Study Looks at Human Factors Affecting Infection Prevention in Dialysis Care

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A wide range of organizational and sociotechnical factors affects infection prevention practices at outpatient hemodialysis centers, reports a study in the American Journal of Kidney Diseases.

The researchers used structured macroergonomic observations at a convenience sample of six US dialysis facilities. Observations were made by a multidisciplinary team following the Systems Engineering Initiative for Patient Safety model 1.0. Observations addressed system components, including human factors, work system factors, and extrinsic factors. The study focused on four infection processes: environmental disinfection, hand hygiene, injection safety, and vascular access care. The researchers underwent a total of 157.5 hours of observations over approximately 2.5 days per facility, from early morning to evening shifts.

Qualitative and quantitative data analyses identified a range of work system barriers to and facilitators of infection prevention. Human factors included interruptions, which occurred in 19% of encounters. Alarms occurred in just over one-half of encounters and were described by staff as “prevalent and disruptive.” Other issues included task stacking or simultaneously performing multiple tasks and inconsistent understanding of the terms “clean” and “dirty.”

Analysis of factors in the physical environment showed wide variation in work practices and design. Several physical design factors were identified as barriers or facilitators of infection prevention, along with workflow scheduling and variation in policies and procedures. Staff at several facilities cited factors associated with a supportive culture, including the presence and engagement of facility leadership during work hours. Staff also identified extrinsic patient factors leading to disruptions in the flow of care, including hygiene, transportation, vascular assess, and hemostasis.

This small, exploratory study identifies macroergonomic factors potentially affecting infection prevention practices during dialysis care. “[T]he complex constellation of human skills required for the optimal completion of infection prevention tasks within dialysis may be significantly affected (both positively and negatively) by the design of our systems of care,” the researchers write. Further studies are needed to incorporate the observations into strategies to reduce infection risks [Parker SH, et al. Human factors contributing to infection prevention in outpatient hemodialysis centers: A mixed methods study. Am J Kidney Dis, published online March 4, 2024. doi: 10.1053/j.ajkd.2023.12.024].