What are the most common symptoms caused by tachyarrhythmias?

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Question

Question 1

More than half of all cardiac arrhythmias involve the atria.

True

False

Question 2.

What are the most common symptoms caused by tachyarrhythmias?

Sweating

Thirst

Palpitations

Headaches

Question 3.

For women with known CAD and diabetes, which is most appropriate to assess CAD risk?

ETT

Coronary bypass surgery

Coronary catheterization

ETT with imaging

Question 4.

Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?

Does not depend on operator experience

Costs are the same

Results are available more quickly

Doesn’t matter because there are no advantages

Question 5.

Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?

E. Coli

Gardnerella Vaginalis

Mycoplasma Hominis

Chlamydia

Question 6.

What purpose does the principle of fidelity serve in the provider/patient relationship?

Ensures that providers honor their commitments to the patient

Obligates the provider to a one-on-one relationship with the individual

Ensures that patients receive whatever they want

Maintains costs in the healthcare arena

Question 7.

In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?

True

False

Question 8.

The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?

True

False

Question 9.

Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?

Prostate cancer

Lung cancer

Lymphoma

Lupus

Question 10.

What ECG changes can reduce the specificity of the ETT?

Exercise induced bundle branch blocks

Paced rhythm and resting bundle branch block

Paced rhythm and exercise induced bundle branch blocks

Low voltage up sloping of the ST-segment

Question 11.

You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?

Newly diagnosed diabetes

Back pain or flank pain

Visual disturbances

Headaches

Question 12.

What is one of the common causes of a Saccular Abdominal Aneurysm?

Poor kidney functioning

Age

Drugs: illicit and prescribed

Trauma

Question 13.

The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons?

Women having thinner ventricular and septal muscles

Women usually have single vessel or non-obstructive disease

Women cannot exercise as vigorously as men

Women typically have multiple vessel disease

Question 14.

Population disease management is a term used to describe:

High specificity disease states

Low specificity diseases states

Low prevalence specific diseases

High prevalence specific diseases

Question 15.

You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is referred to as what kind of aneurysm?

Thoracic aneurysm

Budging sac aneurysm

Saccular aneurysm

Fusiform aneurysm

Question 16.

Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?

Sensitivity is increased

Sensitivity is decreased

Specificity is increased

Specificity is decreased

Question 17.

Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty.What differential diagnosis should you consider in this patient?

Acute viral prostatitis

Stomach virus

Acute bacterial prostatitis

BPH only

Question 18.

We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:

Between the nurse practitioner and their physician mentor

Between two healthcare providers about a single patient

Between the patient and their family

Between the patient and the nurse practitioner

Question 19.

The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?

Rapid heart rates and coronary artery narrowing

Decrease in coronary blood flow

Decreased heart rate and increased systolic blood pressure

Increased coronary flow and increased systolic blood pressure

Question 20.

A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?

You are out of other options

CAD in women is under diagnosed

To please the patient

Women present with the same pattern of CAD as do males

Question 21.

Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment.What do you need to know about these changes to manage your patient’s care?

: This patient needs to see someone more experienced in treatment of CAD

These changes are predictive of myocardial infarction

These changes have minimal predictive value for CAD

These changes predict dire outcomes

Question 22.

When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?

Bloated stomach

Kidney failure

Bleeding ulcers

Abdominal aortic aneurysm

Question 23.

You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly interested in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient?

1.5 g/day

No added table salt

3.0 g/day

2.3 g/day

Question 24.

Why would inability to exercise reduce the specificity of the routine ETT?

Produces QRS changes that cannot be interpreted

Produces persistent ST-segmental changes and T-wave abnormalities

Causes ST-segment changes and P-wave abnormalities

Will not produce any changes in ECG

Question 25.

By standard criteria, how is a positive stress test defined?

Development of a horizontal or down sloping ST-segment depression of 1mm

Down sloping of the ST-segment at the J point of the QRS

Development of a horizontal or down sloping ST-segment depression of 10mm

Upward sloping ST-segment measured at the J point of the QRS

Question 26.

