Highlights
- •Clinician perspectives on sustaining hand hygiene reliability are poorly defined.
- •Human factors engineering is effective but underutilized in infection prevention.
- •Using this framework, we surveyed pediatric clinicians about hand hygiene.
- •Organization, environment, tasks, and tools identified as barriers to hand hygiene.
Background
Hand hygiene (HH) is critical to prevent health care-associated infections (HAIs).
Clinician perspectives on maintaining high reliability are poorly defined.
Methods
We surveyed physicians, nurse practitioners, and physician assistants to understand
perceptions of and barriers to high reliability in HH. The Systems Engineering Initiative
for Patient Safety 2.0 model was used to develop an electronic survey exploring 6
human factors engineering (HFE) domains.
Results
Among 61 respondents, 70% perceived HH as “essential” to patient safety. While 87%
reported alcohol-based hand rub (ABHR) availability as very effective in improving
HH reliability, 77% reported dispensers to be “sometimes” or “often” empty. Clinicians
in surgery/anesthesia were more likely than those in medical specialties to note skin
irritation from ABHR (OR 4.94; 95% CI 1.37-17.81) and less likely to believe feedback
was effective in improving HH (OR 0.26; 95% CI 0.08-0.88). One quarter of respondents
indicated the layout of patient care areas was not conducive to performing HH. Staffing
shortages and the pace and demands of work precluded HH for 15% and 11% of respondents,
respectively.
Conclusions
Aspects of organizational culture, environment, tasks, and tools were identified as
barriers to high reliability in HH. HFE principles can be applied to more effectively
promote HH.
Key Words
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References
HCUP Fast Stats Data Tools | AHRQ Data Tools. Accessed January 5, 2023. https://datatools.ahrq.gov/hcup-fast-stats
CDC. Health Topics - HAI - POLARIS. centers for disease control and prevention. Published, 2021. Accessed January 5, 2023. https://www.cdc.gov/policy/polaris/healthtopics/hai/index.html
- Strategies to prevent healthcare-associated infections through hand hygiene.Infect Control Hosp Epidemiol. 2014; 35: 937-960
- Hand hygiene and human factors.J Infect Prev. 2015; 16: 143-144
- Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control programme.Lancet Lond Engl. 2000; 356: 1307-1312
- Does physician leadership influence followers’ hand hygiene compliance?.Open Forum Infect Dis. 2019; 6: ofz236
- Searching for an optimal hand hygiene bundle: A meta-analysis.Clin Infect Dis. 2014; 58: 248-259
- Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene.Pediatrics. 2011; 128: e689-e698
- Impact of a successful speaking up program on health-care worker hand hygiene behavior.Pediatr Qual Saf. 2017; 2: e035
- Healthcare infection control practices advisory committee, HICPAC/SHEA/APIC/IDSA hand hygiene task force. guideline for hand hygiene in health-care settings. recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Society for healthcare epidemiology of America/Association for professionals in infection control/infectious diseases society of America.MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 2002; 51 (quiz CE1-4): 1-45
- Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand.Int J Pharm. 2020; 584119431
- The impact of COVID-19 pandemic on hand hygiene performance in hospitals.Am J Infect Control. 2021; 49: 30-33
- COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices.J Hosp Infect. 2021; 111: 27-34
- Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic.Am J Infect Control. 2022; 50: 719-723
- Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: A long-term follow-up study.Am J Infect Control. 2021; 49: 1118-1122
- Factors associated with hand hygiene compliance at a tertiary care teaching hospital.Infect Control Hosp Epidemiol. 2013; 34: 1146-1152
- Tailored interventions to address determinants of practice.Cochrane Database Syst Rev. 2015; i-112
Human Factors Engineering. Accessed April 27, 2021. https://psnet.ahrq.gov/primer/human-factors-engineering
Catalyst N. What Is Lean Healthcare? NEJM Catal. Published online 2018. Accessed December 22, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0193
- SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients.Ergonomics. 2013; 56: 1669-1686
Hand hygiene tools and resources. Accessed June 24, 2022. https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene/monitoring-tools
- Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Human factors engineering contributions to infection prevention and control.Hum Factors. 2019; 61: 693-701
- Role of human factors engineering in infection prevention: gaps and opportunities.Curr Treat Options Infect Dis. 2017; 9: 230-249
- Using human factors engineering to improve the effectiveness of infection prevention and control.Crit Care Med. 2010; 38: S269
- Intensive care physicians’ and nurses’ perception that hand hygiene prevents pathogen transmission: Belief strength and associations with other cognitive factors.J Health Psychol. 2017; 22: 89-100
- Using alcohol for hand antisepsis: dispelling old myths.Infect Control Hosp Epidemiol. 2000; 21: 438-441
- Remind me again: physician response to web surveys: the effect of email reminders across 11 opinion survey efforts at the american board of internal medicine from 2017 to 2019.Eval Health Prof. 2021; 44: 245-259
Article info
Publication history
Published online: March 15, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: Ana M Vaughan-Malloy, has disclosed stock ownership, detailed in submitted disclosure form. Jenny Chan Yuen, and Thomas J. Sandora, have no disclosures.
Identification
Copyright
© 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
