Chris Hermann, Founder and CEO at Clean Hands – Safe Hands

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Saul Marquez:
Welcome back to the Outcomes Rocket. Saul Marquez here and today I have the privilege of hosting Dr. Chris Hermann. He’s the founder and CEO of Clean Hands – Safe Hands. He has over 14 years experience working in medical technology, design and health care. His background as a physician and engineer has given him a unique perspective to bridge the gap between engineering and medicine. Dr. Hermann started and led the multi institution research collaboration that developed the core technology utilized in the CHSH Clean Hands Safe System. The research team included investigators from Children’s Health Care, Georgia Tech, Emory School of Medicine, the DA Tech Research Institute and the Centers for Disease Control and Prevention. He is the lead inventor for the patents related to the CHSH technology and serves as the connection between clinicians and engineers. Chris has a Ph.D. in Bioengineering and an MS in Mechanical Engineering and a B.S. in Biomedical engineering with high school honors from Georgia Institute of Technology and his medical degree from Emory School of Medicine. And in this series on just physicians leaving the bedside to do more, I thought it was wonderful to have Dr. Hermann on the podcast. Number one, to tell us about the work that Clean Hands, Safe Hands, but also to hear about his story and what made him shift from bedside to industry and just to be able to contribute in a bigger way. So, Chris, such a pleasure to have you here with us today. Thanks for joining us.

Dr. Chris Hermann:
My pleasure. Thanks for having me.

Saul Marquez:
You know, absolutely. And so, you know, I always kick off the interview with what inspired your work in health care. But, you know, and I want to ask that I also want to dig into what made the shift from bedside to doing something different. Take it out.

Dr. Chris Hermann:
Absolutely. So my my entire career and even going back to early days in education and training, I’ve always noticed this big disconnect between engineering and medicine. And this goes back to even time in high school when I was working with a couple different surgeons in the Atlanta area and just seeing some of the things that they struggled with that were in the grand scheme of things, pretty basic in terms of engineering problems. But they just didn’t necessarily have the skill set or training to do it. And then it kind of the flip side is the engineers that were in the medical field, I spent a lot of time with the orthopedic device world and the engineers and those companies, they had the resources and skills and techniques, but they didn’t understand the clinical side of things. I very vividly remember I had the opportunity to assist with one of the first. There was a minimally invasive knee replacement that was done in the Southeast and got about halfway through the surgery and realized that the the the tool to hold the implant in place, to put it in to the knee, it wouldn’t fit through the incision. And so there was this situation where it’s, oh, we’ve got to figure something out. And the surgery itself went well. But that kind of kicked off. It was honestly a multi-year journey with them trying to figure out how to better design tools and implants to adapt to the kind of the advanced medical field. And as medicine continues to push and develop. There are examples of technology keeping up. But quite frankly, a lot of what happens in health care is way behind the times. I mean, there’s always this kind of joke that we make a lot of a lot of information in health care is conveyed with clipboards and fax machines and pagers. And that’s probably still the only major industry that still relies on very basic written communications to operate. And so that has been something of an interest of mine that is kind of always driven me and always been my passion throughout my entire journey. And so I as you described earlier, I went to Georgia Tech and I thought I was going to go off and become a pretty normal surgeon. My interest has always been in the orthopedics field. And then I got kind of bit by the research bug after my first year of medical school. And then I was fortunate to be in a place with with Emory, have a dual degree program. And I was able to go back Georgia Tech for graduate school. But my whole career, my whole focus at that point was to go off and become a surgeon was more academic focused. And what I personally wanted to do was have that in-depth engineering training. And mine was in my formal training as a mechanical engineering and bio engineering. And because I really wanted to bridge that gap and I thought I was going to go off and run a research lab and do orthopedic bone engineering and bone mechanics. And that was what I was doing through graduate school. And this problem of hand hygiene kind of came up almost accidentally. And this was by no means on my radar or something to that I would actually ever get involved in. But I got approached by some clinicians, primarily Children’s Health Care of Atlanta, and they said, you know what, we struggle with this fundamental, very basic problem. We know that the the biggest thing we can do to prevent infections is wash our hands, but we can’t figure out a way to do it. And I think the conversation went something like along the lines of, can you guys help us develop a way to help improve that. In their minds, you guys or I in that case, was representing the entire collective engineering world, and my response, which I still get made fun of for even today after 15 years. Yeah, sure. It seems simple enough. Let’s give it a shot. And 15 years and we still don’t have it figured out largely. So we kicked off what was a little tiny research program that it was it was, quite frankly, a side project for me in graduate school.

