There is a high turnover rate among the outsourced ESWs , they need to be trained to understand how to do cleaning practice well and realize why their work is important , and to be recognized and
certified to improve compliance and motivation .”
go from patient to patient without performing hand hygiene . Cleaning and disinfection practices are affected by HFE principles as well .
Hung , et al . ( 2020 ) conducted a three-phase study using an HFE approach to enhance environmental cleanliness in a medical center . The three-phases included pre-intervention analysis ( Phase 1 ), implementing interventions by HFE principles ( Phase 2 ), and programmatic analysis ( Phase 3 ). The evaluations of terminal cleaning and disinfection were performed using the fluorescent marker , the adenosine triphosphate bioluminescence assay , and the aerobic colony count method simultaneously in all phases . Effective terminal cleaning and disinfection was qualified with the aggregate outcome of the same 10 high-touch surfaces per room . A score for each high-touch surface was recorded , with 0 denoting a fail and 10 denoting a pass by the benchmark of the evaluation method , and the total terminal cleaning and disinfection score ( TCD score ) was a score out of 100 . In each phase , 840 high-touch surfaces were collected from 84 rooms after terminal cleaning and disinfection . After the interventions , the TCD score by the three evaluation methods all showed significant improvement . The carriage incidence of multidrug-resistant organisms ( MDROs ) decreased from 4.1 per 1,000 patient-days to 3.6 per 1,000 patient-days .
As Hung , et al . ( 2020 ) acknowledge , “ Manual cleaning is a labor-intensive and repetitive task that can become monotonous . There is a need to implement effective and sustainable environmental cleaning and disinfection strategies for environmental service workers ( ESWs ) to remain thorough and use the right technique and product . Strategy guided by human factors engineering principles may be helpful for improving patient room cleaning and disinfection . The elements of HFE include systems initiative , design-driven innovation , and improving system performance and human well-being .”
The researchers add , “ Our findings indicated that using an HFE approach to strengthen the reliable wipe-offs on hightouch surfaces can significantly increase the thoroughness of the terminal cleaning and disinfection and decrease the carriage incidence of MDRO . The use of a uniform container for disinfectant dilution and a checklist reminder reduced potential errors or omissions in the terminal cleaning and disinfection . These interventions improved the accuracy of disinfectant dilution and overall TCD scores … There is a high turnover rate among the outsourced ESWs , they need to be trained to understand how to do cleaning practice well and realize why their work is important , and to be recognized and certified to improve compliance and motivation . Thus , the environmental cleaning and disinfection strategies are not only improving the cleaning knowledge and skills of the ESWs , but also reducing and simplifying the workflow barriers that can balance timeliness of completing tasks and optimize the cleaning practice . After phase 3 of this study , we used a survey to assess knowledge and practices of environmental cleaning among the ESWs ; 97 percent of ESWs agreed that the checklist reminder was helpful to perform terminal cleaning and disinfection well .”
HFE and the Future
Pennathur and Herwaldt ( 2017 ) acknowledge that knowledge gaps around applying HFE principles to IP & C issues exist , and that in their review of the literature , “ most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training , technology evaluations , or physical environment design . The most significant gap pertains to the limited use and application of formal HFE tools and methods . Human factors engineers have developed , tested , and validated rigorous formal techniques and tools in numerous domains . However , investigators assessing usability and those assessing the physical environment were the only ones who used rigorous HFE methods to address infection prevention issues . Moreover , few investigators have evaluated the interaction among human factors variables as described by the systems engineering initiative for patient safety ( SEIPS ) model . This model posits that people ( e . g ., healthcare workers ) interact in a system that includes other people , the tasks they are doing , the organization ( e . g ., healthcare facility ), the environment , and the available technology and tools . Pressure or change in one portion of the system causes pressure or change in the other portions . Thus , if people designing infection prevention interventions do not take into account the effect the intervention has on all portions of the system , the interventions are likely to be ineffective . For example , if well-designed , usable hand hygiene technology is placed in a location where healthcare workers cannot see it or access it , the device will not promote use . If this device is placed where healthcare workers can see it and access it easily but they have not been trained to use it or trained when to use it , the device is unlikely to increase compliance .”
The experts say that investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems : “ For example , a task analysis might identify details about how and when healthcare workers do or do not practice hand hygiene , the number of hand hygiene opportunities in different clinical settings , barriers intrinsic to the hand hygiene process , inefficiencies in current workflow patterns , and design flaws that discourage healthcare workers from doing hand hygiene . Given this information about the overall system , infection prevention investigators together with frontline staff may be able to create and implement solutions that increase hand hygiene compliance and improve clinical workflow .”
HFE has the potential to require an investment in resources by healthcare institutions , but it doesn ’ t have to break the bank . As ECRI ’ s Tremoulet explains , “ Changing human behavior can be extremely difficult , but it does not have to be resource and cost intensive . One of the most elegant IP & C human factors solutions I ’ ve seen recently , aimed at improving hand hygiene compliance in one hospital , entailed attaching neon orange stickers to all hand sanitizer dispensers . Observations and interviews had revealed that clinicians reported that they didn ’ t use sanitizer as frequently inside the studied environment as they should ( per WHO guidelines ) because it wasn ’ t easily accessible . It turned out that they were so focused on the patient and the tools they needed to perform their jobs that they literally were not seeing the hand sanitizer dispensers . Making them very obvious through low tech , low cost stickers helped significantly increase how often clinicians used hand sanitizer .”