Soap-sniffing Technology Encourages Hand Washing To Reduce Hospital-acquired Infections, Save Money

Call it a Breathalyzer for the hands. Using sensors capable of detecting drugs in breath, new technology developed at University of Florida monitors health-care workers' hand hygiene by detecting sanitizer or soap fumes given off from their hands.By reminding workers to clean their hands to remove disease-causing organisms such as the bacteria MRSA, the system could help reduce hospital-acquired infections and save millions of dollars now spent to treat them.

The trademarked system, called HyGreen, logs, down to the second, the frequency of hand cleaning and contact with patients in a database that clinical supervisors can review immediately.

This is the first system that enables real-time monitoring of hand washing.

"This isn't big brother, this is just another tool," said Richard J. Melker, M.D., Ph.D., a UF College of Medicine anesthesiology professor who developed the technology along with professors Donn Dennis, M.D., and Nikolaus Gravenstein, M.D., of the anesthesiology department, and Christopher Batich, Ph.D., a materials science professor in the College of Engineering. "A hospital worker never wants to be responsible for someone getting sick or dying from an infection acquired in the hospital."

HyGreen is now being tested in the Neuro Intensive Care Unit at Shands at UF medical center, and will be presented at the annual meeting of the Association for Professionals in Infection Control and Epidemiology June 6 to June 9 in Fort Lauderdale, Fla.

Here's how it works: The health-care worker squirts sanitizer gel or soap into his or her hand before passing it under a wall-mounted sensor. A wireless signal from a badge worn by the worker activates a green light on the hand-washing sensor. When the worker enters a patient room, a monitor near the bed detects the status of the badge, and flashes green if the person has clean hands. If the person has not washed, or too much time has passed between washing and approaching the patient, the badge will give a gentle "reminder" vibration.

"I do wash my hands more often," said nurse Carrie McGirr, R.N., who volunteered to help test the HyGreen system. "It's a fairly simple process to learn."

Close to 2 million hospital-acquired infections occur each year and more than 250 related deaths occur each day in the United States, according to the Centers for Disease Control and Prevention.

"A substantial number of those are preventable, and also one of the key modes of transmission is via the hands of health-care personnel and patients," said Dr. Lennox Archibald, a professor of infectious diseases at the UF College of Medicine, and the Shands at UF epidemiologist leading the evaluation of HyGreen.

Six pathogens, including the ones known as MRSA and VRE, account for two-thirds of all hospital-acquired infections and are readily transmitted by hand.

Studies have shown that up to half of all hospital-acquired infections might be prevented if health-care workers washed their hands according to guidelines set forth by the CDC.

It costs at least $30 billion a year in additional spending to treat hospital-acquired infections. The Center for Medicare and Medicaid Services last year ruled that it would no longer reimburse hospitals for the expense of treating the infections.

Today, more than 160 years after Hungarian physician Ignaz Semmelweiss was ridiculed for suggesting that hand washing by doctors who moved directly from working with cadavers to delivering babies could reduce fatal cases of birth-related infection, the practice still meets with resistance.

"But it's not because people don't want to do it," Archibald said. "It's not inherent in people's behavior to wash their hands, for some reason."

Various studies show that health-care workers wash their hands less than half the time after direct contact with patients. The reasons people give include skin irritation caused by hand hygiene products, a preference for gloves or simply failure to remember.

Previous hand-washing compliance studies have been based on observation of a limited number of people at a time, who likely improve their behavior when they know they are being watched — a phenomenon known as the Hawthorne effect.

"This system is a noninvasive way of measuring — it allows for nonbiased measurement and is unobtrusive," said Loretta Fauerbach, Shands at UF director of infection control, who helped write the CDC hand-washing guidelines and leads the collaboration with HyGreen to evaluate the system in a hospital setting.

"Nobody has ever taken a systems approach to this problem before," said Melker, chief technology officer of Xhale Inc., which is marketing HyGreen.

Developers anticipate that hospitals will readily accept the system because not only can it help reduce infections, it also will pay for itself within a few months.

"Something has to be done about hand washing," Archibald said. "Otherwise the bugs are going to win."

Newly Discovered Reactions From An Old Drug May Lead To New Antibiotics

A mineral found at health food stores could be the key to developing a new line of antibiotics for bacteria that commonly cause diarrhea, tooth decay and, in some severe cases, death.The trace mineral selenium is found in a number of proteins in both bacterial cells and human cells called selenoproteins. University of Central Florida Associate Professor William Self's research shows that interrupting the way selenoproteins are made can halt the growth of the super bug Clostridium difficile and Treponema denticola, a major contributor to gum disease.

Infections of Clostridium difficile (commonly known as C-diff) lead to a spectrum of illnesses ranging from severe diarrhea to colitis, which can cause death. It's a life-threatening problem in hospitals and nursing homes worldwide, and the number of cases is on the rise. There are an estimated 500,000 cases per year in the United States alone. Between 15,000 to 20,000 people die each year while infected with this superbug. Treponema denticola is one of leading causes of gum disease and costs individuals thousands of dollars in dental care each year.

Self's findings are published in the May and June editions of the Journal of Biological Inorganic Chemistry and the Journal of Bacteriology. The National Institutes of Health and the Florida Department of Health funded the research, which was conducted at UCF during the past three years.

"It's the proof of principle that we are excited about," Self said from his research lab at UCF. "No one has ever tried this approach, and it could potentially be a source for new narrow spectrum antibiotics that block bacteria that require selenium to grow."

The key discovery occurred when the team found that the gold drug Auranofin, used to treat arthritis, impacted selenium's metabolism process. The chemical reaction changes the selenium, which prevents bacteria from using it to grow. Auranofin is an FDA-approved gold salt compound that is used to control inflammation and is already known to inhibit the activity of certain selenoproteins. Since certain bacteria, such as C. difficile, require selenoproteins for energy metabolism, the drug acts as a potent antimicrobial halting the growth of the bacteria.

The initial studies with C. difficile led to studies with T. denticola, known for several years to require selenium for growth. While testing the gold salt, Self's group also uncovered another surprise; the stannous salts found in many antimicrobial toothpastes in the form of stannous fluoride also inhibited the synthesis of selenoproteins. Previous independent research had already established that stannous salts are more effective at preventing tooth decay and inhibiting growth of T. denticola, but the mechanism of this inhibition of growth was not yet known. These findings could lead to new approaches to preventing gum disease.

"No one has tried to block the metabolism of selenium before as a therapeutic approach," Self said. "That's what's new and exciting and could lead to a whole host of other possibilities, including a better understanding of how the gold salt works for arthritis."

Self said more research is needed, and he already has another grant proposal before the NIH that would move his research forward.