A three-year-old medical software company that is moving to Springfield this summer is fielding a wave of calls from non-medical companies about its hand hygiene monitor, which was designed to make sure people wash their hands properly.
Arsana Health has poured its energy into its new medical records software for long-term care facilities. But its original product, developed in 2017 when its founder was at Babson College near Boston, is a device that tracks hand movements and other clues to collect data on how well people are washing their hands.
Improving hand-washing and other hand hygiene habits has been the subject of intense focus in the health care field for years. Since the Covid-19 pandemic paralyzed business in the U.S. this winter, the focus has spread to manufacturing, construction and other workplaces as companies seek to minimize the risk when people return to their workplaces. Health experts say hand-washing is one of the most effective ways to keep the virus from spreading.
Company founder Connor Dahlberg, who lives in Missouri, said he used to spend a lot of time and energy explaining to possible customers in the long-term care industry — where he has based his business — why hand-washing hardware and the software that goes with it were so critical to infection control. In the long-term care environment, he said, patients often move around freely, socialize regularly, and often live in the same place for years.
“I can’t express how much energy we used to put into that conversation,” said Dahlberg, 27. The arrival of Covid-19 changed that. “Now we don’t have to have that conversation.”
Dahlberg started out by creating a device called WashSense, a kindle-like tablet designed to be mounted on a wall next to a sink. The screen delivers real-time feedback on hand-washing technique and collects data about how hand-washers are doing. Dahlberg later expanded the company to include record-keeping software for long-term care facilities, and named that piece of the company Arsana Health.
The battery operated WashSense uses a Bluetooth network for wireless monitoring. It can reward users who earn high scores for their hand-washing technique, for example by entering them into a company’s daily prize drawing. It can collect data anonymously, or can record who was washing their hands at any given time if the hand-washer is wearing an identification tag.
And it can report to managers if someone is skipping the hand-washing, doing a sub-par job, or following World Health Organization instructions by doing a proper scrub for up to 30 seconds, said Vin Fusca, a Windsor resident who is joining the company as chief revenue officer in July.
“When you’re talking about quality improvement processes, it gives you a really good baseline about how often folks are engaging with hand-washing, and gives you good quality detail about are they doing it well,” said Fusca. “Did they sit there for 5 seconds and run their hands through the water, or did they really do the appropriate motions?” The device can also deliver information about traffic volume at a wash station in a public place.
Sensors have been used for several years in health care settings. A study cited in Modern Healthcare magazine found that when four hospitals used staff to unobtrusively observe whether others were washing their hands properly, monitoring happened 100-200 times a month. With an automated system, that number climbed as high as 400,000.
Fusca said WashSense takes this surveillance to a new level by assessing the quality of the washing, and by delivering data to managers. Health care facilities often rely on patient surveys to learn whether clinicians are washing their hands, he said.
“The thermal imaging can capture the hand motion,” Fusca said. “The algorithms were designed to be able to say, for an OR, did they wash down to their elbows? It has evolved over the years as they have refined the algorithms and improved the sensor capabilities to create high-quality information-gathering about the duration and the motions.”
The display screen can also provide coaching and encouragement for the uninitiated.
If you had units in an elementary school, it could help a child through washing its hands,” Fusca said. “It’s a quality measurement and educational tool as well.”
Investment aimed at rural innovation
Long before Covid-19 came along, Dahlberg had been working with the Hartland-based Center on Rural Innovation (CORI) to get funding for Arsana, and that is why Arsana, and with it WashSense, chose to start gathering Arsana’s now-remote employees at the Black River Innovation Campus (BRIC), a year-old nonprofit co-working space in a former school building in Springfield. Fusca is a CORI employee who is moving to WashSense.
Former state Sen. Matt Dunne, who has been working to build a stronger technology presence in Vermont’s Upper Valley through CORI, is on the board of BRIC and has been working with Dahlberg on CORI’s investment in the company. CORI invests in technology startups in rural opportunity zones — designated areas where investors can receive capital gains tax breaks — like Springfield.
Dahlberg expects all three of the WashSense/Arsana employees to start working in the BRIC space in July.
“All of our hiring activity will be taking place out of BRIC as well; we really plan to build a pretty nice presence over the next 12 months,” he said June 19. “There are a ton of really talented people in the health care space (in the Upper Valley). We see ourselves building a company that can effectively achieve what CORI wants, which is building rural American innovative companies, and then hopefully being able to replicate that same model in different pockets around the country.”
WashSense is installing one unit in a Vermont restaurant and several in a Texas office building this fall, and Dahlberg said he’s talking to school systems and distributors.
“We haven’t done any promotion; they’ve been finding us,” he said.
Hand hygiene enters the mainstream
As U.S. companies, schools and public spaces reopen for business, they see hand-washing as one of the most important safety measures they can take.
Evan Langfeldt, CEO of the O’Brien Brothers construction company, installed about a dozen washbasins at the company’s residential construction project, Hillside at O’Brien Farms in South Burlington, where the company is building 150 single-family homes and townhouses. He also has hand sanitizer available throughout the homes under construction. Workers are required to wash their hands before entering the homes.
All of the subcontractors have to fill out questionnaires, similar to the ones required at restaurants and lodging, that will help provide information needed for contact tracing if someone tests positive for Covid-19.
Quality control researchers have been studying hand hygiene for years as a critical piece of reducing infections in the health care setting. Research published in a 2015 article about hand hygiene in the Joint Commission Journal on Quality and Patient Safety found that the most common reasons for failing to comply with hand-washing rules in hospitals included workers forgetting; a broken sink or soap dispenser; distraction; and a perception that wearing gloves negated the need for further measures. People who skipped hand-washing also explained that they did so because their hands were full when they were entering the room, or the cleaning products irritated their hands.
Dahlberg’s device is based on washing techniques recommended by WHO. It reports back to users in real time whether they are scrubbing vigorously enough, with the right technique, and for WHO’s recommended duration of 20 to 30 seconds. The devices cost about $330, although the company is working on units that are one-third less expensive and can be charged overnight. He emphasized that the device is designed to be stuck to walls, not screwed in, and noted that it’s not a camera.
“Devices are going into sensitive areas like bathrooms,” he said. “We can’t see anything.”
It’s too early to know exactly how well proper hand hygiene will suppress the Covid-19 infection rate in non-health care settings. But it’s just common sense that people tend to do a better job – whatever the job is – when they know they’re being watched, said Dahlberg.
“As time goes on, the staff understand it’s kind of like a security blanket for them,” he said. “If an infection happens, they know it’s understood they did a good job.”
It’s also known that if there are no positive or negative consequences over time, engagement in doing the task well tends to dip. Dahlberg said a system that includes performance rewards has shown it’s possible to keep people washing their hands in the way WHO recommends.
“Buy-in is always a better way to go than just forcing it onto people, for lasting behavior change,” he said. “With some of our installs that have been live for three years, we actually haven’t seen a decrease in engagement and we’ve seen consistent improvement year over year in sustaining infection reduction and in commitment to using the system.”
