According to the Centers for Disease Control, almost 75,000 patients died last year from healthcare-associated infections (HAIs) in the United States. It's consistently ranked as one of ten leading causes of death. HAIs are defined as infections that patients contract after they’ve been admitted—that is, the patient arrives at the hospital with one ailment, and then picks up a new infection during his stay. Those preventable infections cost hospitals around $30 billion in added costs a year.

The culprit is usually unwashed hands. Studies vary, but show that on average hospital workers only wash their hands between 10 and 50 percent of the time they enter or exit a patient room. That number, of course, is supposed to be 100 percent. When harried hospital workers forget to wash their hands and move from, say, a sick patient to a surgery, bacteria can travel with them. Unfortunately, “the problem is invisible,” says Brent Nibarger, chief client officer at Biovigil Hygiene Technologies. “The bacteria and things that get transported, you can’t see it. We often say if the bugs glowed orange or green or yellow you could solve this more powerfully.”

Bacteria might not emit flashes of color, but a gadget can. This summer, Biovigil rolled out their first product: a sensor-laden electronic badge that uses traffic-light language—red, yellow, and green flashing lights—to hold doctors accountable for hand-hygiene.

Biovigil's chemical sensors can detect clean hands, and then flash a green light of approval. Biovigil

To use the Biovigil system, hospital workers clip the two-ounce electronic badge onto their pockets. The badge can detect infrared sensors that Biovigil installs in patient rooms, so that every time the doctor or nurse in question walks in or out of a new room, the badge knows. The hospital worker will sanitize his hands, either with Purell or soap and water, and hold one hand near the badge. Chemical sensors in the Biovigil gadget will detect clean hands, and cue a green light. If the doctor delays the process, the badge turns yellow. If they downright ignore it, it glares red.

“A five-year-old can understand it, and a 90-year-old patient understands it. Everyone understands traffic light simplicity,” Nibarger says. “Once you wear this on your chest and have your first patient interaction it instantly changes the accountability and behavior, because no one is going to be running around with a red badge, except in rare circumstances.”

To Shame, or Not to Shame?

Depending on your attitude, that interaction is either a friendly nudge in the right direction or a heavy dose of shame. It’s also what most distinguishes Biovigil from a competitor that also launched at this summer's Association for Professionals in Infection Control and Epidemiology conference in Anaheim, California. General Sensing's MedSense is one of myriad new products and initiatives aimed at getting numbers up for hand-hygiene compliance. (The makers of Purell have even introduced tracking technology for soap dispensers. However, Nibarger says wall mounted solutions aren't ideal because, "if you slow down the natural work flow pattern, when you’re doing this 140 times per shift, users will have a very hard time adopting a solution.")

Like Biovigil, General Sensing uses a clip-on device to keep tabs on whether doctors wash their hands or not. Instead of chemical sensors, the badge interacts with mobile stations—like bottles of hand sanitizer rigged with sensors—negating the need for a system installation. If a doctor doesn't use the hand sanitizatizer, General Sensing simply buzzes them. No lights, no visibility for the patient.

Like Biovigil, General Sensing can collect a ton of data on which hospital workers are washing their hands, and when and where they’re doing it. Biovigil is more emphatic about making the interaction visible. “If you’re not solving the problem at the point of care, and not communicating that the problem is being solved to patients, family members, coworkers in a tangible way, you’re not going to see the impact you’re expecting,” Nibarger says. Indeed, being watched is a powerful motivator: an article in The New York Times reported that when workers at the North Shore University Hospital on Long Island, New York, knew they were being watched, hand-washing compliance rates shot up from 10 percent to 88 percent.

A Useful New Data Set

Biovigil’s badges float from hospital worker to hospital worker as they change shifts. To activate a badge, staff members plug in a modified USB key encoded with their identification number. Later, when the badge charges at a docking station, it downloads the comings and goings of that particular worker into a system. Not the minutiae of workers’ whereabouts—Biovigil isn’t GPS-enabled—but a log of hand-washing activity and timed visits to patient rooms.

For hospitals, that data could answer some big questions: “Are there more or less interactions from the daytime hours to the nighttime hours? More or less from weekend shifts to weekday? Do isolation patients get more or less care than non-isolation patients? What is the average time that nurses versus ancillary departments versus doctors interact with patients?” Nibarger says. Even though Biovigil is vehemently focused on solving what Nibarger calls "the ‘gel in, gel out,'" problem, it could also become a powerful tool for optimizing workflow.

On average, Biovigil costs hospitals $2 to $3 per room, per day. They're approaching installation like a cable company (minus the infuriating wait times, of course): for a blanket fee, Biovigil installs the infrared sensors and supplies hospitals with the hardware and training.