What are the two types of bradycardia recognized by the American Heart Association?

Relative and absolute

Absolute and pending

Refractory and non-refractory

Relative and dynamic

Question 27.

You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?

This happens to all women as they age

No need to worry. This is normal. Your mother was correct.

This is not an expected condition related to aging.

This happens to men as well and most women before your age.

Question 28.

What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?

ETT cannot be used for detection

Difficult to detect by ETT

Requires both for detection of changes by ETT

Easier to detect by ETT

Question 29.

What three conditions definitely alter the results of echocardiography in determining CAD?

Obesity, rapid heart rate and lung disease

Diabetes, kidney disease and tooth decay

Obesity, slow heart rates and hypertension

Previous MI, hypotension and diabetes

Question 30.

Specifically, when is an ETT considered to be negative?

Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate

Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia

Patient exercises to 20% maximum age-predicted heart rate without induced ischemia

Patient exercises until tired without evidence of induced ischemia

Question 31.

All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be used to justify a ETT in an asymptomatic patient?

A smoker of 3 weeks

A member of congress

Sedentary and wishes to begin aggressive exercise

Developmentally challenged

Question 32.

BPH is not a risk factor for Prostate cancer. Is this statement true or false?

True

Question 33.

Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?

True

False(not confirm)

Question 34.

Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are discovered in asymptomatic patients?

40%

20%

10%

75%

Question 35.

Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?

President and Congress

Population management and healthcare practice

Socialized medicine and governmental controls

Monetary savings and limited disruption in healthcare delivery

Question 36.

What are the two main types of heart failure?

Systolic and diastolic

Hopeless and severe

Left sided and main

End diastolic and pressure related

Question 37.

The majority of all strokes are non-ischemic. Is this statement true or false?

True

False

Question 38.

When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?

True

False

Question 39.

Maintenance of an Isometric ST-segment during exercise is the response of?

A normal heart

Hypo profusion

An abnormal heart

CAD

Question 40.

The goal of self-management is to specifically do what?

Engage patients in their own care

Engage insurance providers in patient care

Engage providers in patient care

Engage government in greater involvement in patient care

Question 41.

Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?

Add digitalis to control the heart rate

Consult cardiologist immediately for guidance

Discontinue Beta Blocker and replace with another therapy if necessary

Atropine injections

Question 42.

Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?

Sensitivity would be increased because of lung disease

Specificity would be increased because of obesity

Sensitivity would be reduced because of obesity and lung disease

Specificity would be reduced because of obesity and lung disease

Question 43.

You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?

Negative

Impossible

Positive

Non-readable

Question 44.

Your patient is newly diagnosed with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.

X-Ray of chest

Tranesophageal echocardiography

Ultrasound of chest

CT Scan

Question 45.

Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?

Shortened diastole

Lengthened diastole

Lengthened systole

Shortened systole

Question 46.

At what age is atria fibrillation most common?

In childhood

60 years or older

30 years

45 years

Question 47.

Automaticity is a property common to all cardiac cells. Is this statement true or false?

True

False

Question 48.

Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?

Stroke

Significant CAD

Impending death

Low risk of CAD

Question 49.

You tell a patient that he has a murmur. He says he has been told this before, but wonders what causes the unique sounds of a murmur. Which of the following would be your best option?

Turbulent flow of blood

High pressures caused from HTN

There is no reason, it just happens

Almost always from a sclerotic valve

Question 50.

What is the treatment of choice for uncomplicated community-acquired cystitis?

TMP-SMZ

Any antibiotic will treat this diagnosis

Amoxicillin

Penicillin

Question 51.

Any patient presenting with symptomatic bradycardia should be referred

to a cardiologist for management. Is this statement true or false?

True

False

Question 52.

Encouragement of patients to take effective actions in their own healthcare refers to the concept of:

Self-management support

Interprofessional support

Physician or provider-driven care

Family care givers

Question 53.

You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT.You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?

Enhances sensitivity and specificity of CAD detection

Enhances sensitivity while reducing specificity of CAD detection

Enhances specificity while not changing sensitivity of detection for CAD

You like pretty pictures of wall motion

Question 54.

Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?

True

False

Question 55.

What sexually transmitted disease is most widespread in the USA today?

Chlamydia

Gonorrhea

Syphilis

HIV/AIDS

Question 56.

Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?

Detect and evaluate blood shunting from a septal defect

No advantage is seen for this patient

Gives better screen shots of wall abnormalities

Provides assessment of prosthetic valve function

Question 57.

Sexual partners of a patient with a diagnosed STI should always be examined and treated. Is this statement true or false?

True

False

Question 58.

Your patient presents with tachycardia. The QRS is measured at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?

Ventricular tachycardias

Premature junctional contractions

Atria fibrillation

Ventricular fibrillation

Question 59.

A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been treated numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be included as a potential top suspect in your choice of diagnosis?

Chronic bowel obstruction

Meglacolon

Appendicitis

Abdominal aortic aneurysm

Question 60.

What are the most common mechanisms to produce cardiac arrhythmias?

Decreased automaticity, triggered activity or reentry

Reentry, electrical dysfunction or activity

Stress, hard work or swimming

Enhanced automaticity, triggered activity or reentry

The post What are the most common symptoms caused by tachyarrhythmias? appeared first on Infinite Essays.

You are a project manager assigned to implementing a new computer system in an organization:

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Part one:

Discussion Question:

Try out recording your final presentation. First, create a few PowerPoint slides to be used for the presentation. Next, record a draft version using www.screencast-o-matic.com or another free program. Discuss your experience with usingwww.screencast-o-matic.com or other presentation recording programs. What has worked for you? What are you struggling with?

Reply to at least two peers providing support and recommendations.

Your initial posting should be at least 400 words in length. Please reply to at least two
classmates. Replies to classmates should be at least 200 words in length.

NOTE: Start working on your final PPT now as you will need to share this with your classmates for the final Module 8 Initial Discussion. Directions for the Signature Assignment are in Module 8.

Part two:

Start by reading and following these instructions:

  1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
  2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
  3. Consider the course discussions so far and any insights gained from it.
  4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Implementation of New Systems

Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Be sure to include a title slide, objective slide, content slides, reference slide in APA format. Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly citations to support your claims. This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level. Save your assignment as an MP4 document (.mp4) or link.

You are a project manager assigned to implementing a new computer system in an organization:

  • Why is it important to understand usability, configurability, and interoperability? Should these concepts outweigh the underlining cost of the new system? Which system do you recommend and why?
  • During phase one, you are selecting a team. What characteristics are important to consider when selecting a team?
  • During phase two the following principle was discussed, “lead with culture, determining where the resistance is,” and then, engage all levels of employees (Sipes, 2019, p. 161). What does this principle mean to you and how can you implement this principle?
  • How will you handle physician and other key professionals’ resistance to change and using the new system?
  • Discuss possible pitfalls during the implementation phase and how you can avoid them?
  • Describe your personal experience with automation and new information systems.

Assignment Expectations:

Length: Recorded presentation between 7 and 12 minutes in length. The presentation should include a Power Point and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Use www.screencast-o-matic.com or other software to record your presentation as an mp4.

Structure: Include a title slide, objective slide, content slides, reference slide in APA format.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as an MP4 document (.mp4) or link

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.mp4”)

Presentation: Use a presentation software (PowerPoint, Google Slides) to create a visual presentation. Then use screencast-o-matic or other screen recording program to record an mp4 presentation between 7 and 12 minutes in length. ***Please do not record as voice-over PowerPoint because this cannot be saved in mp4 format.*** If you submit your assignment as a powerpoint with voice over recording you will not receive credit for your assignment (or partial credit as you did not meet the full requirements of the assignment.)

The post You are a project manager assigned to implementing a new computer system in an organization: appeared first on Infinite Essays.

Write your definition or description of the issue or problem here. Define your objective clearly for what you want your brochure to accomplish or the goals of the brochure.

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Get your audience’s attention here with emotional appeal, a provocative question, benefit statement, or picture.

