Improving the communication of hand hygiene procedures: Controlled observation, redesign, and randomized group comparisons

• Type of Material: Article
• Authors: Francis T. Durso, Georgia Institute of Technology; Sweta Parmar, Georgia Institute of Technology; Ryan S. Heidish, Georgia Institute of Technology; Skyler Tordoya Henckell, Georgia Institute of Technology; Omer S. Oncul, Georgia Institute of Technology; Jesse Jacob, Emory University
• Language: English
• Date: 2021-02-01
• Publisher: Cambridge University Press (CUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Society for Healthcare Epidemiology of America 2020
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/ice.2020.407
• Title of Journal or Parent Work: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• Volume: 42
• Issue: 2
• Start Page: 194
• End Page: 202
• Grant/Funding Information: No financial support was provided relevant to this article. JTJ was supported by the Prevention Epicenters Program of the Centers for Disease Control and Prevention (award U54CK000164).
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Objective: To assess the clarity and efficacy of the World Health Organization (WHO) hand-rub diagram, develop a modified version, and compare the 2 diagrams. Design: Randomized group design preceded by controlled observation and iterative product redesigns. Setting: The Cognitive Ergonomics Lab in the School of Psychology at the Georgia Institute of Technology. Participants: We included participants who were unfamiliar with the WHO hand-rub diagram (convenience sampling) to ensure that performance was based on the diagram and not, for example, on prior experience. Methods: We iterated through the steps of a human factors design procedure: (1) Participants simulated hand hygiene using ultraviolet (UV) absorbent lotion and a hand-rub technique diagram (ie, WHO or a redesign). (2) Coverage, confusion judgments, and behavioral videos informed potentially improved diagrams. And (3) the redesigned diagrams were compared with the WHO version in a randomized group design. Coverage was assessed across 72 hand areas from multiple UV photographs. Results: The WHO diagram led to multiple omissions in hand-surface coverage, including inadequate coverage by up to 75% of participants for the ulnar edge. The redesigns improved coverage significantly overall and often substantially. Conclusions: Human factors modification to the WHO diagram reduced inadequate coverage for naïve users. Implementation of an improved diagram should help in the prevention of healthcare-associated infections.