Human factors
Decontamination methods: The choice of decontamination method will depend on the risk of infection associated with the equipment. It is important that the differentiation of items that require disinfection or sterilisation is clear and that measures are taken, where possible, to reduce manual cleaning steps. It is preferential to automate any part of the process that lends itself to a machine centric step. For example, the application of moist heat with mechanical cleaning (such as from using a washer-disinfector) is the preferred disinfection technique for instruments prior to sterilisation.
Using human factors for task assessment and improving procedures The two most important areas where human factors can benefit are through the strengthening of procedures and the involvement of personnel in this activity. It
is important that procedures provide clear, logical and unambiguous instructions. Where procedures are not effective is when every step is not captured (in other words, there is a gap between procedures and how the work is performed. Such gaps are widest when procedures have not been written by those who are expected to follow them). Here, procedures can be improved by introducing tacit knowledge, ensuring they are risk informed. Procedures can also be improved when they are unnecessarily complex, and here it is important to reduce complexity. Procedure can be strengthened through task analysis. Task analysis is the study of what a person is required to do, in terms of actions and mental processes, in order to achieve a goal. This involves describing how a task is done,
often through a series of smaller sub-tasks. This involves8
: l Determining which tasks are goal critical.
l Prioritising sub-tasks for analysis. l Understanding which human action or inaction might make a failure to clean or decontaminate an item more likely or more serious.
l Assessing how to identify and install adequate layers of protection for the sub- tasks in order to reduce the likelihood or consequences of human failure.
With the identification of each sub-task, it is important to identify the performance influencing factors, especially the variabilities that can be introduced into the process. To begin with, the process is relatively
Processing devices
Inspect for dirt and bioburden
Cleaning of instruments
Test instruments for functionality
Placement of correct instruments in trays
Packaging trays for sterilisation
People (staff numbers)
Tools and technology e.g. inspection lights
Physical environment e.g. lighting levels, noise
Organisation e.g. communication
Figure 2: Hierarchical breakdown of surgical processing department work
abstract (such as being mapped out in a meeting room using sticky notes). Following a review of the tasks, the group discussion should proceed to break down the core tasks into sub-tasks (this is useful for helping to differentiate between ‘work-as-imagined’ and ‘work-as-it-actually-is’). From this, an abstraction hierarchy is formed and this can be used to identify the possible performance shaping factors (as illustrated in figure 2, which shows a partial breakdown as an organisational task hierarchy, focusing on the inspection of equipment returned for reprocessing). This can be supported by a variance matrix developed to illustrate the relationship among the tasks, and performance shaping factors. This process can be enhanced by drawing on information, such as considering defect data to identify the percentage and types of defects across reprocessing phases and pinpointing the most common assembly defects provides
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