Patient 4815 wanders from the washroom back to his hospital room, stopping briefly by the waiting area to fish through a stack of worn Reader's Digests. Over the course of half an hour, nearly 10 people sift through the same stack of magazines before going to visit their friends or family in their respective hospital rooms. But unbeknownst to them, tiny bacteria by the name of Clostridium Difficile have already wiggled their way from the fingertips of Patient 4815 to the magazine stack and beyond, spreading throughout the hospital via their un-sanitized hands.
Now imagine the scenario again, but this time there's a way of tracking how often Patient 4815 used hand sanitizer or where 'Support Staff 1623' put 'equipment piece number 42' after he left the patient's room. While monitoring the movement, a technician is able to identify the magazine rack or unsanitary equipment as the disease reservoir and cut the outbreak off at the knees.
"If you were to create the ultimate environment to spread infections, you'd put a lot of sick people close together in an area that wasn't clean while having lots of people touching them and moving equipment around," says Niall Wallace, CEO of
Infonaut, the Toronto-based company behind healthcare surveillance tool Hospital Watch Live (HWL). "Essentially, you’ve just described a hospital environment."
According to government statistics, each year in Canada, more than 220,000 healthcare acquired infections (HAI) result in 8,500 to 12,000 deaths, and one in nine hospital patients in the country get an HAI.
The gravity of the situation is serious, says Wallace. Infections are the fourth leading cause of death in Canada.
That's why Infonaut is hoping its sophisticated real-time disease surveillance system for tracking hand sanitary practices, healthcare equipment movement, and professional/patient contact will break into mainstream hospital and healthcare use.
"With all that information we're really trying to understand movement, contact and interaction and how the staff, patients, and these mobile assets play a role in disease transmission," says Wallace.
The idea for Infonaut was borne of the severe acute respiratory syndrome (SARS) outbreak of 2003 in Toronto where 44 people died. Wallace was working for the Ministry of Health at the time and the outbreak had a profound impact on him.
"I really saw from the inside what effect that had on the system and it really opened my eyes," says Wallace.
He incorporated in 2005, but it wasn’t until five years later that he pivoted the business from tracking outbreaks and superbugs from a regional-based perspective to what it is now: a fine-tuned surveillance tech-focused company.
At first look, the technology seems simple enough -- slap a radio-frequency identification (RFID) chip in a name badge or on equipment and install a few sensors to monitor movements. But Infonaut isn’t trying to track a clandestine spouse. In this case the culprit is microscopic, so the technology needs to reflect those intricacies.
Accuracy is key, says Wallace.
"We want to know where they came from, how long they had contact and where they go from there," he adds. And since hand hygiene is the most accepted practice to prevent infection, HWL monitors how often patients and healthcare professionals are sanitizing their hands and even how long they spend at the hand sanitizer station.
"They were able to leverage a small package of funds dedicated towards applied research and turn it into a large project with expertise and more funding," says Wallace.
They set up the surveillance tech at the
Simulated Practice Centre of the Nursing School. Since then, students and faculty have been working with Wallace and his seven-person team to navigate through potential flaws with the system.
Jorge Olenewa, the Principal Investigator and a program coordinator and professor at the School of Computer Technology at George Brown, says it's an ongoing challenge.
"There are a lot of measurements that we've got to make to make sure the system responds quickly enough," says Olenewa. He points to the frequency at which the tracking badges transmit signals to be picked up by the ultrasound equipment. "If it's one second, the batteries won’t last a week. Ten seconds is too long a time to detect if someone went to the hand sanitizing station, pumped sanitizer and moved on to a patient’s room."
They found three seconds to be a happy medium.
Then there's the position of the tiny microphones on the sensors that monitor the badges ultrasound pulses.
"We have to detect if the patient is actually in bed or whether a person is standing near the bed as well as what position that person is," says Olenewa. It requires a slight tweaking of the microphones but after some trial and error, the technology is working through final assessment.
"We’ve installed a prototype at Toronto General Hospital," says Craig Edwards, the project manager from George Brown.
The surveillance system has been installed in the hospital’s multi-organ transplant unit, an area where dampening the spread of HAI’s is critical. The 18-month pilot system was launched last February and will finish in the fall. So far, everyone involved in the assessment at TGH has volunteered to wear the tracking badge, but Edwards doesn’t see why it wouldn’t become common practice.
“There are very strict protocols as far as privacy goes with all badges reading as anonymous numbers via the software,” he says.
Wallace plans to grow Infonaut beyond his humble Toronto beginnings to the American healthcare market.
"The goal is to prove out the technology in our home market first and look for opportunities for growth, which will most likely come from the U.S.," says Wallace. "But certainly I’ll want to remain in Ontario and Canada and work with hospitals here."
Andrew Seale is a Toronto-based freelance writer whose writing has appeared in The Toronto Star, the Vancouver Sun, The Calgary Herald, and Alternatives Journal among other places. He loves Toronto, but doesn’t like to sit still for too long and publishes stories of his adventures at whenwedrift.tumblr.com. Find him on Twitter @WhenWeDrift.