A human factors engineering approach to improving hand hygiene quality

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) t...

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Main Authors: Michael W. Boyce, Trini A. Mathew, Scott C. Roberts, Michael Aniskiewicz, Kathy Krechevsky, Suzanne Dahlberg, Noelle Frye, Jamie E. Trumpler, Leigh V. Evans, Richard A. Martinello
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:Human Factors in Healthcare
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Online Access:http://www.sciencedirect.com/science/article/pii/S2772501424000216
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author Michael W. Boyce
Trini A. Mathew
Scott C. Roberts
Michael Aniskiewicz
Kathy Krechevsky
Suzanne Dahlberg
Noelle Frye
Jamie E. Trumpler
Leigh V. Evans
Richard A. Martinello
author_facet Michael W. Boyce
Trini A. Mathew
Scott C. Roberts
Michael Aniskiewicz
Kathy Krechevsky
Suzanne Dahlberg
Noelle Frye
Jamie E. Trumpler
Leigh V. Evans
Richard A. Martinello
author_sort Michael W. Boyce
collection DOAJ
description 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.
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spelling doaj-art-9d72bbbaebba4a8cb97ac790b74e16ba2025-08-20T02:32:20ZengElsevierHuman Factors in Healthcare2772-50142024-12-01610008510.1016/j.hfh.2024.100085A human factors engineering approach to improving hand hygiene qualityMichael W. Boyce0Trini A. Mathew1Scott C. Roberts2Michael Aniskiewicz3Kathy Krechevsky4Suzanne Dahlberg5Noelle Frye6Jamie E. Trumpler7Leigh V. Evans8Richard A. Martinello9Department of Emergency Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Center for Healthcare Simulation, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USA; Corresponding Author.HealthTAMCycle3 PLLC, Troy, MI 48085, USADepartment of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Department of Infection Prevention, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USADepartment of Infection Prevention, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USADepartment of Infection Prevention, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USADepartment of Infection Prevention, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USAGrant Resources Office, Yale New Haven Heath, 730 Howard Ave., New Haven, CT 06519, USAGrant Resources Office, Yale New Haven Heath, 730 Howard Ave., New Haven, CT 06519, USADepartment of Emergency Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Center for Healthcare Simulation, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USADepartment of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Department of Infection Prevention, Yale New Haven Health, 730 Howard Ave., New Haven, CT 06519, USA; Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USAHealthcare-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.http://www.sciencedirect.com/science/article/pii/S2772501424000216Hand hygieneInfection control, Human factors engineeringCenters for disease control and preventionWorld health organization
spellingShingle Michael W. Boyce
Trini A. Mathew
Scott C. Roberts
Michael Aniskiewicz
Kathy Krechevsky
Suzanne Dahlberg
Noelle Frye
Jamie E. Trumpler
Leigh V. Evans
Richard A. Martinello
A human factors engineering approach to improving hand hygiene quality
Human Factors in Healthcare
Hand hygiene
Infection control, Human factors engineering
Centers for disease control and prevention
World health organization
title A human factors engineering approach to improving hand hygiene quality
title_full A human factors engineering approach to improving hand hygiene quality
title_fullStr A human factors engineering approach to improving hand hygiene quality
title_full_unstemmed A human factors engineering approach to improving hand hygiene quality
title_short A human factors engineering approach to improving hand hygiene quality
title_sort human factors engineering approach to improving hand hygiene quality
topic Hand hygiene
Infection control, Human factors engineering
Centers for disease control and prevention
World health organization
url http://www.sciencedirect.com/science/article/pii/S2772501424000216
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