title: Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study.
abstract: BACKGROUND
  Hand-hygiene compliance and contacts of health-care workers largely determine the potential paths of pathogen transmission in hospital wards. We explored how the combination of data collected by two automated infrastructures based on wearable sensors and recording (1) use of hydro-alcoholic solution and (2) contacts of health-care workers provide an enhanced view of the risk of transmission events in the ward.
  
  
  METHODS
  We perform a proof-of-concept observational study. Detailed data on contact patterns and hand-hygiene compliance of health-care workers were collected by wearable sensors over 12 days in an infectious disease unit of a hospital in Marseilles, France.
  
  
  RESULTS
  10,837 contact events among 10 doctors, 4 nurses, 4 nurses' aids and 4 housekeeping staff were recorded during the study. Most contacts took place among medical doctors. Aggregate contact durations were highly heterogeneous and the resulting contact network was highly structured. 510 visits of health-care workers to patients' rooms were recorded, with a low rate of hand-hygiene compliance. Both data sets were used to construct histories and statistics of contacts informed by the use of hydro-alcoholic solution, or lack thereof, of the involved health-care workers.
  
  
  CONCLUSIONS
  Hand-hygiene compliance data strongly enrich the information concerning contacts among health-care workers, by assigning a 'safe' or 'at-risk' value to each contact. The global contact network can thus be divided into 'at-risk' and 'safe' contact networks. The combined data could be of high relevance for outbreak investigation and to inform data-driven models of nosocomial disease spread.
authors.affiliation: Aix Marseille Université, Université de Toulon, CNRS, CPT, UMR 7332, 13288, Marseille Cedex 9, France. rossmastrandrea@gmail.com.
authors.forename: Rossana
authors.initials: R
authors.lastname: Mastrandrea
authors.affiliation: Aix Marseille University, IHU Méditerranée Infection, URMITE, UM63, CNRS 7278 IRD 198, Inserm 1095, Marseille, France. alberto.soto-aladro@ap-hm.fr.|Infectious Disease Unit CHU Nord, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France. alberto.soto-aladro@ap-hm.fr.
authors.forename: Alberto
authors.initials: A
authors.lastname: Soto-Aladro
authors.affiliation: Aix Marseille University, IHU Méditerranée Infection, URMITE, UM63, CNRS 7278 IRD 198, Inserm 1095, Marseille, France. philippe.brouqui@univ-amu.fr.|Infectious Disease Unit CHU Nord, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France. philippe.brouqui@univ-amu.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brouqui
authors.affiliation: Aix Marseille Université, Université de Toulon, CNRS, CPT, UMR 7332, 13288, Marseille Cedex 9, France. alain.barrat@cpt.univ-mrs.fr.|Data Science Laboratory, ISI Foundation, Turin, Italy. alain.barrat@cpt.univ-mrs.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Barrat
mesh_terms: D003141:Communicable Diseases / Q000635:transmission*; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission*; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010362:Patients' Rooms / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors