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Portable thermal imaging could help monitor and assess the quality of hand hygiene technique used among health professionals, according to US researchers.
Findings, published in the American Journal of Infection Control, suggest that portable thermal imaging cameras may be able to provide a new approach in improving hand-hygiene practices.
“Our study shows that thermal imaging shows promise as an approach that warrants additional research”
The World Health Organization and the US Centers for Disease Control and Prevention both recommend using alcohol-based hand sanitiser (ABHS) in their hand-hygiene guidelines.
However, the application technique of ABHS, including the quantity of liquid used and the length of hand rubbing, can have a substantial impact on antimicrobial effectiveness.
Several studies have documented that health professionals often failed to apply ABHS to their thumb and fingertips, noted researchers.
Study author Dr John Boyce, an epidemiologist who runs an infection control consultancy firm, said: “Effective hand hygiene is recognised as the single most important act to prevent the transmission of potentially pathogenic microbes in the healthcare setting.
“But there is no widely adopted method for assessing the effectiveness of healthcare professionals’ hand hygiene technique.”
Mr Boyce and his fellow author Dr Richard Martinello, Yale School of Medicine, based their pilot on a previous study, which revealed that transient reductions in skin temperature occur following topical application of ABHS.
They wanted to see if thermal imaging with a portable infrared thermal camera could show whether ABHS had been appropriately applied by health professionals, including to their fingertips and thumbs.
Using an infrared camera attached to an iPhone, they gathered thermal images from the dominant hands of 12 health professionals.
They recorded the baseline readings of the mid-palm area, the tips of the third finger and thumb before, and then at different time points after the participants performed hand hygiene with the ABHS. The time points being immediately following hands felt dry and at one and two minutes later.
In 11 of 12 volunteers, thermal images revealed significant decreases in mid-palm, finger and thumb temperatures after the participants performed hand hygiene, which confirmed that the infrared camera could detect colour changes that reflect a drop in temperature.
The researchers also discovered that when participants performed hand hygiene with ABHS without including their thumbs, a lack of colorimetric change in the thumbs was visible in the thermal images.
Additionally, one participant with large hands did not have decreased temperatures at the palm, finger or thumb after applying ABHS, which suggested that thermal imaging could also help measure the amount of ABHS needed based on the health professional’s individual hand surface area.
Mr Boyce said: “Our study shows that thermal imaging shows promise as an approach that warrants additional research to determine if it can be used for routine monitoring of hand hygiene technique to improve patient care.”
The study concluded that additional studies involving a larger number of people under carrying conditions would be needed to establish if thermal imaging can be a practical modality for teaching or monitoring hand hygiene.
Linda Dickey, registered nurse and president of the US Association for Professionals in Infection Control and Epidemiology, described the findings from the pilot study as “exciting”.
“They are the first to evaluate a new tool that might help infection preventionists assess the quality of hand hygiene technique during educational sessions, periodic competency evaluations, and routine patient care,” she said.
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