Quantifying Mobility Scooter Performance in Winter Environments.

OBJECTIVES: To quantify mobility scooter performance when traversing snow, ice, and concrete in cold temperatures and to explore possible performance improvements with scooter winter tires. DESIGN: Cross-sectional. SETTING: Hospital-based research institute. PARTICIPANTS: Two drivers (50 and 100 kg) tested 8 scooter models (N=8). Two mobility scooters were used for winter tire testing. INTERVENTIONS: Scooters were tested on 3 different conditions in a random sequence (concrete, 2.5-cm depth snow, bare ice). Ramp ascent and descent, as well as right-angle cornering up to a maximum of 10° slopes on winter conditions, were observed. Winter tire testing used the same slopes with 2 scooters on bare and melting ice surfaces. MAIN OUTCOME MEASURES: Maximum achievable angle (MAA) and tire traction loss for ramp ascent and descent performance. The ability to steer around a corner on the ramp. RESULTS: All scooters underperformed in winter conditions, specifically when traversing snow- and ice-covered slopes (χ2 [2, N=8]=13.87-15.55, P<.001) and corners (χ2 [2, N=8]=12.25, P<.01). Half of the scooters we tested were unable to climb a 1:12 grade (4.8°) snow-covered slope without losing traction. All but 1 failed to ascend an ice-covered 1:12 grade (4.8°) slope. Performance was even more unsatisfactory for the forward downslopes on both snow and ice. Winter tires enhanced the MAA, permitting 1:12 (4.8°) slope ascent on ice. CONCLUSIONS: Mobility scooters need to be designed with winter months in mind. Our findings showed that Americans with Disabilities Act-compliant built environments, such as curb ramps that conform to a 1:12 (4.8°) slope, become treacherous or impassible to mobility scooter users when covered in ice or snow. Scooter manufacturers should consider providing winter tires as optional accessories in regions that experience ice and snow accumulation. Additional testing/standards need to be established to evaluate winter mobility scooter performance further.

Toward mitigating pressure injuries: Detecting patient orientation from vertical bed reaction forces.

INTRODUCTION: Prolonged bed rest without repositioning can lead to pressure injuries. However, it can be challenging for caregivers and patients to adhere to repositioning schedules. A device that alerts caregivers when a patient has remained in the same orientation for too long may reduce the incidence and/or severity of pressure injuries. This paper proposes a method to detect a person's orientation in bed using data from load cells placed under the legs of a hospital grade bed. METHODS: Twenty able-bodied individuals were positioned into one of three orientations (supine, left side-lying, or right side-lying) either with no support, a pillow, or a wedge, and the head of the bed either raised or lowered. Breathing pattern characteristics extracted from force data were used to train two machine learning classification systems (Logistic Regression and Feed Forward Neural Network) and then evaluate for their ability to identify each participant's orientation using a leave-one-participant-out cross-validation. RESULTS: The Feed Forward Neural Network yielded the highest orientation prediction accuracy at 94.2%. CONCLUSIONS: The high accuracy of this non-invasive system's ability to a participant's position in bed shows potential for this algorithm to be useful in developing a pressure injury prevention tool.

Effect of intermittent deployment of an electronic monitoring system on hand hygiene behaviors in healthcare workers.

BACKGROUND: Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare-acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels. METHODS: An electronic monitoring system was deployed 3times at 6-month intervals on a musculoskeletal rehabilitation nursing unit in Toronto. Each deployment lasted 4 consecutive weeks. Each wall-mounted soap and hand rub dispenser was outfitted with an activation counter to assess the impact of system deployments on overall handwashing activity. RESULTS: System deployments took place in October 2016, April 2017, and October 2017. A total of 76,130 opportunities were recorded, with an aggregate hand hygiene performance of 67.43%. A total of 515,156 dispenser activations were recorded. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Participation was high at the beginning of each deployment and declined during each deployment but was restored to a high level with the start of the next deployment. CONCLUSIONS: Intermittent deployment of an electronic monitoring intervention counteracts potential declines in participation rates sometimes seen with continuous system use. However, adoption of this strategy requires the acceptance of lower periods of performance between each deployment.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals.

BACKGROUND: Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. METHODS: An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. RESULTS: Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. CONCLUSIONS: Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

Effect of electronic real-time prompting on hand hygiene behaviors in health care workers.

BACKGROUND: Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors. METHODS: Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system. The effect of changing the prompt duration on hand hygiene performance was determined by a cluster-randomized trial on 3 nursing units with 1 acting as control. Sustainability of performance and participation was observed on 4 nursing units over a year. All staff were eligible to participate. RESULTS: Between June 2015 and December 2016, a total of 459,376 hand hygiene opportunities and 330,740 handwashing events from 511 staff members were recorded. Dispenser activation counts were significantly influenced by use of the system (χ2[3] = 75.76; P < .0001). Hand hygiene performance dropped from 62.61% to 24.94% (odds ratio, 0.36; 95% confidence interval, 0.34-0.38) when the prompting feature was removed. Staff participation had a negative trajectory of -0.72% (P < .001), whereas change in average performance was -0.18% (P < .001) per week for the year. CONCLUSIONS: Use of electronic monitoring with real-time prompts of 20 seconds' duration nearly doubles handwashing activity and causes handwashing to occur sooner after entering a patient room. These improvements are sustainable over a year.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

A biomechanical assessment of floor and overhead lifts using one or two caregivers for patient transfers.

