A surgeon carefully washes his hands before putting on gloves and scrubs. He walks into a sterile operating room wearing a mask to contain germs further, and then his cell phone rings. The doctor answers the germ-covered phone, finishes a call, then goes back to his work on the table, ignoring the fact that all the prep was for not, and contaminates the procedure. It may sound like a careless mistake, but it is the sort of thing hospitals contend with all the time. When it comes to keeping up protocol for preserving sterile environments, hospitals actually have a stunningly poor record. “When you look into it, you learn a high compliance rate would be 40 percent,” says Robert Karnick, Robrady Design’s senior business development manager. He speaks from experience, having brought the successful Hygreen Hand Hygiene Recording and Reminding System to market to remedy this issue. The Hygreen system connects a monitor, a simple clip on a scrub, with a red and green light that alerts hospital professionals when they or their peers have failed to keep everything clean. The system gets used in hospitals nationwide, primarily by nurses and support staff, and has brought compliance rates in some areas of operation to near perfect. In designing the product, Karnick’s team had to strike a fine balance between being effective and becoming a nuisance—plenty of nurses complained the lights at some points distracted them from doing their jobs—but the product, after rigorous testing, won approval from the notoriously rigorous Food and Drug Administration, as well as hospital management. The trick, Karnick says, was accounting not just for when people used a product professionally, but also to remember when they screw up. “It’s about taking the step to look at the entire ecosystem and take into account how a product is used.” That’s where the doctor with the cell phone comes in. Yes, this actually happened, but not in a real operating room; the physician was performing mock operations on dummies and cadavers at the inaugural Industrial Design Society of America (IDSA) Medical Design Conference in Tampa in October, where Karnick presented a case study on the success of the Hygreen system and oversaw a group exercise where designers at the conference watched real surgeons in a simulated work environment, flagging potential contamination points like the grabbing of the phone. The goal is take a Hygreen-like system to the next level, though designs created at the event belong to the IDSA, not Robrady. Regardless of what happens to those plans, Karnick hopes the exercises help participants come up with new ways to keep infectious control in mind when designing medical products in the future. Healthcare Associated Infection kills 100,000 people each year and can ramp up medical expenses 15 times over. SRQ