infection prevention
infection prevention
By Susan Singh , MPH , CIC
The Role of Human Factors Engineering in Infection Prevention
Infection prevention and control ( IP & C ) leaders are tasked with effectively implementing new surveillance technologies , creating innovative strategies to combat healthcare-associated infections ( HAIs ), and formulating plans for addressing emerging pathogens . Amidst a widespread shortage of healthcare personnel , IP & C leaders must seek new methods to adjust workload balance , promote long-term adoption and implementation of infection prevention measures , and keep patients , visitors , and staff safe .
Human factors engineering ( HFE ) is an applied field of study that focuses on creating tools , devices , and systems that address human abilities , limits , and characteristics within an environment . The application of HFE in healthcare can be a key method in reducing the more than one million HAIs that occur each year . 1
What is human factors engineering ? HFE is the application of scientific methods to the design and evaluation of people ’ s knowledge , skills , abilities , and limitations as it applies to the design of tools , machines , systems , tasks , jobs , and their surroundings .
The goal of HFE is to focus on how work is done in situ versus how work is perceived to be done , considering environmental stressors that can create fallible situations for humans . HFE attempts to design systems that prioritize and optimize safety and enhance performance in a complex healthcare environment .
Why is it important to understand healthcare as a system ?
When implementing HFE in infection prevention efforts , one must consider healthcare as a complex , multi-layered system . Due to the complexity of healthcare , it ’ s essential to identify and understand the various components of the system and how they interact . Thus , areas where the system is susceptible to errors and near misses are identified which allows human factors engineers
( HFEs ) to analyze performance data , arriving at optimized models of testable workflows striving for improved reliability and outcomes .
HFEs also define healthcare as a sociotechnical system , meaning it involves people and technology working together in the same environment .
Because healthcare is a sociotechnical system , workarounds or errors may arise from inadequate design or unintended use of tools . Issues in one area of the system can generate risks elsewhere : a ripple effect . Left unnoticed , ripples within any component of the system or systems have the potential to harm patients , individual workers , teams , or visitors . Understanding healthcare as sociotechnical reveals that human-environmental interactions are intricate and likely run deeper than what may be perceived upon first glance .
An example of HFE and IP & C Considering that healthcare is a complex sociotechnical system , adverse incidents are not caused by one bad decision or action . Instead , incidents are caused by interactions between the systems component parts : people , tools and technology , tasks and processes , the physical environment , organizational policies , and even things outside the organizational environment .
Let ’ s look at a hypothetical example of how HFE can be used to investigate an increase in infections .
An outpatient hemodialysis clinic saw an increased incidence of methicillin-resistant Staphylococcus aureus ( MRSA ) bacteremia amongst their patients . Between January 2023 – May 2023 , they identified nine patients with MRSA after they presented to clinic with signs and symptoms of an active infection .
Outbreak investigation uncovered that the dialysis treatment area was not being appropriately cleaned and disinfected by environmental services ( EVS ) personnel . An Apparent Cause Analysis placed the blame on EVS , citing non-adherence to protocols as the cause of the outbreak . However , HFEs investigated further and uncovered several problems in the overall hemodialysis work system , including how people interact in the clinics environment :
●Post investigation , the HFEs learned about the challenges that the EVS staff faced . EVS are expected to clean the dialysis treatment area after each of the three dialysis shifts . However , the dialysis treatment area is never without patients and staff members .
●Patients wait in the dialysis treatment area instead of the designated waiting room . Staff and patients are also using empty chairs in the treatment area to store their personal belongings ( e . g ., coats , backpacks , purses , etc .)
●EVS knew how to perform proper cleaning and wanted to keep the area clean and disinfected , but the system didn ’ t support their workflow .
●The HFEs learned of an organizational policy to keep patients in the waiting room until called in for treatment .
●It was discovered , as dialysis patients often develop close bonds with their caregivers , staff allowed patients into the treatment area so the patients could socialize with staff as many of them were friends .
●During the systems analysis , the HFEs were able to assess and develop a plan . Rather than focusing only on re-education of EVS staff and their
10 • www . healthcarehygienemagazine . com • april 2024