Getting Their Attention: Using Human Factors Engineering to Design the Optimal Isolation Sign

Abstract

<h3>Background</h3> The Centers for Disease Control and Prevention recommends transmission-based precautions for patients with suspected or confirmed infection of select pathogens. Isolation signs are used in healthcare to alert staff of the precautions needed to prevent transmission, including the usage of appropriate personal protective equipment (PPE) prior to entering patients' rooms. However, isolation signs can lack clarity or signal saliency, making it difficult for healthcare staff to process critical information. We sought to apply human factors design principles to isolation signs to increase signage clarity to ultimately improve compliance with isolation precautions. <h3>Methods</h3> We applied human factors design principles to modify existing isolation signs at a quaternary care children's hospital in order to increase saliency of the graphics, and align with how individuals naturally process visual information. Key design changes included converting to a vertical layout, increasing graphic size, and adding number indicators to align with proper donning order. Modified signs were trialed on two pilot units between April and May 2019. Staff feedback was collected using a standardized form to assess sign effectiveness and comprehension. Upon sign implementation on four units in July 2019, direct observations were performed to measure PPE compliance. These observations were compared to the baseline compliance from 2017 and 2018 using chi-square. <h3>Results</h3> Seventy-six staff were surveyed during the trial: 94.7% found the order of donning PPE easy to understand and the majority (71.1%) found the signs to be effective. PPE compliance increased on the four post-implementation units from 87.2% (n=141) in 2017 and 2018 to 100% (n=21) between July and December 2019 (p=0.53). <h3>Conclusions</h3> We found that implementation of human factors principles to isolation sign design improved sign effectiveness and correlated with an increase in PPE compliance. Human factors design principles should be considered by Infection Prevention programs to enhance effectiveness of prevention practices in healthcare.