A nurse walks quickly down a busy hallway in a hospital, navigating the usual obstacle course of medical carts, patient visitors and health care professionals in her path. She's carrying a blood pressure monitor, and has some pills to administer, when she enters the patient's room. She knows she needs to pump some sanitizer on her hands, but before she can put down everything she's holding, her patient calls her over. As she's about to help the patient out, a small device clipped to her scrubs vibrates.
“That's my reminder to start looking for a wall unit with a hand-sanitizer dispenser or a sink,” says Dr. Veronique Boscart, a registered nurse and an affiliate scientist at the KITE Research Institute, currently working at Conestoga College. “It's not that I don't want to wash my hands, I just forget because there's so much going on.”
The wearable device, called the Buddy Badge, was spearheaded by Dr. Geoff Fernie, senior scientist and former Research Director of the Toronto Rehabilitation Institute, to address a simple but critical problem: how can we increase hand hygiene to reduce the incidence of hospital-acquired infections? His work is the culmination of 17 years of KITE research – it just so happens that it became ready for use just as COVID-19 hit.
“Each patient admitted to hospital in North America has a 5 per cent chance of catching something they didn't have when they walked in, resulting in 100,000 deaths per year,” says Dr. Fernie, adding that the situation is even more dire at long-term care facilities, with probably approximately 400,000 such deaths per year – and that's before the arrival of COVID-19. “Handwashing is the most effective way of limiting those infections.”
Indeed, studies show that a 20 per cent increase in hand hygiene compliance can cut hospital-acquired infections by up to 80 per cent, he notes.
Previous efforts to improve hand hygiene were flawed. It wasn't enough to monitor overall compliance among health care workers who pop in and out of patients' rooms and might wash their hands 100 times in a single shift. They needed real-time feedback to change their behaviour.
“It's not much help to get a notice a week later telling you your hand hygiene was 4 per cent lower than it was the week before,” says Dr. Fernie. “You need a kind and supportive tap on the shoulder in the moment.”
That's what the Buddy Badge does – it offers a friendly reminder to wash your hands, and only when necessary. The 17-gram wearable device, which looks like a large domino, clips to a shirt and communicates with sensors that are mounted on doorways and hand-sanitizer dispensers to detect when the wearer enters or exits a patient's room and whether they've cleaned their hands. If they have washed, it lights up green; if not, it vibrates. It's discreet enough not to embarrass the wearer, and smart enough to detect if they've washed their hands when necessary.
As an added bonus, users can download their hand hygiene reports to their phones or computers to see how they're doing – and can do so anonymously, if they prefer.
The device has been wildly successful. After completing prototype beta testing, Dr. Fernie and his team published three papers in the American Journal of Infection Control in 2018 and 2019 finding that the Buddy Badge system can double compliance with hand hygiene. That means a 1,000-bed hospital using the system can save 50 lives per year, notes Dr. Fernie.
To make the product commercially available, Dr. Fernie licensed the technology from University Health Network and launched a startup called Hygienic Echo, which is now marketing the Buddy Badge system to hospitals, nursing homes and retirement homes, with demonstration centres being set up at three Ontario hospital wards and a long-term care home where prospective buyers can observe the system in action.
As the COVID-19 pandemic has shown, residents in long-term care homes are particularly vulnerable to infection – in part because they tend to be frail seniors and have underlying conditions – but also because there are so many people coming in and out of long-term care homes, and in general, residents don't stay in their rooms. “We associate hand hygiene with doctors or nurses, but someone serving a meal, giving a haircut or just visiting a resident can spread a virus just as much as a health care professional,” says Boscart, who was one of the nurses who pilot tested the Buddy Badge at Toronto Rehab. “I can see a time when anyone coming in will get a Buddy Badge, in addition to a mask, to better protect residents.”
With the new reality of COVID-19, Dr. Fernie can also see the technology finding a foothold in the food processing and travel (e.g., cruise ships) industries, as well as others. “This virus has finally woken people up – not just in healthcare, but in the whole economy – that antibiotic resistance is climbing and there are a growing number of infections that are untreatable,” notes Dr. Fernie. “This is a huge challenge facing mankind, and the biggest thing we can do is improve hand hygiene.”