Clean Hands Accessible and Manageable for Patients (CHAMPs): A technology-based self-management intervention to improve patient hand hygiene and reduce hand contamination among older adults.

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PROJECT SUMMARY/ABSTRACT Our long-term goal to establish sustainable, patient-centered interventions at the patient level to engage patients in safety and prevention by offsetting barriers such as physical and sensory limitations that prohibit them from actively helping themselves. Unfortunately, older adults are at highest risk for infections and yet while hand hygiene is the single most important way to prevent the spread of infection, mechanisms for older adults to minimize their own risk for infections is often overlooked. Many contamination elements exist in hospital settings and for older adults they will encounter high-touch surfaces and medical devices that harbor pathogens that lead to infections. However, without assistance, hand-hygiene practice rates are poor among hospitalized older adults’ due to frailty, limited dexterity and mobility, cognitive limitations, and risk of falling, which prohibits their independent use of visible hand- hygiene products (e.g., wall dispensers, towelettes, in-room sinks). New solutions are necessary. Therefore, in this proposal, we have updated our investigator-developed, technology-enhanced patient hand hygiene system. Clean Hands Accessible and Manageable for Patients (CHAMPs), our investigator-developed and pilot tested bed rail-affixed hand-sanitizing dispenser, which features verbal, auditory and visual reminders to remind patients to clean their hands. The safe and easily accessible motion-sensing system with usage tracking requires very little physical effort, as users need only to be able to freely move their upper extremities and reach over to the bed rail to clean their hands when prompted (e.g. before meal times). Our pilot results among both a small group of older adults and in a high-tech simulated environment demonstrated both efficacy and feasibility of the intervention. In this 4-year project, we propose a large heterogeneous randomized controlled trial (RCT) comparing two groups of hospitalized adults ≥ 65 years in two public hospitals, one group receives CHAMPs (n=125) and the other is the usual-care (UC) group (n=125). Our research team consists of early and late stage investigators who have a successful record of working together and are ready to address the following aims: (1) to determine the effect of CHAMPs as a method to improve hand- hygiene behavior and reduce patients’ hand contamination, (2) assess the implementation of our intervention, (3) examine factors that influence outcomes associated with our intervention and (4) costs and cost-effectiveness of CHAMPs. The primary outcome is hand contamination as measured by presence, type, and quantity of colony- forming units located on participants’ hands. Our preliminary results offer promise that the CHAMPs technology-enhanced intervention may be an effective approach to engage patients in infection prevention as a solution to reduce colonization and infection rates among older adults. Our proposal aligns with all four goals of NIH/NIA’s 2020-2025 strategic plan, which is to improve the health, well-being, and independence of adults as they age and to prevent or reduce the burden of age-related diseases, disorders, and disabilities.