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Using bottleneck analysis to examine the implementation of standard precautions in hospitals

Published:January 18, 2020DOI:https://doi.org/10.1016/j.ajic.2019.12.003

      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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