A human factors engineering approach to improving hand hygiene quality

Abstract

Healthcare-associated infections (HAIs) are common and expensive complications that can occur during inpatient hospital stays. Hand hygiene (HH)—which includes hand washing with soap and water and hand rubbing with alcohol-based hand sanitizer—is the primary tool used by healthcare personnel (HCP) to prevent HAIs. Consequently, the World Health Organization (WHO) proposed guidelines for effective HH in healthcare settings. However, consistent performance of HH by HCP is still lacking. HH in healthcare requires both compliance with indications for HH and quality of HH. Integrative approaches in human factors engineering (HFE) and infection prevention can be used to promote sustainable techniques that can be implemented by HCP to improve the quality of HH techniques. This research proposes a three-phase integrative approach that uses HFE-based methods to identify why HH is often insufficiently executed by HCP in hospital settings and ultimately to help guide HCP to improve HH quality. We performed i) a tabular task analysis (TTA), constructed by HFE personnel and infection prevention specialists, ii) card sorting with infection prevention subject matter experts to prioritize HH steps and analyzed with criticality analysis and subsequent modifications to the TTA, and iii) TTA validation and verification with subject matter experts. Finally, we conducted qualitative interviews with members of hospital leadership and determined that it is feasible to implement the use of TTAs in hospital settings. This research provides enhanced HH guidance using an integrative HFE-based approach and is directed to increase the quality of HH performed by HCP, thereby reducing HAI rates and improving patient safety. Furthermore, these results can be used to support the effective implementation of the WHO's HH guidance. Our findings elucidate some of the challenges to patient safety regarding HH and clarify best practices for HH in hospital settings.