NON-COMPLIANCE AND HOSPITAL ACQUIRED INFECTION: USING DESIGN METHODOLOGIES TO IMPROVE HAND HYGIENE PRACTICES By John, K.J., Campbell, D., Armstrong, M.C., Degnan, A., Hinds, J. Health Collab, Monash University How can we improve hand hygiene in hospitals through enhanced products, systems and processes that reduce bacterial transmission?
ince Ignaz Semmelweis discovered a direct correlation between high mortality rates and poor hand hygiene 170 years ago (Best & Neuhauser, 2004), resistance to intervention has endured and thus persists as a perennially complex problem. Evidence indicates the global cost of hospital acquired infection (HAI) is between $35.745B (Scott, 2009) and the WHO estimates that in the United States alone there are 80,000 deaths per year attributable to HAI (WHO, 2017). To better understand the scale of the problem, in developed countries, HAI accounts for 5-10% of admission complications, while in developing countries this number is increased between two and twenty times, with some countries experiencing an HAI child death rate of 4,000 per day (WHO, 2017). Despite numerous approaches to addressing the issue of hand hygiene compliance such as; education and awareness, monitoring, product and system improvements, as well as environmental initiatives and infrastructure (Pantle, Fitzpatrick, McLaws, & Hughes, 2009), the introduction of basic hand disinfection procedures in 1847 - to tackle puerperal fever mortality - has remained the gold standard. Recently, technological advances and trends towards cloud computing and machine learning have transcended these existing approaches; becoming exemplars within the field (Pantle et al., 2009). Yet, even with these improvements, the problem is yet to show signs of abating (Pincock, Bernstein, Warthman, & Holst, 2012) and the socio-economic burden of HAI persists. This paper lays out and challenges what the real problem is and the efficacy of several existing solutions; furthering the hypothesis that they address issues that are symptomatic of a bigger problem. Further, this
paper documents a design-led research study to identify and discuss a deeper problem that is thought to be a barrier to the success of existing interventions. It is difficult to trace the transmission of microorganisms back to poor hand hygiene practices by specific individuals and therefore this lack of direct risk relationship makes enforcing hand hygiene an acute compliance issue. While causation for suboptimal hand hygiene is complex, a foundational problem is mindset and how it directs human behaviour. This research introduces the findings of a non-conventional, collaborative research project using design to improve mindsets and human behaviour to facilitate compliance, including forthcoming interventions and testing. Through this, the paper highlights the opportunities for design methodologies to create interventions to improve hand hygiene compliance.
BACKGROUND: The project is a collaboration between Monash University, a leading Australian hospital, and Enware Australia. Enware Australia is a leading manufacturer and supplier of plumbing and personal safety equipment with strong establishments in tapware design for healthcare. The project is supported by an innovations connections grant that is co-funded by Enware Australia. The design team based at Monash Art Design & Architecture (MADA) are part of the Health Collab; a practice based design laboratory with a research focus on medical technology and health and wellbeing. Building empathy using design thinking and co-design techniques in combination with sound product and experience design aims to meet with needs of end-users.
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