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27 May 2020 by Dr Richard Cooke

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Dr Richard Cooke,
Former Consultant Medical Microbiologist and Director of Infection Prevention and Control at Alder Hey Children’s NHS Foundation Trust and Founder of Hy-genie


I retired about two and a half years ago from Alder Hey but I have gone back three days a week as a Consultant Medical Microbiologist, in response to COVID-19. I have to follow the same social distancing restrictions as everybody else, during very strange and troubling times, but I have to admit the strangeness and the sense of inconvenience are mixed with a certain amount of excitement because we’re preparing to introduce a new hand hygiene system across the trust.

I’ve devoted my career to infection prevention control and hand hygiene plays a big role in reducing the risk of cross-infection. As I was retiring from clinical practice, I started to work with Alder Hey’s Innovation department and founded Hy-genie, a remote monitoring system for improving hand hygiene. During the first year of the start-up, I also received helpful and encouraging support from colleagues at the Innovation Agency. 

Just a few weeks ago the Government and the health service started urging people to wash their hands for 20 seconds. All of a sudden hand hygiene – which I’d spent much of my professional life focused on – was all over the news. I can’t deny that the COVID outbreak has been a powerful argument in favour of better hand hygiene. It’s definitely accelerated the introduction of Hy-genie here – I’m 100 per cent sure of that. 

I reckon we would have had installed it by early next year, perhaps in spring, if it hadn’t been for the coronavirus, so the whole process has been accelerated by between six and nine months and we are expecting it to be installed in the next six weeks or so. 

The principle behind Hy-genie is really simple: a member of staff wears a sensor incorporated into their NHS ID card-holder which triggers a sensor in a gel or soap dispenser every time they use it. That information is collected in a base station and the system provides a very accurate measure of hand hygiene compliance in the unit or across a trust. Confidential and personalised feedback is given to every member of staff, with encouragement to achieve individual performance goals.

The system we’re introducing shortly at Alder Hey is the ‘lite’ version – it’s different in that it doesn’t record data at individual level but at a ward or unit level. This has been developed specifically as a rapid response to COVID-19.

It will give us aggregated data by unit or ward level and then we’ll be able to try to improve people’s performance with hand washing.

 

Dealing with bugs is a challenge

From the National Audit Office report in 2009, around 300,000 people a year come down with healthcare-associated infections. A significant number are preventable infections which can have a devastating impact. I find it frustrating that so much illness is preventable – based on prevalence data, around four to five per cent of patients in hospital beds at any one time have healthcare-associated infections. 

I don’t recall the exact moment I decided to specialise in infection prevention and control but there would have been a point when I was an undergraduate that certain people influenced me and changed the direction of my career. I liked the challenge of dealing with bugs. 

Bugs tend to be one step ahead of us in terms of intelligence (eg antibiotic resistance), so dealing with them is always challenging. You want to outwit them. You even feel a kind of respect for the bugs you’re dealing with, and that’s certainly true of coronavirus.

Every healthcare organisation tries to monitor compliance with hand hygiene. Every time you touch a patient you should wash your hands before and after. The usual monitoring approach is direct observation, perhaps a nurse on a ward observing people. It’s not very reliable if you know someone is watching you (the Hawthorne effect), it’s not 24/7 and it captures only a small percentage of all hand hygiene events in an organisation. 

The biggest weakness is that normal monitoring doesn’t generate meaningful data. If you have no strong data, it’s difficult to persuade people their hand hygiene is good or bad because you’ve weak evidence to back it up. So, unless you give individual feedback there’s little incentive to change.

 

Not seen as Big Brother

People are receptive to change, so long as you make it very clear that an individual’s data stays at an individual level and people aren’t identified and made to feel ashamed.

One of the great strengths of the Hy-genie system is that it depends on sensors in an individual’s NHS ID badge. Every member of staff wears a card-holder so they’re not required to change their behaviour in any way. If you ask people to change their behaviour they often won’t.

In the end, I’m helping to set the strategy to avoid infections but the responsibility is everybody’s. I see my role as an educator. All staff want to do their best for patients but occasionally they forget and we can help them. We’re just giving them a nudge. It just requires one break in hand hygiene for the bugs to break in. They’re clever, let’s not forget.

 

Benefits to virtual meetings

Alder Hey is observing social distancing just like everybody else. We have virtual meetings, virtual handovers, virtual multi-disciplinary meetings. It’s radically different from when I left in 2017. You spend a lot more time looking at a computer screen than when I retired. 

There are definite benefits to virtual meetings. When you have people in a room together there can be a bit of jostling for space, which can be a challenge. You can’t let that happen with digital technology because it would be complete chaos. People have to be on mute when someone else is speaking, so that’s quite refreshing. But it can be a problem when you’re trying to watch someone and read a table of data at the same time. I’ve come into this with zero training and I’ve had to pick it up, the same as everybody else.

It’s working very well so far but I think there’s a lot to be said for being able to view people’s body language in a meeting. The whole business of building relationships with people just can’t happen unless you’re physically together. You have to go with it and make it work. At Alder Hey people are thinking about office space and whether more people can work remotely. But what we can’t weigh up at the moment is the impact on patient care. We just can’t know that.

 

Volunteering stopped

Since I retired, I have been involved in a variety of volunteering roles. I have had to train as a volunteer cycle mechanic which has been as challenging as founding a new hand hygiene monitoring system! Unfortunately, all these roles have had to cease thanks to COVID-19. However, I am glad to be back at Alder Hey to help out.

 

Story told on 15 May 2020


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