Caitlyn Ngam1, Ann Schoofs Hundt2, Nicholas Haun3, Pascale Carayon4, Linda Stevens5, Nasia Safdar6. 1. University of Wisconsin School of Medicine & Public Health, Madison, WI. 2. Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI. 3. Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine & Public Health, Madison, WI. 4. Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI; Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, WI. 5. Department of Nursing and Patient Care Services, University of Wisconsin Hospital and Clinics Authority, Madison, WI. 6. Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine & Public Health, Madison, WI; William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI. Electronic address: ns2@medicine.wisc.edu.
Abstract
BACKGROUND: Clostridium difficile infection (CDI) is a critical patient safety issue. Consistent and regular performance of appropriate practices is effective in preventing CDI. Variation in adherence to these practices can impede their effective implementation and weaken CDI prevention. METHODS: Using the Systems Engineering Initiative for Patient Safety (SEIPS) framework we convened a focus group of 10 nurses to identify barriers and facilitators to compliance with a CDI prevention bundle that includes (1) prompt diagnostic testing, (2) empirical isolation for patients with suspected CDI, (3) consistent and appropriate contact isolation, (4) hand hygiene, and (5) disinfection of the patient room and objects in the room. On completion of transcript coding, analyses were performed based on bundle intervention and the work system element of the SEIPS model. RESULTS: A total of 58 excerpts were coded. Work system barriers or facilitators were associated with nearly every bundle intervention. The work system elements raised in over half of the excerpts were task (n = 31) (eg, amount of additional effort required to don and doff gloves and gowns) and organization (n = 30) (eg, recognition by all staff of the severity of CDI). Contact isolation was the most frequently discussed bundle intervention (n = 24). CONCLUSIONS: The SEIPS systems engineering framework is useful to evaluate infection prevention practices for CDI and identify opportunities for improvement. Addressing the work system barriers and facilitators identified in this study is essential to effective implementation of infection prevention interventions, specifically for CDI. Published by Elsevier Inc.
BACKGROUND:Clostridium difficileinfection (CDI) is a critical patient safety issue. Consistent and regular performance of appropriate practices is effective in preventing CDI. Variation in adherence to these practices can impede their effective implementation and weaken CDI prevention. METHODS: Using the Systems Engineering Initiative for Patient Safety (SEIPS) framework we convened a focus group of 10 nurses to identify barriers and facilitators to compliance with a CDI prevention bundle that includes (1) prompt diagnostic testing, (2) empirical isolation for patients with suspected CDI, (3) consistent and appropriate contact isolation, (4) hand hygiene, and (5) disinfection of the patient room and objects in the room. On completion of transcript coding, analyses were performed based on bundle intervention and the work system element of the SEIPS model. RESULTS: A total of 58 excerpts were coded. Work system barriers or facilitators were associated with nearly every bundle intervention. The work system elements raised in over half of the excerpts were task (n = 31) (eg, amount of additional effort required to don and doff gloves and gowns) and organization (n = 30) (eg, recognition by all staff of the severity of CDI). Contact isolation was the most frequently discussed bundle intervention (n = 24). CONCLUSIONS: The SEIPS systems engineering framework is useful to evaluate infection prevention practices for CDI and identify opportunities for improvement. Addressing the work system barriers and facilitators identified in this study is essential to effective implementation of infection prevention interventions, specifically for CDI. Published by Elsevier Inc.
Entities:
Keywords:
Health care associated; Health system; Infection
Authors: Amye J Tevaarwerk; Jennifer R Klemp; Gijsberta J van Londen; Bradford W Hesse; Mary E Sesto Journal: Cancer Date: 2018-09-12 Impact factor: 6.860