Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology.

BACKGROUND: Hand hygiene is one of the most effective ways of preventing health care-associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. OBJECTIVE: This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. METHODS: A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. RESULTS: In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%). CONCLUSIONS: Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene-related issues.

Eyes-free Target Acquisition During Walking in Immersive Mixed Reality.

Reaching towards out-of-sight objects during walking is a common task in daily life, however the same task can be challenging when wearing immersive Head-Mounted Displays (HMD). In this paper, we investigate the effects of spatial reference frame, walking path curvature, and target placement relative to the body on user performance of manually acquiring out-of-sight targets located around their bodies, as they walk in a spatial-mapping Mixed Reality (MR) environment wearing an immersive HMD. We found that walking and increased path curvature negatively affected the overall spatial accuracy of the performance, and that the performance benefited more from using the torso as the reference frame than the head. We also found that targets placed at maximum reaching distance yielded less error in angular rotation and depth of the reaching arm. We discuss our findings with regard to human walking kinesthetics and the sensory integration in the peripersonal space during locomotion in immersive MR. We provide design guidelines for future immersive MR experience featuring spatial mapping and full-body motion tracking to provide better embodied experience.

Fully-Occluded Target Selection in Virtual Reality.

The presence of fully-occluded targets is common within virtual environments, ranging from a virtual object located behind a wall to a datapoint of interest hidden in a complex visualization. However, efficient input techniques for locating and selecting these targets are mostly underexplored in virtual reality (VR) systems. In this paper, we developed an initial set of seven techniques techniques for fully-occluded target selection in VR. We then evaluated their performance in a user study and derived a set of design implications for simple and more complex tasks from our results. Based on these insights, we refined the most promising techniques and conducted a second, more comprehensive user study. Our results show how factors, such as occlusion layers, target depths, object densities, and the estimation of target locations, can affect technique performance. Our findings from both studies and distilled recommendations can inform the design of future VR systems that offer selections for fully-occluded targets.

Design and Evaluation of Visualization Techniques of Off-Screen and Occluded Targets in Virtual Reality Environments.

This research explores the design and evaluation of visualization techniques of targets that reside outside of users' view and/or are occluded by other elements within a virtual reality environment (VE). We first compare four techniques (3DWedge, 3DArrow, 3DMinimap, and Radar) that use different types of visual elements to provide direction and distance information of targets. To give structure to their evaluation, we also develop a framework of four tasks (one for direction and three for distance) and their assessment criteria. The results of the first study show that 3DWedge is the best-performing and most usable technique. However, all techniques, including 3DWedge, have poor performance in dense scenarios with a large number of targets. To improve support in dense scenarios, a fifth technique, 3DWedge+, is developed by using 3DWedge as its foundation and including additional visual elements that are derived from the other three techniques which are shown to be useful. A second study is conducted to evaluate the performance of 3DWedge+ in relation to the other techniques. The results show that both 3DWedge and 3DWedge+ are significantly better in distinguishing user-to-target distance and that 3DWedge+ is particularly suitable for dense scenarios. Based on these results, we provide a set of recommendations for the design of visualization techniques of off-screen and occluded targets in 3D VE.

RingText: Dwell-free and hands-free Text Entry for Mobile Head-Mounted Displays using Head Motions.

In this paper, we present a case for text entry using a circular keyboard layout for mobile head-mounted displays (HMDs) that is dwell-free and does not require users to hold a dedicated input device for letter selection. To support the case, we have implemented RingText whose design is based on a circular layout with two concentric circles. The outer circle is subdivided into regions containing letters. Selection is made by using a virtual cursor controlled by the user's head movements-entering a letter region triggers a selection and moving back into the inner circle resets the selection. The design of RingText follows an iterative process, where we initially conduct one first study to investigate the optimal number of letters per region, inner circle size, and alphabet starting location. We then optimize its design by selecting the most suitable features from the first study: one letter per region, narrowing the trigger area to lower error rates, and creating candidate regions that incorporate two suggested words to appear next to the current letter region (close to the cursor) using a dynamic (rather than fixed) approach. Our second study compares text entry performance of RingText with four other hands-free techniques and the results show that RingText outperforms them. Finally, we run a third study lasting four consecutive days with 10 participants (5 novice users and 5 expert users) doing two daily sessions and the results show that RingText is quite efficient and yields a low error rate. At the end of the eighth session, the novice users can achieve a text entry speed of 11.30 WPM after 60 minutes of training while the expert (more experienced) users can reach an average text entry speed of 13.24 WPM after 90 minutes of training.

PizzaText: Text Entry for Virtual Reality Systems Using Dual Thumbsticks.

We present PizzaText, a circular keyboard layout technique for text entry in virtual reality (VR) environments that uses the dual thumbsticks of a hand-held game controller. Text entry is a common activity in VR environments but remains challenging with existing techniques and keyboard layouts that is largely based on QWERTY. Our technique makes text entry simple, easy, and efficient, even for novice users. The technique uses a hand-held controller because it is still an important input device for users to interact with VR environments. To allow rapid search of characters, PizzaText divides a circle into slices and each slice contains 4 characters. To enable fast selection, the user uses the right thumbstick for traversing the slices, and the left thumbstick for choosing the letters. The design of PizzaText is based on three criteria: efficiency, learnability, and ease-of-use. In our first study, six potential layouts are considered and evaluated. The results lead to a design with 7 slices and 4 letters per slice. The final design is evaluated in a five-day study with 10 participants. The results show that novice users can achieve an average of 8.59 Words per Minute (WPM), while expert users are able to reach 15.85 WPM, with just two hours of training.