Dr. Chris Hermann:
And we scrounged around enough. I think our first grant was for a whopping five thousand dollars, but we were able to take that money and build a prototype and then learn and then apply for larger grants and larger grants. And then we kind of fast forward about seven years or so. And there’s a pretty big research program built with among the big research institutions here in Atlanta. And and then at that point, we were kind of hit a crossroads. And for me personally, I was in my third year, I was basically finishing my third year of medical school. And several things kind of intersected is one is we got about as far as we could in the research environment. There are a lot of things that the research community is very, very well and very supportive of early technologies. But we were at a point where we had to go sort of to scale up our manufacturing. We’re having interest. We were having both from a research perspective and also some real pure customers, and we just couldn’t manufacture and run a company as part of the research institutions. And so I took what we thought was going to be two months off of medical school to partially study for my boards and then partially to just go explore is this real? Is there going to be an opportunity here? And that ended up taking that two months turned into about four and a half years before I finally was able to go back and finish medical school. And fortunately, the leadership at Emory were very, very understanding and accommodating, going back and forth between company stuff, going and trying to finish my clinical rotations. But I did finally finish. It took quite a while, but it did finally get across the goal line.

Saul Marquez:
Congrats. Thank you. It’s I mean, and it’s super interesting, right. You found yourself in the OAH and they’ve got this amazing, minimally invasive approach and the spacer doesn’t fit in. Are the are the it’s like how in the world right here, like this disconnect is Bab. I’ve got to do something about it. And so then it kind of leads you down this path of Clean Hands – Safe Hands. And so, you know, you’re in between both worlds. And now, 15 years later, this has become a thing and you guys are reducing infections. You’re you’re helping save lives, right, health care acquired infection deaths. So talk to us a little bit about the business now and how you’re adding value.

Dr. Chris Hermann:
Absolutely. So our name pretty well encapsulate what what we do. And it is in theory, very simple. So the problem that we address with health care associated infections. And so these are infections that you get while you’re in a hospital. So this is not something that you come in with. This is something you require while you’re in the hospital. And these infections, there are several causes, but by far and away, the biggest cause of these infections spread is by performing hygiene or as a result of poor hygiene. Excuse me. And and when it comes from it’s the you have very well intended clinicians, doctors, nurses, technicians, whatever those rules may be. But they touch things. And the problem that we’re all facing with COVID certainly is raise the awareness that at a point probably more so than ever any time in history. But what happens is the health care environment isn’t necessarily set up to promote those good practices. So the clinicians get busy. They’re focusing on the patients. They’re trying to take care of everything else. They’ve got 60 things, but they have to click on a computer to get to the day and they just get busy and they forget. And that was our going back to the engineering and medicine disconnect. That was our critical observation that we made years ago, is that health care workers are hardworking, very compassionate, very well-educated. They just need a reminder. And so that’s kind of where we came in. And our first technology, our very first prototype was this big, ugly box that had a blinking light on it. And we took it to our partners at Children’s Health Care of Atlanta at the time. And the Division Chief, I vividly remember this moment. I was describing it to her, showing it to her. Everybody’s excited. And she said no beeps. What are you talking about? It’s great, inexpensive. It works well. It’s great for the infrastructure. She said no more beeps. I have so many beeps in my ICU. I know everyone except the ventilator. And when we rewind fifteen years ago, that was before. There’s a pretty well documented phenomenon called alarm fatigue. Totally. But what she was describing is that everything in their ICU beeps and whistles and because there’s so many of them, they just ignore them. But the ventilator has a very specific one. She has learned over the years that if that one gets ignored, something really bad is going to happen in this case to a child, which she was absolutely spot on. So we went back with our tail between our legs and scratched the head a little bit and came back with the voice. You said, you know what, let’s give it a shot.

Saul Marquez:
And so it was instead of a beep, it was, hey,.

Dr. Chris Hermann:
It was, we said, please, we’re in the south so you have to say please. Our very first one, it was my my niece at the time was, I think four or five. And their hand hygiene slogan was foam up. So we said, Please foam up. So at that point, any time somebody would walk out of the rooms and forget it was this gentle reminder saying, please do whatever we wanted to do. And honestly, that was a case of better being lucky than good. But that simple voice reminder is there has been the single biggest driver of reducing and changing those hand hygience.

Saul Marquez:
Chris. So so the voice happens. So it happens audibly so that even everybody around could hear. So it becomes like a social pressure thing.

Dr. Chris Hermann:
It is now that was a component that wasn’t necessarily by design.

Saul Marquez:
Sure.

Dr. Chris Hermann:
So when so when if let’s say a doctor was to enter a patient’s room and they forgot to perform hand hygiene right. at that moment, that there are basically about to forget about to walk over and touch the patient. It’s a very quiet reminder and everybody is surprised how quiet it actually is for it to work. So it’s very, very quiet. And so it’s a it’s to the point where if a patient is awake and aware of what’s going on, they will hear it. But we’re not going to wake them up at night. We’re not going to disrupt them. We made the mistake early on to waking up a sleeping baby in the in the pediatric ICU, and we made sure never to do that again.

Saul Marquez:
Oh boy.

Dr. Chris Hermann:
And so it’s very, very quiet. And so but you’re right, it doesn’t necessarily create an overt pressure. But I’ve actually watched this happen is what happens with a voice goes off. The patient just makes eye contact with the clinician and everybody kind of knows why that happened. And they don’t have to speak up. They don’t have to say anything. And usually just the eye contact is enough to kind of redirect that clinician to perform the hand wash.

Saul Marquez:
Fascinating, Chris. And so how does this thing docs know that it hasn’t happened like that handwashing has not happened.

Dr. Chris Hermann:
So we put sensors throughout all of the patient care areas and specifically they go on all of the soap dispensers and all of the alcohol based hand sanitizers. And the way the technology works is there’s one there’s one main sensor that’s associated with each room, usually inside. It’s almost always inside the room. And when somebody walks by, it knows that detects somebody walk by it, then looks to see who that person is. We give all of the health care providers a little badge that sends a wireless signal to help identify who that person is.

Saul Marquez:
And that was my next question. Gotcha.

Dr. Chris Hermann:
And then all of those sensors talk to each other. And this is kind of the magic. It’s under the hood is we say, all right, I just saw Dr. Chris walk into the room, all those sensors and talk to each other and say, hey, I see him clean his hands on any of those dispensers. If the answer is yes, what you guys there’s no disruption whatsoever to the normal clinical environment. And this is the reality is most of the time clinicians forget, then they make the decision. Hey, first that voice reminder, it reminds them and then we get a chance, a second chance to come back to clean their hands. And then all of that data that those sensors generate is sent to our analytics platform to be analyzed, to be sliced and diced, to be then sent back out to the hospital so they can help identify and address any of the challenges that may remain with you.

Saul Marquez:
Wow, that’s amazing. So, I mean, you’ve got this down to a science and and those nudges to help clinicians do the right thing. And I mean, it’s like, to your point, right., everybody is busy and the surgeon is thinking about the plan. They want the best thing you’re in it. Maybe it’s a tough case. So you’re just like focused, right? You on the right thing and you make my forget you have that basic thing done. And so and so I’ve never heard of anything like this out there. And I think it’s really neat, you know, I guess talk to us a little bit about the the outcomes. How are you guys making things better?

Dr. Chris Hermann:
Yeah. For us, the main bread and butter, what we do is it’s pretty simple. It’s when we can come in and we’re most organizations, we can double or triple their rates within about six months. And we’ve identified a very systematic way to go through that process. And we lead them on a very specific we call it the hand hygiene pathway. In doing so, we can very systematically and very efficiently improve hand hygiene and then we see infections fall. And so we’re very proud of the fact that we’ve had eighteen consecutive hospitals over the last year and a half. When you look at them individually, all of them saw a statistically significant reduction in infections within six months of implementing our system. And that average infection, when you look across all of those hospitals, is over sixty five percent now, which is in the grand scheme of things of our reductions. It’s a home run. Most hospitals look to maybe five or 10 percent a year and we can come in within a very short period of time and demonstrate that you have the sixty five percent reduction in infections. And then also, more importantly, despite all the complexities that go into causing these infections, we have data to show that we can reduce every single type of health care associated infection.

