Samara Rosenfeld

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The use of an electronic wearable device did not change hand hygiene compliance among healthcare workers, according to the findings of a new study.

Still, the technology increased the duration of hand rubbing and the volume of alcohol-based handrub used by healthcare workers.

The findings suggested the technology must be further developed and tested.

Daniela Pires, M.D., Ph.D., and colleagues determined whether providing real-time feedback on a simplified hand hygiene action would improve compliance with the World Health Organization’s “5 Moments” and the quality of the hand hygiene action. The open-label, cluster randomized, stepped-wedge clinical trial took place between June 1, 2017 and Jan. 6, 2018. The trial took place in a geriatric hospital of the University of Geneva Hospitals in Sweden. Of those eligible, 97 healthcare workers volunteered to wear a novel electronic wearable device that delivered real-time feedback on hand rubbing duration and application of a hand-sized customized volume of alcohol-based handrub.

The device, dubbed SmartRub, consisted of two elements: a bottle and a wristband. Individual alcohol-based handrub bottle was equipped during the transition and intervention periods with a volumetric flow meter that measured the volume of alcohol-based handrub poured onto the hands. It also provided feedback by vibrating as soon as the predefined volume was applied. The wristband measured the duration of each hand hygiene action and, during the intervention period, vibrated after 15 seconds independently of the hand rubbing duration performed by the healthcare worker.

The study consisted of a baseline, transition, and intervention period. Participants did not wear the device at baseline. The device was worn during the transition period, but the feedback mode (vibration) was not activated, though the device actively monitored the volume of alcohol-based handrub and duration of hand friction for each hand hygiene action. During the intervention period, the feedback mode was activated and monitoring of practices continued. The technology was not worn during the follow-up period.

Hand hygiene compliance was the primary outcome of the study. Additional outcomes included volume of alcohol-based handrub and duration of hand rubbing for each hand hygiene action, along with adherence to device use and frequency of hand hygiene.

Overall, 12 healthcare workers did not fully complete the intervention but were included in the analysis. Nearly 6,900 hand hygiene opportunities were observed during 759 observation sessions. At intervention, hand hygiene compliance (62.9%; 95% CI, 61.1-64.7) was lower than at baseline (66.6%; 95% CI, 64.8-68.4). Hand hygiene compliance was not different between study periods (OR, 1.03; 95% CI, .75-1.42; 

= .85). Factors independently associated with reduced hand hygiene compliance included days since study onset (.997; 95% CI, .994-.998; 

 <.001), older age (OR, .97; 95% CI, .95-.99; 

 = .015), and workload (OR, .29; 95% CI, .2-.41; 

The median volume of alcohol-based handrub and duration of hand rubbing in transition and intervention periods increased from 1.12 (.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds.

The overall sensitivity of the wearable was 94.1% (95% CI, 91.4-96.2) and the specificity was 99% (95% CI, 97.5-99.7).

The study, “Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers,” was published online in 

Articles

The technology must be further developed and tested to improve hand hygiene compliance.

Wearable Device Does Not Change Hand Hygiene Compliance Among Healthcare Workers

There is no question telehealth use has boomed amid the COVID-19 pandemic. Now, investigators are probing data for patterns of usage that will yield insights into the boom and future use of the technology.

A team of Harvard investigators, including Ateev Mehrotra, a member of the 

editorial advisory board, found 30.1% of all visits were provided through telemedicine and the weekly number of visits increased twenty-three-fold compared with before the pandemic. The team examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020.

Telemedicine use was lower in areas with higher poverty rates (31.9% vs 27.9% for the lowest and highest quartiles of poverty rate).

In rural counties, there was a lower proportion of care performed through telemedicine than in urban counties (23.9% vs 30.7%).

The use of telemedicine varied by specialty, with 68%of visits being with an endocrinologist and 9% being with ophthalmologists.

Other specialties that did not see large spikes of telemedicine visits included optometry (3.3%), physical therapy (6.6%) and orthopedic surgeons (20.7%).

Mental health reasons such as depression (53% of visits), bipolar disorder (55%), and anxiety (53.9%), all resulted in increased telemedicine visits, while 3% of visits were for glaucoma.

Higher usage rates for common conditions were associated with smaller decreases in total weekly visits.

“It is important to interpret these findings in the context of our study population, which disproportionately included employed adults and their family members with commercial insurance. Therefore, these results should be interpreted as conditional on having commercial insurance or a Medicare Advantage plan,” Mehrotra and the team wrote.

Future research may help understand the persistence of such trends over longer periods of time and the impact of the changes on patients’ overall health.

The study, “Outpatient Care During the COVID-19 Pandemic In The United States,” was published in the February issue of 

Trends show how telemedicine has been used during the COVID-19 pandemic.

Exploring Telehealth Trends During COVID-19

Patients with HIV experience worse COVID-19-related outcomes compared to those without the diagnosis, according to new findings.

The findings demonstrated those with HIV had higher rates of severe disease requiring hospitalization relative to patients without HIV, suggesting patients with HIV may need to be recategorized to “increased risk” in the Centers for Disease Control and Prevention’s underlying medical conditions list.

