healthcare-associated infections; human factors; patient safety; behaviour science; qualitative research; infection control; medical simulator
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.
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.
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
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.
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.
Clack Lauren, Sax Hugo (2017), Human Factors Design and Hand Hygiene, in Allegranzi Benedetta, Pittet Didier, Boyce John (ed.), 185-192.
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.
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.
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.