Healthcare-associated infections (HCAIs)
Module overview
Healthcare-associated infections (HCAIs) continue to be a challenge in developed and developing countries. Hand hygiene practice is considered to be the most effective strategy to prevent HCAIs, but healthcare workers’ compliance is poor. Using a human factors perspective, this module explores elements that affect healthcare workers’ hand hygiene compliance. Slips, lapses and mistakes can occur depending on the worker’s skills and knowledge levels. Violations of protocols may also occur, and these may be associated with the intention to provide care efficiently. Strong leadership and an understanding of why non-compliance with hand hygiene occurs assists with developing strategies to improve compliance.
Healthcare-associated infections (HCAIs) continue to be a challenge in developed and developing countries. Hand hygiene practice is considered to be the most effective strategy to prevent HCAIs, but healthcare workers’ compliance is poor. Using a human factors perspective, this module explores elements that affect healthcare workers’ hand hygiene compliance. Slips, lapses and mistakes can occur depending on the worker’s skills and knowledge levels. Violations of protocols may also occur, and these may be associated with the intention to provide care efficiently. Strong leadership and an understanding of why non-compliance with hand hygiene occurs assists with developing strategies to improve compliance.
Keywords
hand hygiene, handwashing, HCAIs, healthcare-associated infections, human factors, infection, infection control, infectious diseases, patient safety, professional issues
hand hygiene, handwashing, HCAIs, healthcare-associated infections, human factors, infection, infection control, infectious diseases, patient safety, professional issues
Conclusions
- Improving healthcare workers’ compliance with hand hygiene protocols is imperative if we are to reduce HCAI rates.
- Understanding the cognitive processes involved in undertaking tasks identifies those circumstances when healthcare workers may forget to wash their hands or perceive that hand hygiene is not necessary.
- It is important to recognise that, in situations where healthcare workers perceive low risk, deliberate hand hygiene violations can occur. In some areas, these violations can become routine practice.
- Improvement in compliance with hand hygiene practices requires targeted interventions that address organisational constraints, training and education, and organisational safety culture, and also challenge healthcare workers’ perceptions of low risk that lead to hand hygiene protocol violations.
Acronyms
HCAIs: healthcare-associated infections
NHS: National Health Service
WHO: World Health Organization
Glossary
Aseptic procedure: involves antiseptic hand hygiene (using alcohol, betadine or chlorhexidine) and sterile gloves. Used for short invasive procedures.
Erroneous violations: violations in which a person does not intentionally decide to deviate from the rules, but instead lack of knowledge and understanding form the basis of the violation.
Exceptional violations: those that occur as a response to unusual situations.
Foresight training: encourages NHS staff to evaluate pressures during their daily work situations. This is explored in the realms of self, context and task, where slips, lapses or mistakes often occur.
Hand hygiene: a general term that refers to a method of removing microorganisms from the hands, to prevent cross-infection. The two most common types of hand hygiene are handwashing with soap and water and an alcohol-based handrub.
Hawthorne effect: where an individual’s behaviour changes because they become aware of being observed.
Human factor: the relationship and interaction between how people think (cognitive processes) and act, the environment they work in, and the tools they use are studied in the discipline of human factors.
Knowledge-based errors: mistakes occur when we are consciously paying attention to the task, and are more likely to be related to a lack of knowledge.
Routine violations: violations where non-compliance has become routine and accepted practice. This is due to a cultural climate where there are no apparent negative consequences for violations.
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