Topic or Purpose

Resources Available

List the available in this order with contact information.

· Community Resource #1

· Community Resource #2

· National Resource

· Web-Based Resource

 

 

·

 

·

 

 

Definition or Description:

Write your definition or description of the issue or problem here. Define your objective clearly for what you want your brochure to accomplish or the goals of the brochure.

References

Logo placeholder

Reminder of the Importance of the Topic

Explain why the topic is important.

· Insert your first reason here.

· Insert your second reason here.

· Insert your third reason here.

 

 

Topic

Lead With Evidence

Provide data, information, or research from an evidence-based source of your choice. Cite your source.

FAQs or Testimonials

· Insert your first example or intervention here.

· Insert your second example or intervention here.

· Insert your third example here.

 

 

What do you want your audience to do now?

Do not be subtle. Tell readers exactly what you want them to do, and tell them to do it now. People may forget if they do not act right away. And you do not want them to forget.

· Insert your first here

· Insert your second here.

· Insert your third here.

 

 

 

 

·

The post Write your definition or description of the issue or problem here. Define your objective clearly for what you want your brochure to accomplish or the goals of the brochure. appeared first on Infinite Essays.

Abstract Hand hygiene compliance is the most significant, modifiable cause of hospital-acquired infections, yet national averages for compliance rates remain unsatisfactory

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SYSTEMS-LEVEL QUALITY IMPROVEMENT

A Hand Hygiene Compliance Check System: Brief Communication on a System to Improve Hand Hygiene Compliance in Hospitals and Reduce Infection

Tracey S. Hong1,2 & Emily C. Bush1,3 & Morgan F. Hauenstein1 & Alec Lafontant1 & Chen Li1 & Jonathan P. Wanderer5,4 & Jesse M. Ehrenfeld4,5,6,7

Received: 13 March 2015 /Accepted: 30 April 2015 /Published online: 12 May 2015 # Springer Science+Business Media New York 2015

Abstract Hand hygiene compliance is the most significant, modifiable cause of hospital-acquired infections, yet national averages for compliance rates remain unsatisfactory. Noncompliance can contribute to patient mortality, extended hospital stays, higher re-admission rates, and lower reimburse- ment for hospitals under the Patient Protection and Affordable Care Act. Although several hand sanitizing tracking systems currently exist, they pose problems of personal tracking, workflow interference, system maintenance concerns, among others. Considering these barriers, we created a prototype sys- tem that includes compliance rate tracking, real-time sanitiza- tion reminders, and a data archive for future studies.

Keywords Hand hygiene compliance . Hand sanitation .

Handwashing . Nosocomial infections . Reinforcement system . Compliance rate tracking . Rreadmittance rates

Introduction

Over 98,000 deaths per year in the United States can be attributed to hospital-acquired infections – many of which can be attributed to methicillin-resistant Staphylococcus aureus (MRSA) [1]. The frequency of MRSA infections is inversely proportional to hand hygiene compliance, which is the most significant, modifiable cause of noso- comial infections in hospitals [2]. Hand hygiene compli- ance is defined as properly washing one’s hands with soap and water or an antiseptic agent before and after all pa- tient or patient environment contact [3]. Vanderbilt University Medical Center (VUMC) uses manual observa- tion, education, and incentives to address this problem, but these are time and resource-intensive methods of en- forcement. Other hospitals have employed methods of compliance rate enforcement and tracking but they have proved to be unsatisfactory, as they are either subject to human error, are extremely costly, or infringe on employee privacy.

Non-compliance with hand hygiene is a critical prob- lem because it impacts our ability to provide optimal care, leads to increased transmission of nosocomial diseases, and can lead to significant additional costs incurred by patients and hospitals. These risks could be mitigated through the implementation of sensing technology that is designed around the shortcomings of existing methods. In the 2013 Centers for Disease Control and Prevention (CDC) Antibiotic Resistance Threats report, it was esti- mated that the direct healthcare cost of antibiotic

This article is part of the Topical Collection on Systems-Level Quality Improvement

Tracey S. Hong and Emily C. Bush contributed equally to this work.

