Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-07-01T04:36:56.928Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementation of a Clostridioides difficile prevention bundle: Understanding common, unique, and conflicting work system barriers and facilitators for subprocess design

Published online by Cambridge University Press:  13 June 2019

Jackson S. Musuuza ,
Ann Schoofs Hundt ,
Pascale Carayon ,
Karly Christensen ,
Caitlyn Ngam ,
Nicholas Haun  and
Nasia Safdar
Jackson S. Musuuza
Affiliation:
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
Ann Schoofs Hundt
Affiliation:
Center for Quality and Productivity Improvement, University of Wisconsin–Madison, Madison, Wisconsin
Pascale Carayon
Affiliation:
Center for Quality and Productivity Improvement, University of Wisconsin–Madison, Madison, Wisconsin Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin
Karly Christensen
Affiliation:
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Caitlyn Ngam
Affiliation:
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nicholas Haun
Affiliation:
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
Nasia Safdar*
Affiliation:
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Author for correspondence: Nasia Safdar, Email: ns2@medicine.wisc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Clostridioides difficile (C. difficile) poses a major challenge to the healthcare system. We assessed factors that should be considered when designing subprocesses of a C. difficile infection (CDI) prevention bundle.

Design:

Phenomenological qualitative study.

Methods:

We conducted 3 focus groups of environmental services (EVS) staff, physicians, and nurses to assess their perspectives on a CDI prevention bundle. We used the Systems Engineering Initiative for Patient Safety (SEIPS) model to examine 5 subprocesses of the CDI bundle: diagnostic testing, empiric isolation, contact isolation, hand hygiene, and environmental disinfection. We coded transcripts to the 5 SEIPS elements and ensured scientific rigor. We sought to determine common, unique, and conflicting factors across stakeholder groups and subprocesses of the CDI bundle.

Results:

Each focus group lasted 1.5 hours on average. Common work-system barriers included inconsistencies in knowledge and practice of CDI management procedures; increased workload; poor setup of aspects of the physical environment (eg, inconvenient location of sinks); and inconsistencies in CDI documentation. Unique barriers and facilitators were related to specific activities performed by the stakeholder group. For instance, algorithmic approaches used by physicians facilitated timely diagnosis of CDI. Conflicting barriers or facilitators were related to opposing objectives; for example, clinicians needed rapid placement of a patient in a room while EVS staff needed time to disinfect the room.

Conclusions:

A systems engineering approach can help to holistically identify factors that influence successful implementation of subprocesses of infection prevention bundles.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 8 , August 2019 , pp. 880 - 888
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
Lucado, J, Gould, C, Elixhauser, A. Clostridium difficile infections (CDI) in hospital stays, 2009: Statistical Brief 124. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: US Agency for Healthcare Research and Quality; 2006.Google ScholarPubMed
Weiss, K, Boisvert, A, Chagnon, M, et al. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol 2009;30:156–162.CrossRefGoogle ScholarPubMed
Evans, ME, Kralovic, SM, Simbartl, LA, Jain, R, Roselle, GA. Effect of a Clostridium difficile infection prevention initiative in Veterans Affairs acute care facilities. Infect Control Hosp Epidemiol 2016;37:720–722.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Ngam, C, Hundt, AS, Haun, N, Carayon, P, Stevens, L, Safdar, N. Barriers and facilitators to Clostridium difficile infection prevention: a nursing perspective. Am J Infect Control 2017;45:1363–1368.CrossRefGoogle ScholarPubMed
Hundt, AS, Ngam, C, Carayon, P, Haun, N, Safdar, N. Work system barriers and facilitators to compliance with infection prevention intervention: initial findings regarding hand hygiene from three target roles. Proceedings of the HFES 60th Annual Meeting. Washington, DC, 2016.Google Scholar
Yanke, E, Moriarty, H, Carayon, P, Safdar, N. A qualitative, interprofessional analysis of barriers to and facilitators of implementation of the Department of Veterans’ Affairs Clostridium difficile prevention bundle using a human factors engineering approach. Am J Infect Control 2018;46:276–284.CrossRefGoogle Scholar
Xie, A, Carayon, P, Cartmill, R, et al. Multi-stakeholder collaboration in the redesign of family-centered rounds process. Applied Ergonomics 2015;46:115–123.CrossRefGoogle ScholarPubMed
Xie, A, Carayon, P, Cox, ED, et al. Application of participatory ergonomics to the redesign of the family-centred rounds process. Ergonomics 2015;58:1726–1744.CrossRefGoogle ScholarPubMed
Detienne, F. Collaborative design: managing task interdependencies and mulitiple perspectives. Interact Comput 2006;18:1–20.CrossRefGoogle Scholar
Smith, MJ, Carayon-Sainfort, P. A balance theory of job design for stress reduction. Int J Indust Ergonom 1989;4:67–79.CrossRefGoogle Scholar
Smith, MJ, Carayon, P. Balance theory of job design. In: Karowski, W, ed. International Encyclopedia of Ergonomics and Human Factors. London: Taylor & Francis; 2001. Pp. 1181–1184.Google Scholar
Carayon, P, Hundt, AS, Karsh, B-T, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2006;15(suppl I):i50–i58.CrossRefGoogle ScholarPubMed
Yanke, E, Carayon, P, Safdar, N. Translating evidence into practice using a systems engineering framework for infection prevention. Infect Control Hosp Epidemiol 2016;35:1176–1182.CrossRefGoogle Scholar
Patel, PR, Kallen, AJ. Human factors and systems engineering: the future of infection prevention? Infect Control Hosp Epidemiol 2018;39:849–851.CrossRefGoogle ScholarPubMed
Shekelle, PG, Pronovost, PJ, Wachter, RM, et al. Advancing the science of patient safety. Ann Intern Med 2011;154:693–696.CrossRefGoogle ScholarPubMed
Giorgi, A. The descriptive phenomenological psychological method. J Phenomenol Psychol 2012;43:3–12.CrossRefGoogle Scholar
Brown, KA, Mitchell, TR. Performance obstacles for direct and indirect labour in high technology manufacturing. Int J Prod Res 1988;26:1819–1832.CrossRefGoogle Scholar
Carayon, P, Gurses, AP, Hundt, AS, Ayoub, P, Alvarado, CJ. Performance obstacles and facilitators of healthcare providers. In: Korunka, C, Hoffmann, P, eds. Change and Quality in Human Service Work. Mering, Germany: Rainer Hampp Verlag; 2005.Google Scholar
Robson, C. Real World Research. 2nd ed. Malden, MA: Blackwell; 2002.Google Scholar
Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2012;34:69–73.CrossRefGoogle ScholarPubMed
Tschudin-Sutter, S, Lucet, JC, Mutters, NT, Tacconelli, E, Zahar, JR, Harbarth, S. Contact precautions for preventing nosocomial transmission of extended-spectrum β lactamase-producing Escherichia coli: a point/counterpoint review. Clin Infect Dis 2017;65:342–347.CrossRefGoogle ScholarPubMed
Martin, EM, Bryant, B, Grogan, TR, et al. Noninfectious hospital adverse events decline after elimination of contact precautions for MRSA and VRE. Infect Control Hosp Epidemiol 2018;39:788–796.CrossRefGoogle ScholarPubMed
Bartley, JM, Olmsted, RN, Haas, J. Current views of health care design and construction: practical implications for safer, cleaner environments. Am J Infect Control 2010;38:S1–S12.CrossRefGoogle ScholarPubMed
Wilcox, MH, Planche, T, Fang, FC, Gilligan, P. What is the current role of algorithmic approaches for diagnosis of Clostridium difficile infection? J Clin Microbiol 2010;48:4347–4353.Google ScholarPubMed
Musuuza, JS, Roberts, TJ, Carayon, P, Safdar, N. Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veterans’ Hospital by examining nurses’ perspectives and experiences. BMC Infect Dis 2017;17:75.CrossRefGoogle Scholar
Carayon, P. Human factors of complex sociotechnical systems. Appl Ergon 2006;37:525–535.CrossRefGoogle ScholarPubMed
Supplementary material: File

Musuuza et al. supplementary material

Musuuza et al. supplementary material 1

Download Musuuza et al. supplementary material(File)
File 28.8 KB
Supplementary material: File

Musuuza et al. supplementary material

Musuuza et al. supplementary material 2

Download Musuuza et al. supplementary material(File)
File 22.4 KB