Highlights
- •Bottleneck analysis was used to examine hospitals’ standard precaution implementation.
- •Service providers’ improper use of protection equipment was the primary bottleneck.
- •High workload and misperceptions contributed to incompliance of standard precaution.
- •Secondary bottlenecks included difficulties in finance, recycling, and procurement.
Background
Service providers are often inadequately compliant with standard precaution protocols.
This study used bottleneck analysis to identify the weakest link in standard precaution
implementation and its associated challenges in hospitals.
Methods
Bottleneck analysis was conducted in 12 hospitals in Fujian Province, China. In each
hospital, a focus group was organized among the key informants to illustrate the sequential
steps of standard precaution implementation graphically. The level of difficulty and
the specific challenges associated with each step were discussed.
Results
The sequential activities of standard precaution implementation generally start with
making budget for personal protection equipment (PPE), followed by procurement, storage/inventory,
in-hospital distribution, in-department distribution, usage/monitoring, and recycling
of PPE. Service providers’ improper use of PPE was the primary bottleneck. The reasons
for improper use of PPE included high workload, time constraints, the sense of wearing
PPE would interfere with clinical judgment, and various misconceptions. Making financial
planning, recycling, and procurement of PPE were the secondary bottlenecks.
Conclusions
Bottleneck analysis is useful to illustrate workflow in healthcare systems and pinpoint
constraints in standard precaution implementation. Institutional changes, including
targeted provider training, adjustment of providers’ workloads, and allocation of
budget, are suggested strategies to address the identified bottlenecks in standard
precaution.
Key Words
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Article info
Publication history
Published online: January 18, 2020
Footnotes
This study was supported by the National Institute of Mental Health (NIMH) Grant K01MH102147.
Declaration of interest: None to report.
Identification
Copyright
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
