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From: Food Quality & Safety magazine, June/July 2006

Waves of Change

The Impact of Wireless Technology on Hand Hygiene Behavior

by Sue Stedd

Today’s world is built on technological advances. We take so much of it for granted. The latest big buzz is wireless technology but it’s really nothing new. Take, for example ,two small behavioral changes in our lives due to wireless technology. Where once we were confined by the length of the telephone cord connecting the handset to the base, we now lose the handset somewhere in the house and search frantically for it each time it rings. Years ago, if we settled down for the evening in front of the TV, we were content with one channel or had to coax ourselves from the comfort of a favorite chair to change it. The advent of the remote control reduced our effort to a click or two, increasing many a waistline by an inch or two.

What is important to realize is that wireless technology has indeed modified our behavior. We think and act very differently from previous generations who lived without telegraph, radio, television, wireless phones, and wireless Internet access. Most every aspect of our lives has been touched by wireless technology, and those areas that have not, soon will be.

When it comes to our food supply, wireless is already in use in multiple areas. For example, RFID tag systems are fast becoming commonplace in animal control—tracking an animal from birth all the way to the retail market.

It is only natural then, that the impact of wireless technology filter down to those day-to-day functions like hand washing, which play such a critical role in food safety. Before we see how this is happening, let’s examine the issue of hand washing performance and its effect on food safety.

Hand Washing, Foodborne Illness and Education

Proper hand washing has long been recognized as critical to the reduction of foodborne illness. We have all heard and read the statistics. Food service risk managers and corporate management are familiar not only with the hazards of poor hand hygiene, but the skyrocketing costs of illnesses attributed to foodborne infection that may result. Containment, correction and insurance can lead to a financial demise. Perhaps even more deadly to the bottom line is the public relations nightmare that ensues when an outbreak of infection is traced back to improper hand hygiene.

On occasion the subject is highlighted in the nightly news when, for example, an outbreak of foodborne illness occurs because an employee in a quick service restaurant did not properly wash his or her hands. Likewise, as topics such as an avian flu pandemic become weekly news items for the general consumption, the public becomes more aware of the necessity of good hand hygiene.

In health care facilities where proper hand washing is just as critical as food service, legislation that requires the collection and reporting of infection rates is currently under consideration in at least 31 states and already enacted in seven states. This legislation grants public access enabling us to make more informed decisions when choosing where we want to receive care. The goal is to help consumers find the best quality care by promoting public disclosure of hospital infection rates. If hospitals disclose this key information, consumers and employers can select the safest hospitals; competition among hospitals will quickly force the worst to improve.

If we were to substitute the words “food service” for “health care” and “foodborne illness” for “hospital-acquired infections” in the Conclusion of the July 2005 Research Brief released by the Pennsylvania Health Care Cost Containment Council, it would read:

Accurate and complete data collections along with dissemination of information to all stakeholders are essential components of food service improvement initiatives. Reducing foodborne illness is imperative to reducing food service costs for consumers…and the food services themselves and to improving the quality of service and quality of life.

It is probably safe to say that similar proposed legislation for food services is right around the corner, if not already underway. Concerns for good health will guide people to seek reports and statistics that identify the most hygienic places to eat. All this really means is that the public is becoming better educated to the necessity of improved food handling and thus, improved hand hygiene.

Within the food service industry the educational process for proper hand washing methods has been underway for some time. Organizations such as Handwashing for Life promote continuing education as the primary element to improve hand-washing performance. Continuing education together with monitoring and compliance to established hand-hygiene standards among food handlers has become accepted procedure in food processing environments. These practices have filtered down to every food handler in quick service restaurants. Food service businesses today have defined processes, procedures and performance standards for hand hygiene. But just how is a system put in place to ensure compliance?

The Importance of Measurement

Anything important is worth measuring, and those things that are not measured will never improve or ever be taken seriously. Without understanding what the hand washing performance of your food handlers is today, how can you decide what needs to change? And perhaps more importantly, without statistical data how can you convey the necessity of change to your food handlers?

The coupling of measurement, statistics, and process control is a very old concept with proven results. Your business is undoubtedly employing measurement in other areas requiring process control. Manufacturing processes strive for zero defects. Clearly we can identify the similarity with food services striving for zero outbreaks of foodborne illness. Employing a process that includes education, providing access to proper hand washing facilities, using measurement techniques and reporting the statistical data generated can and will improve performance and reduce risk.

