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Created with Fabric.js 1.4.5 Re-designing hand hygiene interactions A human factors approach to improving hand hygiene compliance in the medical surgery unit Fact s Hand hygiene compliance is a necessary practice in healthcare settings. Clinical researchhas come to the consensus that correctly performed hand hygiene is the #1 behavior thatprevents the spread of healthcare associated infections. Between 200,000-400,000 people die as a resultof hospital associated infections & other medicalerrors each year. 1 in every 20 patients admitted to a hospital contract an infection Hospital acquired infections are the leading cause of preventable fatalities in the US. 440,000 patients are afflicted from HAI's yearly As auditing data and recording practices become more reliablethese figures increase... Root Cause Redesig n The 5 Moments for Hand Hygiene Compliance What causes the problem?- Prioritization- Inconvenience- Time constraints- Accountability- Hospital culture- Poor modeling- Lack of reminders- No reinforcement Human Factors Implications- Sustained vigilance task- Prospective memory issues- Behavioral compliance- The Hawthorne Effect- The Bystander Effect- Regulatory feedback The World Health Organization describes the proper hand sanitizing process with alcohol gel Before clinical examination Wound dressing Drawing andmanipulatingblood Helping a patientmove around Changing bed linen The placement of warning labels and prompts in locations specified by the WHOs 5 momentsfor hand hygiene, may help circumvent some of the cognitive failures (memory, workload, etc.)associated with noncompliance concerning standard hand hygiene protocols.This will demonstrate that the integration of warning controls into a nurses natural workflow willlead to hand hygiene compliance, thus, reducing performance errors such as memory failure,environmental limitations, workload, the personal perception of dirt, and incorrect decision making.
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