* Tracey S. Hong tracey.s.hong@Vanderbilt.Edu

1 Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA

2 School of Medicine, Vanderbilt University, 201 Light Hall, Nashville, TN 37232, USA

3 Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA

4 Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232, USA

5 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37232, USA

6 Department of Surgery, Vanderbilt University, Nashville, TN 37232, USA

7 Department of Health Policy, Vanderbilt University, Nashville, TN 37232, USA

J Med Syst (2015) 39: 69 DOI 10.1007/s10916-015-0253-z

 

 

resistance was near $20 billion annually. This figure does not include the additional estimated $35 billion cost to society attributed to lost productivity [4]. Additionally, the largest cost for patients is often due to extended hos- pital stays. Research shows that increasing sanitization rates can reduce mortality rates and length-of-stay. The North Carolina Children’s Hospital Pediatric Intensive Care Unit implemented sanitization strategies that cut death rates by 2.3 %, decreased hospitals stays by 2.3 days and cut costs by over $12,000 per case [5].

A sustainable accountability and compliance checking sys- tem is needed to address the aforementioned problems. We therefore designed and implemented a prototype system that includes the ability to provide compliance rate tracking, real- time behavior modification, and a mechanism to archive in- formation to be used for future studies comparing infection and compliance rates.

Methods

Our study protocol was approved by the Vanderbilt Institutional ReviewBoard. During the design phase, we iden- tified a series of goals, constraints, and assumptions, which are as follows:

Goals

1. Integrate foam dispenser sensors and a door sensor into a dual-sensing system with a warning alarm to create a sus- tainable device that encourages active avoidance learning.

2. Accurately track hand hygiene compliance rates with the dual-sensing system at VUMC.

3. Store hand hygiene compliance rates in a centralized database.

Constraints

1. Our system has no personal tracking. This is an important feature because of personal privacy concerns which might otherwise impede end-user adoption. [6, 7]

2. The systemmust have easily serviceable parts. A hospital- wide system could include thousands of units, therefore it is critical that those units would not require constant main- tenance. It is also paramount that the system does not interrupt workflow.

3. Finally, to assist with compliance rates moving forward, this system should have the ability to archive data for compliance studies and trend determination. [8, 9]

Assumptions

1. Only one person enters at a time and all entries are human. This assumption is made to exclude the entry of carts, gurneys, and other medical equipment.

2. Everyone must sanitize prior to entry. There are a few instances in which a person is not required to sanitize (if hands are still wet from a prior sanitization), but we are excluding those events.

3. The patient is already in the room. 4. The hand sanitizing canisters are full and users know how

to correctly use them. 5. Sanitization occurs in a timely manner. After observing

patient rooms, we have set this time to be 2 s. 6. The system resets after 2 s. Specifically, this means that

the next event cannot take place until 2 s following the first.

It should be noted that we focused primarily on the sim- plest environment: a single patient room. This made testing the sensing system for accuracy and reliability straightfor- ward because there is a single entryway, fixed sanitizing stations, and one patient per room. Additionally, it helped to solidify our assumptions and constraints for the prototype.

System Design

Our system prototype is comprised of a doorway sensor, two sanitizer dispenser sensors, a microprocessor and an alarm. The doorway sensor, used to track room entry, is an ultrasonic sensor (Maxbotix LV-EZ1 Ultrasonic Sensor, Max Range 6.45 m, Digital Output) attached to the outside of the doorframe. It works by creating continuous distance readings, which are constant in an empty doorway, by outputting correlated pulse widths (Fig. 1c). When the beam is broken (Fig. 1d), the change in distance is detected, which signals the activa- tion of doorway entry. The hospital’s existing hand san- itizing units were equipped with a BFlatback U-Ring^ (Fig. 1a), a device we created to house small IR beam detectors (SHARP Infrared Sensor (GP2D120XJ00F), Range: 4-30 cm, Analog Output). These are used to determine if the hand sanitizer has been used due to a hand breaking the beam under the nozzle (Fig. 1b). The sensors are wired to an Arduino microprocessor (Arduino Uno Micro-processing Board), housed on the wall, where the sensing information is processed. Using built-in Wi-Fi capabilities, the Arduino can send the data to the hospital’s wireless network, allowing the data to be captured in one centralized location for anal- ysis. The Arduino sends counts of both compliant and noncompliant events, and these numbers can be

69 Page 2 of 4 J Med Syst (2015) 39: 69

 

 

recorded to create compliance rates by department. In addition to sending data, when a non-compliant event occurs, the Arduino uses a built-in speaker to sound a short, audible alarm, reminding the person entering the room to sanitize.