James M. Tesoriero, Ph.D., and colleagues evaluated the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State. The investigators included individuals with confirmed COVID-19 diagnosed between March 1 and June 7, 2020 in New York State. They collected data from the New York State HIV surveillance registry, the New York State Electronic Clinical Laboratory Reporting System, and the State Health Information Network for New York.

The team evaluated COVID-19 diagnoses, hospitalizations, and in-hospital deaths among those living with diagnosed HIV and those living without diagnosed HIV. Among patients with HIV, race/ethnicity, HIV transmission risk at diagnosis, receipt of HIV-related care, stage of HIV infection at last test, and viral load suppression at last test were available.

Nearly 3,000 patients living with diagnosed HIV (70.6% men; 2,409 living in New York City; mean age, 54 years old) were diagnosed with COVID-19. Of those patients, 896 were hospitalized and 207 died in the hospital through the end of the study period. There were similar diagnosis rates between those living with diagnosed HIV and those living without (sRR, .94; 95% CI, .91-.97). Still, those living with diagnosed HIV were hospitalized more than patients living without diagnosed HIV, per population (sRR, 1.38; 95% CI, 1.29-1.47) and among those diagnosed (sRR, 1.47; 95% CI, 1.37-1.56).

The investigators also found an elevated mortality among patients living with diagnosed HIV per population (sRR, 1.23; 95% CI, 1.07-1.4) and among those diagnosed (sRR, 1.3; 95% CI, 1.13-1.48), though not among those hospitalized (sRR, .96; 95% CI, .83-1.09).

For patients living with diagnosed HIV, non-Hispanic Black patients (aRR, 1.59; 95% CI, 1.4-1.81) and Hispanic patients (aRR, 2.08; 95% CI, 1.83-2.37) were more likely to be diagnosed with COVID-19 than White patients. Despite that, those populations were not more likely to be hospitalized once diagnosed with COVID-19 or to die when hospitalized.

The risk of hospitalization increased with progression of the disease to HIV stage two (aRR, 1.29; 95% CI, 1.11-1.49) and stage three (aRR, 1.69; 95% CI, 1.38-2.07).

The findings represented the first population match of an entire U.S. state’s HIV registry against its COVID-19 diagnosis and hospitalization databases, the investigators wrote. The findings suggested those with HIV may warrant recategorization from “might be at increased risk” to “increased risk” in the Centers for Disease Control and Prevention’s underlying medical conditions list. Further, the findings represented an opportunity to address health equity through prevention and treatment approaches.

COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

The findings suggest patients with HIV should be recategorized to "increased risk" when looking at COVID-19 underlying medical conditions.

HIV Patients Have Worse COVID-19 Outcomes than Counterparts

An increase in drug prices may be coming, according to recent report findings. In fact, in the 

Vizient Winter 2021 Pharmacy Market Outlook

, results projected a 2.67% increase in the price of pharmaceuticals purchased by health systems, academic medical centers, pediatric hospitals, and non-acute practices from July 1 to June 30, 2022.

Further findings demonstrated an overall increase for oncology spend, a potential increase in cancer mortality due to the impact of COVID-19 on screenings and the pandemic’s impact on plasma-derived products.

“The trend toward more moderate drug price increases is a welcome one, given the financial difficulties created by the pandemic,” Dan Kistner, Pharm.D., group senior vice president, pharmacy solutions for Vizient, said in 

. “Even so, without question the pandemic continues to have an impact on clinical and financial outcomes. Increased use of high-cost drugs vasopressin and tocilizumab as well as many critical care drugs used to treat COVID patients are continuing to impact budgets.”

A recent FDA approval of vasopressin caused the price to spike significantly, according to the press release. But there are substantial price decreases projected for other drugs including injectable acetaminophen, daptomycin, and regadenoson. Adalimumab is the drug with the largest anticipated price increase and is used to treat arthritis and ulcerative colitis. The drug is projected to increase in price by 7.5% over the next 18 months as biosimilar competition cannot yet be marketed.

According to the report, oncology medications which make up 24.67% of pharmaceutical purchases are expected to increase 2.68%. Additionally, screening rates for breast, colon, and cervical cancer reduced dramatically since April, which led to a 65.2% decline in the incidence of new cancer diagnoses. Such could lead to mortality increases up to 9.5% from breast cancer and up to 16.6% for colorectal cancer within five years.

Vizient expects supply of plasma-derived products to tighten in the first quarter of 2021 due to the reduction of plasma donations and concerns about contracting COVID-19.

What’s more, biosimilars may make their biggest impact in the next five years, according to the report. There are 29 FDA-approved biosimilars with more yet to be launched. Biosimilars resulted in cost savings of $19 billion between 2015-2019. Such savings are expected to increase to $104 billion by 2024.

“It’s not yet possible to determine the total expense associated with COVID-19 on the health care industry. We know that spend on COVID-related drugs began to decline in the second quarter of last year, but we saw an uptick of $60.5 million over five of the most commonly used COVID-related drugs in the third quarter of 2020 compared to the same quarter in 2019,” Kistner concluded.

Samara Rosenfeld

Articles

Wearable Device Does Not Change Hand Hygiene Compliance Among Healthcare Workers

Exploring Telehealth Trends During COVID-19

HIV Patients Have Worse COVID-19 Outcomes than Counterparts

COVID-19 May Continue to Impact Healthcare Costs