Recent studies demonstrate the importance of using human factors principles when designing and evaluating
PPE to better match the PPE to the healthcare workers ’ needs and limitations , their tasks , and the environmental constraints .”
HCP still experienced contamination during doffing in the follow-up simulation . The authors pessimistically concluded that HCP contamination during doffing “ seems to be caused by natural flaws ” ( Kang , et al ., 2017 ), which ignores the contribution that better PPE design could have on performance .
Bagian , et al . ( 2011 ) say that PPE training is “ weaker ” than other interventions , while John , et al . ( 2016 ) identified suboptimal training and lack of proficiency testing as contributors to failures during glove and gown removal . The CDC recently funded work by Gurses , et al . ( 2018 ) to develop a web-based training program to complement and clarify PPE guidelines , where researchers applied HFE principles and methods to translate PPE use guidelines into instructions focused on reduced guideline ambiguity , redesigning the work system , and improving teamwork of HCP caring for patients .
Drews , et al . ( 2020 ) note , “ Given relatively low adherence rates , HFE has great potential to increase adherence via improved training , equipment , and built environments . Given that low adherence must be addressed from a number of angles , a sociotechnical systems perspective appears to be the way to integrate the separate efforts into one comprehensive , effective approach .”
They are echoed by Pennathur and Herwaldt ( 2017 ), who observe further , “… PPE designs are not standardized , and PPE items and doffing protocols were not designed or tested based on human factors principles . Thus , one should not be surprised that healthcare workers ’ knowledge about proper PPE use and their use of PPE are suboptimal and that they contaminate themselves when they doff PPE … Recent studies demonstrate the importance of using human factors principles when designing and evaluating PPE to better match the PPE to the healthcare workers ’ needs and limitations , their tasks , and the environmental constraints .”
HFE and Medical Devices
Over the last decade , an 80 percent reduction in central line-associated bloodstream infections ( CLABSI ) in U . S . intensive care units has been achieved according to Pronovost , et al . ( 2016 ), with this decrease in CLABSI partly attributable to interventions similar to those implemented in a collaborative of 103 intensive care units ( Pronovost et al ., 2008 ). The intervention targeted HCP behavior changes and included both technical and organizational components ( Dixon-Woods , et al ., 2011 ).
As Drews , et al . ( 2020 ) explains , “ Participating hospitals first addressed organizational issues by having site leaders implement a comprehensive unit-based safety program to improve safety culture . The program trained staff in hazard recognition , safety culture , teamwork , and communication . The specific bundle of interventions to reduce CLABSI included education , providing central line carts with needed supplies , a checklist of practices for safe line insertions , permission to stop HCP if practices were not adhered to , and daily central line removal discussions . An implementation in Spain that initially focused on the use of checklists alone did not reduce CLABSI ; only implementation of the full program led to a reduction ( Palomar et al ., 2013 ), emphasizing the importance of a sociotechnical systems perspective .”
Line maintenance issues are another CLABSI contributor . The conceptual framework of adherence engineering addresses increasing adherence to protocols in complex tasks ( Drews , 2013 ). The core assumption of adherence engineering is that task behavior is partly shaped externally and that external factors can be used to increase protocol adherence . Seven principles aim at increasing adherence : deliberately create object affordance ( a quality of an object / environment that promotes performance of a specific action ), provide task-intrinsic guidance ( the task guides the user on how to perform it ), implement nudging ( provide optimized choices ), select and implement smart defaults ( provide default values that are commonly used ), provide feedback , and reduce the cognitive effort required for a task , and reduce the physical effort required for a task .
An HFE-based central line maintenance kit was developed by applying this framework ( Drews , Bakdash , et al . , 2017 ). Clinical performance using the central line maintenance kit was evaluated in clinical observations . This 29-month , pre-post implementation assessment study suggests that the HFE-based kit improved adherence and lead to a significant reduction in the number of CLABSI . Thus , application of HFE design principles to medical kit development can improve protocol adherence and clinical outcomes .
Drews , et al . ( 2020 ) emphasize that , “ Successful interventions targeted HCP behavior with a focus on technical and organizational components . The development of better tools ( carts , kits ) improves performance , as does training in hazard recognition , teamwork , communication , and a culture of safety . Finally , by developing conceptual frameworks , guidance can be provided to develop future interventions that support HCPs in their tasks .” They add , “ A sociotechnical systems perspective that is essential to the HFE approach has significant potential to improve HCP performance and patient safety . HFE frameworks have widespread applicability for guiding future interventions . This review suggests that HFE can contribute in numerous ways to improving performance at the individual , group , and system level . Example areas of contribution are development / application of conceptual frameworks of human performance , improved understanding of HCP cognitive processes ( e . g ., individual and shared mental models ), simplification or redesign of workflows , improvement of equipment design , development / optimization of standardized training programs and requirements , elimination of communication / guidelines ambiguity , task-based improvements of the built environment and