Saul Marquez:
That’s pretty impressive. And the numbers speak for themselves. Sixty five percent reduction is a big deal, and when you’re talking about lives and dollars, it’s it’s impactful. I was looking at your site and Chris, I mean, seventy five thousand deaths per year, 30 billion in costs.

Dr. Chris Hermann:
Yes. And when you look at the especially with all of the financial pressures that COVID is putting on hospitals, these are the dollars are hidden and they’re kind of tucked away in reimbursements. But the average hospital bed spends ten thousand dollars a year just on the direct cost of these infections. And we can very confidently say, you know, we can count those numbers in half and we have done that in and since we developed this structured pathway, we’ve done that in every case. And so in many cases, we can take hospitals from losing money every year to being profitable. It’s not uncommon for us to save especially larger organizations, five to 10 million dollars per year or more. There is also some of your listeners probably are aware of the health care associated complications list. So it’s a hack list which further penalizes hospitals with the highest rates of complications. And the way that those have shifted over the years is very, very heavily weighted to infections. And we’re very proud of the fact that any of the hospitals that we had that were on the list before using our technology are now off of that list. And that saves that’s a it’s one percent of their total Medicare revenue. And so that’s when you have hospitals that operate on a one to three to maybe four percent profit margin. That’s a huge swing for many organizations in terms of revenue and in terms of profitability.

Saul Marquez:
Totally. The numbers speak for themselves. And and so as you reflect on the company, the progress you guys are making, what what has been one of the biggest challenges you faced and the learning that came out of that?

Dr. Chris Hermann:
Absolutely. So probably the the biggest one in this kind of goes back to the early joke where it’s a simple concept. It should be simple to do. It turns out that it was much, much more complicated than that. And the week when I think back to it was our first real independent customer and it wasn’t associated with the research. And we we came in and we were very proud of all the advancements we made, the technology, we had the sensors, we had new analytics, we had this new platform. And we came in, we turned the voices on this on improvement, and everybody was excited. And then they kind of hit a wall. And what we found is, well, the voice is the single biggest driver. It’s not the only one. And what we ran into is that once you get beyond those simple factors of people just forgetting, there are a lot of really complex ways or barriers to performing hand hygiene and quite frankly, any clinical care practice. And this is before we were really exposed to kind of change management and quality improvement methodologies. And in our industry, when you what we do is we were part of an industry that is called hand hygiene monitoring. And what we learned really quickly is that just because you monitor hand hygiene doesn’t mean you improve it.

Dr. Chris Hermann:
And about this time, I had a conversation with Dr. Bill Bornstein, who’s the chief quality officer for for Emory Health Care, and he shared one of his data isms with me, which is just because you weigh a chicken, it doesn’t make it fatter. And that really resonated in kind of very succinctly describe what we were experiencing is you can measure a problem 18 different ways and have the most accurate way of measuring or weighing the proverbial chicken or measuring the hygiene. But it doesn’t really create value or doesn’t really create better outcomes until you actually change people’s behavior. And that’s where the complexity comes in. When you look at some large multi hospital health systems, it’s not uncommon for them to have five to 10 to actually even have one health system. That’s thirty five thousand different health care providers scattered in some cases across multiple states, multiple facilities, multiple leadership teams, all with different roles in the organization. How do you then go take that and change their behavior simultaneously and efficiently without having to hire an army of people to go in? And that’s where we identify that. It took us years to figure out this pathway. And when we started to identify and what it came down to is we would have a hospital that would do something and it would work and we’d see a pattern in the data. And then they would early on, they would struggle to take six, sometimes 12 months for them to figure out something else.

