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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4004 — Identifying Improvement Opportunities to Reduce Common Pathogen Transmission During Routine Care

Lead/Presenter: Lauren Weston, COIN - Ann Arbor
All Authors: Krein SK (VA Ann Arbor Center for Clinical Management Research and University of Michigan) Harrod M (VA Ann Arbor Center for Clinical Management Research) Weston LE (VA Ann Arbor Center for Clinical Management Research) Drews F (VA Salt Lake City COIN and University of Utah) Mayer J (VA Salt Lake City COIN and University of Utah) Samore M (VA Salt Lake City COIN and University of Utah)

Personal protective equipment (PPE) and hand hygiene are recommended in hospitals to reduce transmission of common infectious agents. General adherence or the circumstances surrounding these practices during routine hospital care are not well known. The objective of this study was to better understand and characterize elements of the work system and identify issues that might lead to transmission-risk during the care of patients with common pathogens.

Direct observation of healthcare workers, both inside and outside patient rooms involving either contact (MRSA, VRE, C. difficile) or droplet (e.g., influenza) precautions, were conducted at one VA medical center from March--June 2016. The dataset consisted of field notes recorded by trained observers on medical/surgical units and an ICU. The data were coded using a content analysis approach based on the Systems Engineering Initiative for Patient Safety (SEIPS) Model to characterize issues with respect to process, tools and technology, tasks, internal environment and outcomes.

Field notes from 21 outside and 28 inside room observations were analyzed. Issues surrounding the process of donning and doffing PPE included inconsistent performance of hand hygiene and overhead removal of gowns. A common issue related to the use of tools and technology was the movement of equipment in and out of rooms without being cleaned, including personal (e.g., pens, stethoscopes) and shared items (e.g., computer carts, wheelchairs). With regards to tasks, the interruption of work flow was observed when healthcare workers exited rooms (partially or completely) while wearing PPE to find assistance or additional supplies for task completion While PPE supplies were available, location and use were not always obvious due to the internal environment. Lack of awareness was observed as a factor in adherence, error, and self-contamination outcomes, seen when healthcare workers touched themselves or personal items (e.g., phone, pager) while wearing gloves.

This analysis identified several themes involving non-adherence, procedural deviations, and potential transmission-risk during routine hospital care.

The SEIPS model provides a useful framework for systematically identifying targeted opportunities for improvement related to the work system and strategies to reduce potential transmission of common infectious agents in this setting.