From the Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
J Patient Saf. 2021 Dec 1;17(8):e806-e814. doi: 10.1097/PTS.0000000000000500.
Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers' (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle.
A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework.
Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients' family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene.
Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.
采用一种新的人为因素工程方法，即系统工程倡议患者安全模型，我们评估了环境服务工作人员（ESW）对影响遵守国家授权退伍军人事务部艰难梭菌感染（CDI）预防捆绑包的障碍和促进因素的看法。
对 ESW 进行了焦点小组讨论。采用视觉矩阵显示进行定性分析，以确定与退伍军人事务部 CDI 捆绑包遵守相关的障碍/促进因素主题，使用系统工程倡议患者安全工作系统作为框架。
环境服务工作人员报告说有足够的清洁用品/设备，并且对 CDI 手部卫生要求有出色的了解。环境服务工作人员描述了当前的监督实践，为清洁 CDI 房间提供了可接受的时间，但其他医护人员经常迫使 ESW 更快地清洁房间。环境服务工作人员对 CDI 患者的家属表示了极大的关注，并对家属是否需要遵守感染预防措施表示不确定。小而杂乱的病房使清洁任务更加困难，ESW 的清洁任务经常被其他医护人员打断。ESW 不觉得向医生要求更多时间来完成清洁房间很舒服，也不觉得向医生指出手部卫生失误很舒服。
多个工作系统组件是 ESW 遵守国家授权退伍军人事务部 CDI 捆绑包的障碍和促进因素。环境服务工作人员可能是医院感染预防的一个未被充分重视的资源，应该进一步努力让 ESW 成为医疗保健团队的一员。
