INFECTION CONTROL
Human factors and hand hygiene
MIKE SULLIVAN, managing director of GOJO Industries – Europe, discusses the benefits of integrating human factors in healthcare and how hand hygiene fits into the bigger picture.
Human factors encompass everything that can influence individuals and their behaviour. The aim of integrating human factors into healthcare is to ensure that high quality care is delivered and that every patient has a positive experience, while healthcare professionals, on whom the quality of care depends, are fully supported. Clinical performance can be enhanced by having a better understanding of the behaviour of individuals, their interactions with each other and within the environment. Acknowledging human limitations, under a culture of openness, and understanding why mistakes are made, while tackling poor designs and procedures, are key to improving patient safety. The NHS has started to include human factors approaches by adopting patient safety and quality improvement science and, in November 2013, the National Quality Board released a Concordat which aims to provide leadership to embed human factor principles and practices into the healthcare system.
A ‘how to guide’ to implementing human factors in healthcare produced by Patient Safety First outlines some of the some of the common human factors that can increase risk including: • Mental workload. • Distractions. • The physical environment. • Physical demands. • Device/product design. • Teamwork. • Process design.
A study into patterns of hand hygiene behaviour
Clearly, hand hygiene behaviour is just one of many human factors which should be addressed, but the importance of good hand hygiene and its positive impact on
64 THE CLINICAL SERVICES JOURNAL
patient outcomes and safety cannot be underestimated, and has been an accepted fact for many years. Research conducted by Infonaut in a hospital in Canada, studied human factors using a real-time tracking system within a hospital to measure the movement of staff, patients and equipment, including the use of soap and alcohol-based hand sanitisers. They searched for patterns of behaviour that could facilitate the transmission of serious hospital pathogens. As these mostly travel by the faecal-oral route, they paid particular attention to patient washrooms. The study observed 279 patients making more than 12,000 bathroom visits and found that hand hygiene only occurred 30% of the time. When patient hand hygiene was studied around thousands of meal times they found a similar rate at breakfast and only marginally better at lunch and dinner. The research then looked at patient hand hygiene when patients entered and left their rooms – precisely when staff hand hygiene is emphasised – and found average rates of only 5%. There was only a 3% rate in the patient kitchen. All of these patients were organ transplant recipients taking immunosuppressant drugs.
Mike Sullivan Steps to improve hand
hygiene behaviour The entrances and exits to wards, as well as other public spaces such as waiting rooms and eating areas are key places to target, not just with the means to clean and sanitise hands, but also to educate and inform. Eye-catching signage, posters and other visual displays can help greatly, and good hand hygiene companies can offer sound advice on the most effective approaches, and provide materials, based on their knowledge of the sector. However, education is only part of the solution, because we also need to make it easy for patients and visitors to comply. Asking fundamental questions such as: are patients provided with the means to clean their hands before eating if they are bed-ridden and do they have ready access to sinks and/or hand sanitisers could reveal some interesting results, and quickly identify areas for improvement. The Canadian study was summarised by indicating there is some evidence that providing hand hygiene points within reach of patients in bed may dramatically improve their hand hygiene rates. As patients mouths are touched by their own hands more than anything else, bedside hand hygiene could cause some infection rates to plummet – just as they did when the World Health Organization’s Five Moments for
APRIL 2015
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