The issue of implementing defined processes and procedures via a hand hygiene system that is integrated with a viable educational program can be overwhelming. Ideally, the system must be able to gather hand-wash data unobtrusively, process it without human intervention in a timely manner and display the results in a format that can be easily read and acted upon by management. Ideally, hand hygiene performance results should be easily available to each stakeholder with a vested interest in using these results as a process control tool. In the case of operations with multiple locations where comparative analysis may be advantageous, or when remote access to information is necessary, the performance results may reside on a corporate network or a secured Web site.

Managers must have a tool that can be used to measure and report compliance status as well as one that aids in the improvement of hand hygiene performance. For example, the system may produce displayable charts that can be used to further educate and motivate employees. The total system—educating, measuring, reporting—should promote and encourage buy-in at every level of the organization for complete success.

Using Wireless Technology in the Process

Various system options are available to respond to the hand hygiene performance improvement process. Selecting the system that best suits the environment takes careful evaluation. Reliable, affordable wireless technology today influences this buying decision tremendously. With the right educational program, a wireless system removes many, if not all, of the obstacles to installation, and outperforms manual methods.

There are a range of factors to consider when selecting an appropriate system, including cost and return on investment to the psychological and emotional matters of ease of use and overcoming concerns with respect to personal privacy. Also, the system should complement and support the ongoing educational program.

Counting Soap/Sanitizer Dispensers

As an alternative to no means of measurement, today there are several manufacturers, who produce soap/sanitizer dispensers that contain counter modules. The counter is tripped each time soap or sanitizer is dispensed.

In those cases where hand washing should be part of an established procedure, these counting dispensers seemingly offer a low-cost entry-level system. Technically these dispensers are without external wires but are not considered “wireless technology” as they cannot communicate with other devices. Since the dispenser has no means of transmitting its data contents, valuable information remains locked inside. To retrieve data, a manual reading of each counting dispenser is required. That means that at the appointed time (hourly, per shift, per day) someone must be assigned to open each such dispenser, read the count displayed, and record it. Recording might be done via traditional pen and paper or PDA. Obviously, unless strict operating procedures are defined and adhered to, it is quite possible that valuable hand-hygiene performance data might never leave the dispenser.

The manually obtained recorded information must then be transferred to a computer. It is processed either through manual manipulation of an Excel-like software package or through custom software to generate reports for management review.

Although the actual cost of these counting dispensers is low, the gathering and processing of data is highly labor intensive and subject to error. Note, too, that processing software is not included and is an additional expense. In the long run, this method of monitoring hand washing to meet compliance criteria becomes expensive, invites inaccuracies, and thus, is ineffective.

An additional item to note is that this type of system becomes very cumbersome, if not altogether impossible, when there are multiple sites and multiple locations that need to be combined into a single report for comparative analysis and corporate review.

Active RFID

Built inside a badge or piece of clothing, an RFID chip or tag can wirelessly communicate with other devices (e.g. a sensor at the entry to the kitchen or a soap dispenser) and can detect events such as an employee in the wrong location of the food processing plant, or a staff member who did not wash their hands. Several types of badge-based or active RFID systems have been introduced in the last 10 years. Current badge-based systems may be partially or wholly implemented using wireless technology, depending upon the vendor.

Strictly controlled environments, such as food processing plants, require this level of detailed individual employee information and warrant this invasion into personal hygiene behavior. In these cases, RFID technology appears the best solution and may even become a de facto standard for compliance monitoring in areas requiring high levels of security and enforcement.

Employees wear badges or clothing with embedded RFID tags. When someone does not comply with the system “rules,” as defined by the company, and/or possibly by government agencies, that person can be immediately identified to avert potential hazards. Identification may occur at the badge level, i.e. the badge may turn a different color permitting everyone with whom the out-of-compliance individual comes in contact to be aware of the infraction, or, more subtly, a notification may be sent to the supervisor for resolution. Alternatively, both actions may occur.

Such systems require not only badges or clothing equipped with RFID tags, but also the appropriately configured complementary devices that communicate with these tags and transmit these communications for immediate notification and data gathering. Note that systems which use their own proprietary soap or sanitizer dispensers can also disrupt the supply chain, potentially forcing the purchase of soap and sanitizer from at least two vendors (i.e. one supplier of soap/sanitizer for the badge-based system and one supplier for all other dispensers in the enterprise that are not part of the system). The best solution to this issue is a dispenser agnostic system, which avoids this problem.

In the case of a wholly wireless system that is dispenser agnostic, retrofitting existing soap/sanitizer dispensers is a cost-savings possibility to be seriously considered. Additional components are required for processing and delivering reports to management and may be included in the total system purchase. Each vendor will approach system configuration differently. It is critical that your evaluation take all of these various elements into consideration.

