Human Factors in a post COVID-19 Healthcare System
Introduction
The COVID-19 pandemic has shone a light on our ability to control the spread of infection as a society. Significant changes to how we operate have occurred including social distancing and stricter personal hygiene practices. This pandemic has had specific implications also for how healthcare facilities operate and their ability to control the spread of infection, considering the nature of these facilities as a place where people with transmittable viruses and infections attend. Ineffective management in healthcare facilities is likely to lead to these locations becoming “hotspots” and the source of larger outbreaks.
This paper discusses the challenges surrounding infection control within healthcare facilities as well as actions that can be taken to mitigate risks of transmissions and how Human Factors can help.
The Issue
People attend hospitals and other healthcare facilities for treatment of various ailments, acute and chronic conditions, and specific purposes such as surgery and emergency medical care. We typically see these environments as clean and places where people come to recover. These facilities are intended for people who are unwell and despite the continuing best efforts of staff, transmittable infections and viruses remain prevalent. Infections contracted in these environments (including COVID-19) are known as healthcare-associated infections (HAI). HAI typically consist of multi-drug resistant organisms (MDRO) that are difficult to eradicate due to their resistance against many common antibiotics.
The challenge COVID-19 has presented is that of an infectious virus with higher rates of severe morbidity (e.g. hospitalisations, ICU admissions) and mortality compared to typical strains of influenza. Healthcare facilities have become a primary potential source of transmission to non-infected patients and staff.
Inadequate control of HAI and viruses can have a significant impact on a patient’s health outcomes. Contracting a HAI can complicate an existing medical condition, particularly some chronic conditions, extending recovery time or even resulting in death.
Such complications place additional strain on the healthcare system. 180,000 patients experience HAIs in Australia each year. This equates to 2 million additional hospital bed days and increases staff workload in a sector that often experiences insufficient staffing levels. These prolonged bed days and ongoing care also contribute significant financial costs. One Australian state reported the additional costs associated with management of just 126 surgical site infections being over $5 million.
Management of the Issue
Healthcare facilities around the globe have started implementing multiple practices designed to stop the spread of COVID-19, which may also reduce the rate of other HAI. These practices include the use of higher levels of personal protective equipment (PPE), additional procedures to manage hygiene and increased frequency of cleaning and disinfection. However, to effectively manage the spread we need to carefully consider how the practices are implemented in relation to the associate risk.
Cleaning and disinfection within healthcare facilities is a well-established practice, intended in part to limit the potential for the HAI spread. Staff are typically assigned tasks to do in each area, using selected equipment in specific way and at a frequency intended to ensure cleanliness. This is often based upon what areas and items are perceived as high-touch and high-risk areas for potential transmission.
The risk with designing tasks and processes based upon perception is that this perception is often not reflective of the actual circumstances.
Studies have shown that applying a Human Factors approach to the development of cleaning and disinfection practices can substantially improve the efficacy of the practices. Techniques such as observation studies can be highly effective in identifying the actual high-touch, high-risk areas and items that should be a focus for cleaning and disinfection. This information can assist in redesigning work practices to align to the risk identified, ensuring these locations and items are prioritised accordingly and staff complete the practices in a safe, effective manner. This approach has already been seen to significantly reduce the detection of the MDRO that are commonly responsible for HAI (Hung et al. 2020).
Minimising Risk of Infection Transmission
To minimise the risk of transmission of infections including COVID-19 in healthcare facilities, a strategy can be applied that focuses on designing the process to support users, optimising the work process and minimising the potential for human error.
The first step is to minimise risk related to cleaning and disinfection by understanding the processes, tasks and the environment in which they are completed. An observation study of cleaning and disinfection activities in healthcare facilities allows identification of:
• high-touch points within the environment
• safety, efficiency and effectiveness of existing cleaning and disinfection practices
• needs for a redesigned cleaning and disinfection process
Identification of the high-touch points allows prioritisation of cleaning and disinfection to specific areas, likely provide the greatest benefits to infection control. Once current practices have been identified the next step is to assess how well these practices meet the actual cleaning and disinfection needs.
Any gaps identified are resolved through redesign of the existing work practices or development of new work practices. Work practices are then then validated to ensure they are safe, effective and that appropriate equipment is being provided for tasks identified.
Once work practices have been validated the tasks within them can be prioritised according to their difficulty to learn and perform, importance from a risk perspective and frequency. This analysis informs both the structure and content of initial training and competence assurance activities to ensure cleaning and disinfection practices are conducted effectively. Tools such as checklists can also be developed to drive completion of tasks.
Human Factors professionals specialise in the application of tools and techniques to achieve each of the activities outlined above. Our aim is to develop practical and efficient practices, which promote safety for staff and assist in limiting the spread of infection.
Author:
Rhys Thompson
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