This study investigated the differences in peak external hand forces and external moments generated at the L5/S1 joint of the low back due to maneuvering loaded floor-based and overhead-mounted patient lifting devices using one and two caregivers. Hand forces and external moments at the L5/S1 joint were estimated from ground reaction forces and motion capture data. Caregivers gave ratings of perceived exertion as well as their opinions regarding overhead vs. floor lifts. Use of overhead lifts resulted in significantly lower back loads than floor lifts. Two caregivers working together with a floor lift did not reduce loads on the primary caregiver compared to the single-caregiver case. In contrast, two-caregiver operation of an overhead lift did result in reduced loads compared to the single-caregiver case. Therefore, overhead lifts should be used whenever possible to reduce the risk of back injury to caregivers. The use of two caregivers does not compensate for the poorer performance of floor lifts.

Design of built environments to accommodate mobility scooter users: part II.

PURPOSE.Accessibility standards for wheeled mobility devices currently use a 1.5 m turning circle, designed to accommodate manual wheelchairs. Scooters are less manoeuvrable than wheelchairs, so allowing a full turning circle would require too much space. Instead, we propose using a rectangle that provides space for a three-point turn. Here, we determine the area requirements of this approach. METHOD. For rectangular 'rooms' of varying aspect ratios, we measured the minimum dimensions in which two four-wheeled scooters (the Celebrity-X and Fortress-1700), which combine good outdoor performance with reasonable indoor manoeuvrability, could enter the space, perform a three-point turn and exit. Moveable Styrofoam walls defined each 'room', and a doorway was located either near the corner of the space or in the middle of one wall. 'Room' size was decreased until our expert driver could no longer perform the manoeuvre. RESULTS. Compared to the area required for a turning circle, 42-54% savings were achieved. Relative to existing requirements, 53-95% more space is required to accommodate the Celebrity-X; 173-223% increases are necessary for the Fortress-1700. CONCLUSIONS. When accommodating four-wheeled scooters, our proposed three-point turn definition would require more space than the current standards, but considerably less than if a full turning circle were used.

Design of built environments to accommodate mobility scooter users: part I.

PURPOSE: To determine the minimum dimensions needed to allow five models of powered mobility scooters to manoeuvre within five commonly encountered indoor spatial configurations. METHOD: We measured manoeuvrability of five scooters judged by their manufacturers to have a good combination of indoor mobility and outdoor performance (including in rural environments). We determined the minimum space needed to manoeuvre the scooters through the following five spatial configurations: turning 180° in a corridor, performing U-turns around 50 mm (2″) and 1200 mm (4') obstacles, turning 90° from a doorway and approaching a counter or work surface from the side. Free-standing styrofoam walls were used to define each configuration. An expert driver repeatedly manoeuvred the scooters through each configuration while we incrementally decreased the dimension of interest until it was no longer possible to complete the manoeuvre. Each scooter's turning diameter was also measured and compared to the manufacturer's specification. RESULTS: Minimum space requirements for each scooter for five spatial configurations are given and compared to existing standards. CONCLUSIONS: None of the scooters tested were capable of completing all manoeuvres within the space allowed by existing standards. These findings will contribute to recommendations for new standards for built environments that can accommodate scooter users.

The experiences of using an anti-collision power wheelchair for three long-term care home residents with mild cognitive impairment.

PURPOSE: Presented are three case analyses of long-term care home residents with cognitive impairment who tested an anti-collision power wheelchair. We discuss technology design and research implications for this population. METHOD: Case studies involved 371 h of participant observation and 7 h of open-ended interview with residents (n = 3), family members (n = 3) and clinical staff (n = 11). Thematic analysis generated themes related to technological, psychological and social aspects of residents' inclination and disinclination towards power mobility use. RESULTS: Themes examined the discordance between others' and residents' reports of anti-collision power wheelchair use; a facet of response bias; unanticipated implications for independence and dependence; and implications of device design for self-presentation. CONCLUSIONS: Technology alone is insufficient to help residents to fully benefit from the autonomy that a wheelchair intervention can provide: close attention is required to the social and organisational factors of institutional life. For technology to be acceptable, the design must meet the functional and aesthetic needs of users. Considerations in the design of future power wheelchairs for residents with cognitive impairment include capabilities to drive on uneven surfaces, effort-reducing driving modes, improved user interface usability, and acceptable driving speed, size and appearance.

Advanced technologies to curb healthcare-associated infections.

The commentary was prepared in response to the manuscript "Healthcare-Associated Infections as Patient Safety Indicators," by Gardam, Lemieux, Reason, van Dijk and Goel. Healthcare-associated infections are a severe patient safety hazard. Current patient safety initiatives targeting increased healthcare worker hand hygiene to prevent some of these infections have had limited effect. This commentary describes recent advances in electronic sensing and computational power that have provided new options to increase hand hygiene compliance as a step toward reducing healthcare-associated infections. Smart electronics can provide reasoning about a healthcare worker's circumstance and prompt the worker to perform hand hygiene when necessary. These novel approaches in technology development have tremendous potential to enhance the hand hygiene of healthcare workers and can support the prevention of this significant problem for patients in our hospitals.

Power mobility for a nursing home resident with dementia.

OBJECTIVE: This case study describes an occupational therapy intervention to increase the self-mobility and social participation of a nursing home resident with dementia using a power wheelchair equipped with a collision-prevention system. METHOD: We used an exploratory case study design. Data sources included the medical record, standardized assessments, interviews, observations of daily activities, and a driving log. RESULTS: During driving sessions, changes in affect such as smiling and attempts to socialize were noted. The resident required ongoing prompting to operate the modified power wheelchair. CONCLUSION: The resident was unable to achieve self-mobility with an intervention involving a modified power wheelchair. However, this study demonstrates that even supervised mobility can have a positive impact on affect and social participation. Observations from this study are being applied to the design and testing of the next generation of power wheelchairs intended for use by nursing home residents with dementia.