Hand Hygiene Quality Assessment Using Image-to-Image Translation

Abstract

Hand hygiene can reduce the transmission of pathogens and prevent healthcare-associated infections. Ultraviolet (UV) test is an effective tool for evaluating and visualizing hand hygiene quality during medical training. However, due to various hand shapes, sizes, and positions, systematic documentation of the UV test results to summarize frequently untreated areas and validate hand hygiene technique effectiveness is challenging. Previous studies often summarize errors within predefined hand regions, but this only provides low-resolution estimations of hand hygiene quality. Alternatively, previous studies manually translate errors to hand templates, but this lacks standardized observational practices. In this paper, we propose a novel automatic image-to-image translation framework to evaluate hand hygiene quality and document the results in a standardized manner. The framework consists of two models, including an Attention U-Net model to segment hands from the background and simultaneously classify skin surfaces covered with hand disinfectants, and a U-Net-based generator to translate the segmented hands to hand templates. Moreover, due to the lack of publicly available datasets, we conducted a lab study to collect 1218 valid UV test images containing different skin coverage with hand disinfectants. The proposed framework was then evaluated on the collected dataset through five-fold cross-validation. Experimental results show that the proposed framework can accurately assess hand hygiene quality and document UV test results in a standardized manner. The benefit of our work is that it enables systematic documentation of hand hygiene practices, which in turn enables clearer communication and comparisons.