The level of infrastructure required is dependent upon many issues, including but not limited to the size of the facility, the number of hand wash areas and stations, the method of transmission (i.e. via internal LAN or Internet) to the data server computers. Note that the most ecological and efficient of systems will deliver all reports and graphical analyses via the Internet. This eliminates the necessity of being at the right computer with the right software to view the information. Instead, reports are available to all authorized persons within the enterprise, regardless of their location.

It can easily be argued that active RFID wireless implementation is the most costly in terms of system hardware. If your company requires the individual level of monitoring that these systems offer and is considering a badge-based system, keep in mind that a wholly wireless implementation is significantly less costly than a partially wireless system. A truly wireless badge-based system is also a much easier to install, maintain and upgrade.

Vendors offer multiple options and system configurations. As with any major purchase, a return on investment analysis is highly recommended to determine the vendor and configuration that will provide the best performance for your operation.

Beyond cost and complexity, a food service business that implements a badge-based system must overcome questions relative to the invasion of the individual employee’s privacy. The average quick service restaurant may be best served by a simpler, less intrusive system.

Team Performance

Now you may think this is a bit off the subject of wireless technology and hand hygiene, but allow me to digress for a moment to discuss the concept of teamwork. It has long been held that working in teams is more effective in the execution for a common purpose and for achieving departmental or corporate performance goals. Without delving further into the psychoanalysis of teams, a basic reason is that the team concept generates mutual accountability for a group’s success.

Recognizing the team concept as a viable performance improvement tool and continuing education as a necessity in improving hand hygiene, let’s look at one more method of improving hand hygiene—team performance measuring.

We have discussed two virtual extremes thus far, simple counting dispensers versus complex active RFID or badge-based systems. Counting dispensers indirectly use the team concept; RFID systems are focused on the individual’s performance. In between the two is another wireless technology focused on improving hand hygiene performance and promoting the performance goals of the team.

The team performance measuring system spans the first two methods described. First, it embeds a wireless transmitter within the counting dispenser. When soap or sanitizer is dispensed and counted, the information is electronically stored. Then the collected data is transmitted wirelessly to a building Internet gateway. The gateway is nothing more than a receiver and transmitter. It receives data from the building network of dispensers and transmits the information via the Internet to the vendor’s secure, remote data servers. Accumulated data on these servers is processed automatically. Performance measurements can be presented by individual location and comparatively reported by multiple locations. Authorized users within a particular food service enterprise can view the graphical analysis reports through any web browser from any location.

Wholly wireless systems are easily installed, operated, maintained and upgraded. By eliminating the human element in the data gathering stage, and storing and processing data remotely, such systems prove to be the lowest cost implementation. No additional labor costs for data collection or analysis are incurred and there is no need to purchase data storage servers or other computer peripheral equipment.

Rather than reporting individual actions, these systems consider the team approach. Reports are based on team events such as the shift or the day or the number of meals served. This enables the team to view and improve performance as a group without singling out any individual. In so doing, higher performance results while personal privacy concerns are avoided.

Team performance measuring systems are an excellent solution for any food service enterprise employing the latest wireless technology, economically priced and totally unobtrusive, regardless of the size of the operation or number of locations.

Conclusion

It’s said that the only thing constant in life is change. Over the years, the waves of wireless technology have created major shifts in our behavior. Today’s changes applied to soap/sanitizer dispensers to improve hand washing may appear minor but the impact on our quality of life will be significant.

And the effect on our lives does not stop at hand hygiene and the soap dispenser. Wireless systems are available today that can detect near empty soap and paper status, track consumption of these items, monitor water usage, and alert maintenance of overflow conditions. The beauty of wireless technology, now that the basic networking infrastructure is becoming ubiquitous, is that adding additional systems, such as wireless hand hygiene performance monitoring systems becomes very straightforward, associated costs are incremental and efficiencies of cost are significant.

Recall that wireless TV remote control that increases waistlines. Well, it is fairly safe to predict that wireless technology may not be reducing waistlines anytime soon. However, it just might ensure our good health. How’s that? It won’t be long before selecting a place to dine will include looking for the sign that indicates a restaurant utilizes a trusted hand hygiene system to help ensure the safest and hygienic dining experience available.

Those enterprises that implement a hand hygiene performance improvement process that includes education and automated, wireless measuring and reporting, will profit well from the investment.

Sue Stedd, of Cognos Systems, can be reached at 858-566-5758 or sue.stedd@cognos-systems.com.

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