QAPI 162 - Utilizing Human Factors and System Design Approach Improved Isolation Compliance at a Community-based Acute Tertiary Care Facility

Background: Transmission-based precautions (TBPs) are recommended in preventing the transmission of infectious pathogens between patients and healthcare workers (HCW). To determine compliance, a point prevalence study was conducted. Patient isolation status was validated by an infection preventionist (IP). Isolation audits were conducted on the correct isolation sign on the patient room door and personal protective equipment (PPE) availability. Isolation categories included contact, airborne, droplet, enhanced, and enteric isolation. Results revealed 73% isolation compliance. To address this issue and identify barriers, human factors and system approach was utilized to improve compliance.

Methods: A system approach was used to identify factors (People, Environment, Tools, Tasks) that contributed to the low isolation compliance. People identified included nurses, IPs, and providers. Environmental factors included isolation signs not matching the new electronic medical record (EMR) isolation order, and availability of PPE. Tools and tasks included policy alignment with the EMR isolation orders and alerts, staff knowledge, isolation reconciliation, and ensuring adequate supply of PPE based on individual department needs. The interventions implemented included new isolation signs that appropriately aligned with EMR orders, unit ownership for stocking PPE cabinets, staff education by IP (unit huddles, orientation, staff meetings), daily isolation reconciliation, and weekly isolation audits. Isolation compliance was monitored for the same variables as the initial point prevalence study.

Results: A total of 2,840 isolation rooms (approximately 250 per month) were audited. Results were tabulated for 11 months from January to November 2023. During this period, isolation compliance with TBP’s increased from baseline 73% to 92% which was a 26 % increase.

Conclusions: By using human factors and system design approach, isolation compliance with TBP’s increased 26% from 73% to 92%. This approach helped to understand the interactions among healthcare workers, processes, and systems. This project ultimately addressed factors that could impact safety outcomes for patients and healthcare workers.