With COVID-19 being a global pandemic, the importance of healthcare and hygiene has skyrocketed. The eight steps to correctly wash your hands, for one, has been widely circulated as a means to keep bacteria at bay. Hand sanitisers are running out of stock, and people have even stepped up to create homemade hand sanitisers for the community.

Herein begets the question of whether we are able to go a step further to ensure hygiene? Instead of limiting it solely to educating and encouraging the masses, what if individual hygiene can be tracked and enforced in real time? Contact tracing will be made much smoother to better contain the outbreak.

What if the National Centre for Infectious Diseases (NCID) already had plans for this, even prior to COVID-19?

What exactly is the NCID?

NCID and its staff. (Source)

Despite the NCID being in the spotlight in recent months given the spread of COVID-19, it is actually a fairly new entity that was opened about half a year back in September 2019.

The NCID houses clinical services, public health functions, outbreak training, public education and community engagement in outbreak readiness under one roof. Essentially, the centre provides a comprehensive and integrated approach to handling infectious disease threats.

Located at HealthCity Novena, it is a 14-storey, 330-bed purpose-built facility set up by the Ministry of Health to enhance infectious disease outbreak management and public health preparedness for the nation. While the building is equipped to handle 330 patients, this number can rise to 500 when there is a surge required.

It even has specific containment facilities such as the High Level Isolation Unit to contain suspected or confirmed patients with highly infectious diseases, negative pressure wards which prevent airborne spread of disease, as well as a self-contained lock-down system that can be applied to individual wards, floors, wings or even the whole building.

What is this real time hygiene tracking that you were talking about?

The RTLS in action. (Source)

Innovations in Information Technology (IT) can boost any industry’s capabilities, and healthcare is no different. NCID announced in September 2019 that it will roll out a pilot of the Real-Time Location System (RTLS) in late 2019. This very timely trial is almost optimally timed with COVID-19, given that it was first reported to the World Health Organisation Country Office as a pneumonia of unknown cause in Wuhan, China, on 31 December 2019, with the first case dating as early as 17 November 2019.

The RTLS can track patients, visitors and staff inside the hospital during an outbreak. Individuals are considered to have come into contact when their tags detect that they are within two metres of each other for five minutes or more. This allows for rapid and reliable contact tracing so that necessary actions can be taken quickly to curb further transmission.

As evident, this system tracks the precise movements of people, as compared to the past when only entry and exit points of visitors and staff to the hospital and patient rooms were tracked. This means that without RTLS, multiple methods will need to be in place when doing contact tracing. Patient interviews, perusals of medical records and more are needed to piece information together.

Given that hand hygiene is key to infection control in a healthcare setting such as hospitals, the RTLS can also monitor and alert hand hygiene compliance of healthcare workers. Pressure sensors are placed under hand sanitisers and soap dispensers to ensure that staff does a thorough hand hygiene procedure. Failure to do so before interacting with a patient will result in a beeping of their tag until the procedure is finished.

The RTLS will also facilitate asset tracking, making it easy to locate and recall key equipment like beds and wheelchairs in the event of a surge situation or an outbreak.

Alright, but how does it actually work?

The RTLS tags and IDs. (Source)

As its name suggests, RTLS is a system used to provide immediate or real-time tracking and management of medical equipment, staff and patients. It can be thought of as an “indoor GPS” for hospitals.

Typically, a location sensor is attached to an asset, which can be a piece of equipment, such as a staff’s badge, and more. Using a unique ID, the system can locate the tags and provide real-time information about its position within a facility.

Would this system be useful in other instances?

The RTLS not only helps in the event of an infectious disease outbreak, but is also useful in improving workflow, reducing costs, and increasing clinical quality, just to list a few.

As one can imagine, a patient in a hospital is subject to many risks. Equipment errors or hospital-acquired infections are a constant threat. An example of a hospital error that could have been prevented using RTLS occurred at a hospital in Pasadena, California. 11 patients died due to infections from three dirty duodenoscopes. It is clear that hospitals need to relook the reprocessing and storage of their equipment to prevent recurrence.

RTLS could have helped by automatically tracking and creating alerts through every stage of this cleaning process. Hospital staff will immediately know when medical scopes need to be cleaned and will be instantaneously notified of any possible infection risks.

Beyond advancements in the RTLS, Singapore has also created the fever screening system that you see everywhere. The country is also exploring plasma therapy for COVID-19 patients given that the antibodies in blood of recovered patients can be helpful in treatment, with some success already seen in trials in China. These are all exciting news for the world in a time when hope seems low.

Author

Vanessa Ng

Contributor

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