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Human Factors Analysis of Infectious Risk Moments

English title Human Factors Analysis of Infectious Risk Moments
Applicant Sax Hugo
Number 149474
Funding scheme Project funding (Div. I-III)
Research institution Abt. für Infektiologie und Spitalhygiene Universitätsspital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Infectious Diseases
Start/End 01.09.2014 - 30.04.2018
Approved amount 429'000.00
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All Disciplines (2)

Discipline
Infectious Diseases
Psychology

Keywords (7)

healthcare-associated infections; human factors; patient safety; behaviour science; qualitative research; infection control; medical simulator

Lay Summary (German)

Lead
Spitalerworbene Infektionen sind kostspielig und verursachen zusätzliches Leid. Obwohl einige Massnahmen dagegen bekannt sind, werden sie nicht konsequent umgesetzt. Diese Studie erstellt ein Inventar aller infektiösen Risikomomente und erforscht dann die ergonomischen, gedanklichen und psychologischen Gründe für risikobehaftetes Verhalten der Spitalmitarbeiternden. Die Methoden für diese Forschung kommen aus der Welt des Human Factors Engineering. Diese wissenschaftlichen Disziplin beschäftigt sich mit dem Zusammenspiel zwischen Menschen und seiner Umgebung, um die Effizienz des Gesamtsystems und das Wohl der darin involvierten Menschen zu optimieren.
Lay summary

Im Zusammenhang mit medizinischer Betreuung erworbene Infektionen bedrohen die Patientensicherheit und kommen leider immer noch häufig vor. Gemäss Hochrechnungen aus dem Jahr 2005 sind in der Schweiz jährlich ca. 75'000 Patienten davon betroffen. Diese Infektionen führen zu Verlängerungen des Spitalaufenthalts, zusätzlichen Operationen und Todesfällen.

Wie erfolgreiche Qualitätsverbesserungsinitiativen zeigen, ist ein Teil dieser Infektionen mit relativ einfachen Mitteln verhinderbar. Dennoch werden diese Massnahmen nicht konsequent umgesetzt. Warum?

Mit dieser Studie hoffen wir endlich Licht in dieses Dunkel bringen. Dafür werden Forscher in Abteilungen eines Akutspitals viel Zeit mit Beobachtungen verbringen, um ein Inventar aller möglichen infektiösen Risikomomente zu erstellen. Jeder dieser Momente stellt ein Risiko dar für ein Infektion oder eine Keimübertragung. Ein Gremium von Experten in Mikrobiologie, Infektiologie und Epidemiologie wird anschliessend im Konsensusverfahren die Gefährlichkeit diese Momente bewerten. Die daraus entstandene Liste an infektösen Risikomomenten stellt dann ein ganzheitliches Abbild der infektiösen Gefahr im Spital dar. Gleichzeitig werden mit den Beobachtungen auch die Ursachen von riskantem Verhalten erforscht, sowohl auf ergonomischer Ebene (Arbeitsumgebung und Instrumente) als auch auf den Ebenen der gedanklichen Vorstellungen (Visualisierung der Keime) und der sozialer Interaktion (Was sagt mein Chef, meine Kollegin dazu?). Die Methoden für diese Forschung kommen aus der Welt des Human Factors Engineering. Diese wissenschaftlichen Disziplin beschäftigt sich mit dem Zusammenspiel zwischen Menschen und seiner Umgebung, um die Effizienz des Gesamtsystems und das Wohl der darin involvierten Menschen zu optimieren.

