iScrub online: a system for standardized hand-hygiene observation and feedback

Background:  One of the most common causes of preventable healthcare-associated infections is poor hand-hygiene. To improve compliance, many hospitals track hand-hygiene rates and feed them back to healthcare workers (HCW). Recently, several groups have introduced computer-based, mobile recording systems to increase the accuracy and ease of recording. iScrub 1.0 for the iPhone / iTouch is one such system. However, these tools do not provide a standard platform for collecting and reporting rates. Also, many of these tools do not include the functionality to track the World Health Organization's (WHO) 5 Moments of Hand Hygiene.

Objective:  Our objective is to update iScrub 1.0 to support observing the WHO's 5 Moments and develop an interactive web-based application that allows users to quickly and easily generate reports using data synced directly from iScrub. This website should allow institutions to quickly customize iScrub to handle institution-specific settings and be scalable to support analysis and feedback for hundreds of hospitals.

Methods: iScrub 2.0 was created using Objective-C and Apple Computer's Cocoa framework.  The web-based application was implemented using the Python programming language, HTML, and the Django web framework. Analysis tools use JavaScript and jQuery to provide interactive visualizations of hand-hygiene compliance data.  The iPhone app provides user authentication utilizing Secure Socket Layer encryption, through either a cellular network or WiFi hotspot, to communicate with the web application while ensuring privacy of user data.

Results: iScrub 2.0 supports both traditional In Room/Out of Room hand-hygiene tracking and the WHO's 5 Moments, as well as one-touch synchronization with the web application. The iScrub web application provides tools for storing, tracking, and viewing synchronized data immediately after synchronization. Data can be aggregated across all units within an institution, and then filtered by time period, job categories, opportunity types, or contact precautions. Plots can be customized, and quickly generated for feedback purposes or writing reports. In addition, users can customize the iScrub app using the web application, allowing users to standardize institution specific parameters such as observation locations or job types. During pilot deployment, HCW who had never used an iPhone were comfortable using the application within a few minutes.

  

Conclusions: iScrub and its companion web application provide a scalable, inexpensive, mobile, and inconspicuous method for recording and analyzing hand-hygiene observations. Use of the iScrub application and companion web application eliminates the need for transcription, minimizes data entry errors, and makes generating a variety of statistics and charts as easy as possible. iScrub 2.0 will be available in the iTunes App Store and the iScrub web application is accessible at http://iscrub.cs.uiowa.edu/