Dr. Chris Hermann:
We’re going to see another bump. And what we were able to do is go back and analyze that data. And we saw very consistent patterns. Now, they were separated in time across all of our different hospitals to that point. But every pattern was the same. And what we tried to do and it turns out we were very successful at this, is we began to systematically link those interventions in a very specific order. And not only did we could we do it and lead to better clinical outcomes, we could do it very efficiently and very and be able to scale across very large health systems. And so what we started out from a research perspective, trying to make a technology that would measure actually in our case, we did want to improve it. When we look at what we have built today, most of our focus is to go back to our chicken analogy for a minute Yes, we do have the ability to weigh that proverbial chicken, but a lot of what we do is, is we have built a way to feed the chicken and get it and get it to grow. And in our world, it’s not just about measuring hand hygiene. It’s about using data, using technology to help drive clinical behavior change that leads to a reduction of infections.

Saul Marquez:
Yeah, and it sounds like you guys have have gained a lot of learnings and built that into the technology, the process, and it’s working.

Dr. Chris Hermann:
And so there’s been a lot of very long and at times painful journey. But it is working.

Saul Marquez:
I certainly applaud your your persistence, Chris, the work that you’ve done is is making a huge difference. And as as we think about the transition of doctors like yourself that have taken different paths, obviously the work that you’re doing is meaningful and one could argue impactful in as much as or even greater amount than if you had stayed at the bedside. And so I want to applaud you for that, number one, and also for physicians and others listening, you know, it’s inspiration for you to consider doing more beyond the bedside. And if you’re a company that’s wanting to make a difference, Right. Chris mentioned at the beginning the gap. And so the importance of including physicians in the decision making process is critical. And so this is a really great opportunity for us to take some time and ask you, Chris, what are you most excited about today?

Dr. Chris Hermann:
For me, it’s kind of like the accumulation of all the hard work, the blood, sweat and tears, if you will, that is kind of going into what we do. And you mentioned making a difference. And we’re actually very proud of the fact that at this point in time, every day that we all get up and work hard and go to work, we prevent over 10 infections a day and we save at least one life a day, kind of on average. And that’s been the biggest driver for me over the years, as I’ve always kind of with my medical background, I’ve always wanted to take care of people and help improve the quality of their life. And it’s well, I’m not necessarily doing that with a stethoscope on the bedside anymore. That’s what it’s all about. For me personally, as I’ve been able to apply my engineering background work at a very, very talented group of engineers who have been able to build something that really does work. But the key to our success is we kind of locked arms very early on with those conditions. And we frustrated a bunch of nurses early on and kind of locked arms with them and kind of jointly worked through the challenges in terms of data, in terms of technology. And that’s the key is we didn’t necessarily we didn’t have a magic crystal ball when we first started this 15 years ago by any stretch, but by really kind of combining the as close as possible, the engineers and the equations together kind of worked through and address some of these. In the grand scheme of things. This is a big, massive problem that compared to what a lot of the engineering world does, isn’t necessarily really complicated or super hard. But we’ve been able to combine those in a unique way to have huge clinical benefits, huge financial benefits and ultimately to save people’s lives. And that’s that’s what has been my driver to all throughout. My training is and continuing on is launching a startup from the ground up and continuing to run into the growth.

Saul Marquez:
That is so great, Chris. And and folks, if you’re curious about how Clean Hands – Safe Hands can help you and your hospital, it’s Clean Hands – Safe Hands dot com. If you go to Google, just type in Clean Hands – Safe Hands, and it’ll take you straight to their website. Just an incredible and inspiring story by Dr. Hermann today. And as we conclude the podcast, I’d love to have you, Chris, conclude with a closing thought and the best way the listeners can engage with you and continue the conversation.

Dr. Chris Hermann:
Yeah, absolutely. So the best way to engage with me is probably you can reach out to LinkedIn is probably honestly the best way to get a hold of me these days. Just search Chris Herminn, that’s HERMANN or email me at Chris@cleanhand-safehands.com. And I think probably a closing thought is that with all of what’s happening in the world today with COVID and all of these massive changes that have had health care overnight, in many respects it’s just the opportunity for innovation and to drive clinical change is probably now greater than it’s ever been. And to take a huge need to do things differently, to innovate and just whatever those approaches are, just what we have seen over the years is the absolute best way to do that is get as much front line support and buy in from those clinicians to help lead to that meaningful change.

Saul Marquez:
Love it Chris, thank you so much for that. And we really appreciate the work that you and your team are doing to help reduce infections by improving hand hygiene. Thanks for all you do and thanks for sharing your story.

Dr. Chris Hermann:
It’s my pleasure. Thank you for having me on.

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