Direct link to Lay Summary Last update: 30.04.2014

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
Frequency and nature of Infectious Risk Moments during acute care based on the INFORM Structured Classification Taxonomy
Clack Lauren, Passerini Simone, Wolfensberger Aline, Sax Hugo, Manser Tanja (2018), Frequency and nature of Infectious Risk Moments during acute care based on the INFORM Structured Classification Taxonomy, in Infect Control Hosp Epidemiol, 39(3), 272-279.
Likelihood of infectious outcomes following Infectious Risk Moments during patient care - an international expert consensus study and quantitative risk index
Clack Lauren, Passerini Simone, Manser Tanja, Sax Hugo (2018), Likelihood of infectious outcomes following Infectious Risk Moments during patient care - an international expert consensus study and quantitative risk index, in Infect Control Hosp Epidemiol, 39(3), 280-289.
Implementing Infection Prevention Practices Across European Hospitals: An In-Depth Qualitative Assessment
Clack Lauren, Zingg Walter, Saint Sanjay, Casillas Alejandra, Touveneau Sylvie, da Liberdade Jantarada Fabricio, Willi Ursina, van der Kooi Tjallie, Damschroder Laura, Forman Jane, Harrod Molly, Krein Sarah, Pittet Didier, Sax Hugo (2018), Implementing Infection Prevention Practices Across European Hospitals: An In-Depth Qualitative Assessment, in BMJ Quality and Safety, 1-10.
"First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool
Clack Lauren, Scotoni Manuela, Wolfensberger Aline, Sax Hugo (2017), "First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool, in Antimicrobial Resistance & Infection Control, 6, 108.
Annals for Hospitalists Inpatient Notes - Human Factors Engineering and Inpatient Care—New Ways to Solve Old Problems
Clack Lauren, Sax Hugo (2017), Annals for Hospitalists Inpatient Notes - Human Factors Engineering and Inpatient Care—New Ways to Solve Old Problems, in Annals of Internal Medicine, 166(8), HO2-HO2.
Human Factors Design and Hand Hygiene
Clack Lauren, Sax Hugo (2017), Human Factors Design and Hand Hygiene, in Allegranzi Benedetta, Pittet Didier, Boyce John (ed.), 185-192.
Mental models: a basic concept for human factors design in infection prevention
Sax Hugo, Clack Lauren (2015), Mental models: a basic concept for human factors design in infection prevention, in Journal of Hospital Infection, 89(4), 335-339.
Infectious Risk Moments: A Novel, Human Factors–Informed Approach to Infection Prevention
Clack Lauren, Schmutz Jan, Manser Tanja, Sax Hugo (2014), Infectious Risk Moments: A Novel, Human Factors–Informed Approach to Infection Prevention, in Infect Control Hosp Epidemiol, 35(8), 1051-1055.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
International Forum on Quality and Safety in Healthcare Conference 2018 Poster Behavioural determinants of infectious risk behaviours: a video-reflexive approach. 02.05.2018 Amsterdam, Netherlands Bogdanovic Jasmina; Sax Hugo; Clack Lauren Catherine; Passerini Simone;
11th International Meeting for Behavioural Science in Surgery & Acute Care Settings Talk given at a conference Video reflexive ethnography: uncovering healthcare provider risk perceptions 20.10.2017 Zurich, Switzerland Sax Hugo; Passerini Simone; Bogdanovic Jasmina; Clack Lauren Catherine;
Zürcher Hygienekreis Talk given at a conference Video-reflexive Ethnography: Ein praktisches Instrument für Ihre Infektionsprävention-Toolbox 19.09.2017 Zürich, Switzerland Wolfensberger Aline; Sax Hugo; Bogdanovic Jasmina; Clack Lauren Catherine; Passerini Simone;
Swiss Society for Hospital Hygiene Annual Congress Talk given at a conference Qualitative Research Methods: Practical applications for Infection Prevention 30.08.2017 Basel, Switzerland Clack Lauren Catherine;
International Consortium for Prevention and Infection Control Poster Review of video-reflexive ethnography in healthcare 20.06.2017 Geneva, Switzerland Passerini Simone; Sax Hugo; Clack Lauren Catherine;
International Consortium for Prevention and Infection Control Poster COINFORM: a comprehensive inventory of infectious risk moments during acute care. 20.06.2017 Geneva, Switzerland Clack Lauren Catherine; Bogdanovic Jasmina; Passerini Simone; Sax Hugo; Wolfensberger Aline;
Centre for Behaviour Change, Digital Health Conference Poster Virtual reality enhanced behaviour-change training for healthcare associated infection prevention. 22.02.2017 London, Great Britain and Northern Ireland Clack Lauren Catherine; Sax Hugo;
Swiss Society for Hospital Hygiene Annual Congress Talk given at a conference Design and validation of visual cues to improve isolation compliance. 03.09.2015 Interlaken, Switzerland Gabler Verena; Clack Lauren Catherine; Sax Hugo;


Knowledge transfer events



Self-organised

Title Date Place
Human Factors in Health Care - Short Course 20.04.2016 University Hospital Zurich, Switzerland

Communication with the public

Communication Title Media Place Year
Media relations: radio, television Spitalhygiene: Der Kampf gegen die ansteckende Fahrlässigkeit SRF Puls German-speaking Switzerland 2017

Awards

Title Year
Swiss Society for Hospital Hygiene Annual Congress, Best presentation of innovation in infection control (2nd place), for "Design and validation of visual cues to improve isolation compliance" 2015
Swiss Society for Hospital Hygiene Annual Congress, Best presentation of innovation in infection control (3rd place), for "Infectious Risk Moments - A novel, human factors-informed approach to infection prevention" 2014

Associated projects

Number Title Start Funding scheme
122324 Effectiveness of different strategies to improve hand hygiene and reduce healthcare-associated infections: a cluster randomised controlled trial 01.04.2009 Project funding (Div. I-III)

Abstract

Background: Healthcare-associated infections continue to represent a major threat to patient safety. Healthcare worker (HCW) behavior is known to be often unsafe in this respect. The nature, frequency, implications, and behavioral determinants of the full range of risk-prone manipulations in the complexity of real-life care are largely unknown. We present a novel approach to identifying infectious risk during routine patient care and their behavioral determinants. Working hypothesis: We propose that healthcare-associated infectious risk resides to a considerable proportion in seemingly innocent but frequent care-related manipulations at ‘infectious risk moments’ (IRM). We define IRM as moments in the workflow of HCWs that are associated with a risk of patient colonization or infection. IRM are associated with contextual behavioral determinants that are better understood on a system level. Human Factors science provides excellent investigational instruments for this type of research. Objectives:1.To determine the full range of IRM, including but going beyond indications for hand hygiene2.To understand the behavioral determinants for safe versus unsafe behavior at IRMs, including physical (ergonomics of work environment and devices), cognitive (mental models and subjective experience), and psychosocial (safety leadership) factors Study procedures and methods: Prolonged time in the field in 3 typical acute care wards (intensive care unit, general medical ward, emergency ward) allows for a rich contextual data collection analyzed by human factors methods.Objective 1: a) Semi-structured observations to produce a tentative broad IRM inventory; b) Delphi process with an international expert panel to confirm and rate IRM with their risk level and outcome; c) Structured observations to assess the frequency of IRM and safe behavior.Objective 2: Ethnographic observations and interviews/focus groups for the physical and psychosocial level; concept mapping for the cognitive level; and, video-reflective technique as integrative method for all three levels.Expected value of the project: This project is designed to produce a break-through in the field of infection control. Its novel approach lies in the detection of IRM and associated behavioral determinants in the context of a rich, interdisciplinary system using a powerful mixed-methods approach. The results will lay the ground for design solutions to be studied in a follow-up trial.
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