PREVENTON OF CLOSTRIDIUM DIFFICILE INFECTION: A HUMAN FACTORS AND SYSTEMS ENGINEERING APPROACH
Methods: Using a human factors approach – the Systems Engineering Initiative for Patient Safety (SEIPS) – we performed a work system analysis to guide direct observation data collection with the goal of systematically identifying work system barriers and facilitators of adherence to hospital-mandated contact isolation protocols for patients with suspected or confirmed CDI at two hospitals.
Results: A total of 288 observations were undertaken at the two sites. 175 observations were of nurses, 59 observations were of physicians, 17 observations were of visitors, remainder were of ancillary staff. Full compliance with contact isolation precautions was low at both hospitals, the main SEIPS processmeasure. At hospital A, 17 persons (7%) fully complied with contact isolation precautions. Full compliance in hospital B was significantly higher and observed for 11 persons (22%) (P = .004). Rates of gown and glove use were similar between hospitals A and B (63% vs. 71%; P = .337; 52% vs. 61%; P = .283). The rate of hand hygiene use before room entry was low at both hospital A and B (18% vs. 29%; P = .079). After room exit, use of soap and water for hand hygiene was significantly higher at hospital B (23% vs. 55%; P = <.001). Full compliance with contact isolation precautions as compared to non-compliance required a significantly greater amount of time before room entry, inside room, and after room exit (59.9 sec vs. 3.2 sec; P < .001; 507.3 sec vs. 149.7 sec; P = .006; 15.2 sec vs. 1.3 sec; P < .001). Significantly less time was required before room entry and inside room in non-isolation rooms as compared to full compliance (59.9 sec vs. 0 sec; P < .001, 507.3 sec vs. 28.4 sec; P = .027). Physicians had a significantly higher rate of full compliance compared to nursing staff (17% vs. 7%; P = .043).
Conclusion: Infection control interventions for CDI prevention are complex, time consuming tasks. An analysis of the work system using a human factors approach can guide understanding of CDI prevention practices.
C. Zellmer, None
H. Moriarty, None
N. Safdar, None
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