that of P1-P7 throughout phases 2 and 3 (214 ± 93 vs. 49 ± 25, p < 0.001), indicating a 4.4-fold difference.

Conclusions: While HCWs maintained stable hand hygiene compliance, the introduction of the robot significantly improved hand hygiene practices among patients in the chemotherapy day center. This underscores the importance of integrating technology into routine practices to promote infection prevention and control in healthcare settings.

Keywords: Chemotherapy day center; Hand hygiene; Promotion; Robot.

Fig. 1

Distribution of pressure sensor-equipped alcohol-based hand rubs and robot path in the chemotherapy day center. Note P1–P7 represent seven pressure sensor-equipped alcohol-based hand rub bottles designated for patient use. P1, P2, P4, and P5 are located in the waiting areas of the chemotherapy day center. P3 is situated at the center’s entrance, while P6 and P7 are positioned at the entrance of the chemotherapy administration area. S1 to S33 represent 33 pressure sensor-equipped alcohol-based hand rub bottles shared by patients and healthcare workers. S1 and S2 are located in the reception area. S3 is placed in the nursing station designated for intravenous catheter insertion for receiving chemotherapeutic agents. S4 and S5 are located in the corridor of the waiting area. S6 to S 33 are located inside the chemotherapy administration area. H1–H13 represent 13 pressure sensor-equipped alcohol-based hand rub bottles designated for healthcare workers. H1 and H2 are in the consultation room, H3 and H4 are on the table for blood pressure monitoring, H5 is in the treatment room, and H6 is adjacent to the nursing station. H7–H9 are located in the nursing station for intravenous catheter insertion, H10–H12 are on the medication administration cart in the chemotherapy administration area, and H13 is in the nursing station within the chemotherapy administration area. A robot named Temi Medic (Temi) was programmed to operate in the corridor from 9:00 AM to 10:00 AM, coinciding with patient registration at the entrance reception area. It moved around during three different time intervals: 11:00 AM to 12:00 PM, 1:00 PM to 2:00 PM, and 3:00 PM to 4:00 PM. During these intervals, Temi stopped at seven designated spots (excluding the reception area at the entrance), including the waiting areas, reception area, and chemotherapy administration area, along a specified path, as indicated by the dotted line, to promote hand hygiene by broadcasting videos at these locations