The scenarios that our system can handle are shown in Fig. 2.

1. Scenario 1: The user would sanitize, activating the infrared sensor on the dispenser, and walk through the door within two seconds, activating the ultrason- ic sensor on the door. This would register as a com- pliant event.

2. Scenario 2: The user walks through the door first; activat- ing the ultrasonic beam and then uses the hand sanitizer inside the patient’s room within two seconds. This also registers as a compliant event. If the hand sanitizer inside the room is bypassed or activated after two seconds post room entry, an alarm will sound, signaling a non- compliant event.

3. Scenario 3: If a hand sanitizer on either side of the door is activated and there is no entry/exit within two seconds, no event is recorded.

This method accounts for most probable scenarios, even when multiple users are involved. Additionally, the user never interacts with the system because it is automated. The only interaction necessary would be for maintenance purposes (i.e. battery replacement or system repair).

Results

During a pilot testing period, 40 compliant and 40 noncom- pliant events were simulated in a single patient pre-operative holding room. With a successful detection of 97.5 % of the compliant events and 100 % of the non-compliant events, our system delivered an overall accuracy of 98.75%. The Arduino device exported the data to a local spreadsheet every 5 s. Our system also has the capability of wirelessly transmitting data to a centralized hospital database via broadcasted Wi-Fi net- works. The data spreadsheet has the ability to automatically calculate compliance rates for shifts, days, months, etc. based on specific areas of the hospital. The archived compliance data can be compared to the existing gold standard of measuring compliance rates (e.g. secret shoppers), to see whether the alarm system has a positive impact on hand hygiene compliance.

Future Directions and Conclusions

Future applications would include more complex situa- tions such as trauma bays, preoperative rooms and re- covery rooms, which have large quantities of beds sep- arated by curtains and mobile sanitizing stations. With the time and materials at hand, our proof of concept prototype achieved our goals and exhibited the potential for future development. The integration of high perfor- mance wireless sensors with an alternate micro- processing platform could allow for a noninvasive and sustainable hospital-wide sensor system. We have suc- cessfully demonstrated the temporal integration of IR and ultrasonic sensors to detect hand sanitizer use and doorway entry, as well as developed an alarm mecha- nism to increase compliance rates in hospitals. Our sys- tem has created a platform for exporting and archiving data to be saved and compared with existing gold stan- dards, such as secret shoppers. With the push for an increase in hand hygiene compliance rates, and decrease in hospital acquired infections and re-admittance rates, our device demonstrates the practicality and need for a system that can solve these problems.

Fig. 1 Hand sanitizing unit equipped with BFlatback U-Ring^ (a); Hand breaking IR beam on the unit during hand sanitization (b); Door with US beam mounted to frame (c); US beam on door being interrupted by human entry to room (d)

Fig. 2 Decision tree outlining the different operational scenarios which could occur

J Med Syst (2015) 39: 69 Page 3 of 4 69

 

 

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http://dx.doi.org/10.1086/651096
http://dx.doi.org/10.1086/651096
http://dx.doi.org/10.1016/j.ajic.2013.02.004
http://dx.doi.org/10.1377/hlthaff.2010.1282
http://dx.doi.org/10.1007/s10916-014-0019-z
http://dx.doi.org/10.1007/s10916-014-0181-3
http://dx.doi.org/10.1007/s10916-014-0181-3
http://dx.doi.org/10.1007/s10916-014-0015-3
http://dx.doi.org/10.1007/s10916-009-9302-9

 

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