Using a human-factors engineering approach to evaluate environmental cleaning in Veterans' Affairs acute and long-term care facilities: A qualitative analysis.

BACKGROUND: Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance is low. Evaluation of human factors influencing variations in cleaning practices can be valuable in developing interventions to standardized practices. We conducted a work-system analysis using a human-factors engineering (HFE) framework to identify barriers and facilitators to environmental cleaning practices in acute and long-term care settings within the Veterans' Affairs health system. METHODS: We conducted a qualitative study with key stakeholders at 3 VA facilities. We analyzed transcripts for thematic content and mapped themes to the HFE framework. RESULTS: Staffing consistency was felt to improve cleaning practices and teamwork. We found that many environmental management service (EMS) staff were veterans who were motivated to serve fellow veterans, especially to prevent infections. However, hiring veterans comes with regulatory hurdles that affect staffing. Sites reported some form of monitoring their cleaning process, but there was variation in method and frequency. The EMS workload was affected by whether rooms were occupied by patients or were semiprivate rooms; both were reportedly more difficult to clean. Room design and surface finishes were identified as important to cleaning efficiency. CONCLUSION: HFE work analysis identified barriers and facilitators to environmental cleaning. These findings highlight intervention entry points that may facilitate standardized work practices. There is a need to develop task-specific procedures such as cleaning occupied beds and semiprivate rooms. Future research should evaluate interventions that address these determinants of environmental cleaning.

Longitudinal survey of antibiotic stewardship practices in Wisconsin nursing homes, before and after a policy change.

The Centers for Medicare and Medicaid mandated that nursing homes implement antibiotic stewardship programs (ASPs) by November 2017. We conducted surveys of Wisconsin nursing-home stewardship practices before and after this mandate. Our comparison of these surveys shows an overall increase in ASP implementation efforts, but it also highlights areas for further improvement.

Effect of comparative data feedback on intensive care unit infection rates in a Veterans Administration Hospital Network System.

BACKGROUND: Infection control surveillance is not performed with standardized methodology within the Veterans Affairs (VA) health system. The purposes of this study were (1) to provide network hospitals with a standardized intensive care unit (ICU) surveillance system developed by the Centers for Disease Control and Prevention (CDC); (2) to compare ICU infection rates in hospitals that receive comparative data with those that do not; and (3) to compare network device-associated infection trends to national trends. METHODS: One VA Medical Center served as the central coordination site where surveillance data were analyzed with CDC's criteria and reported back to the sites. During 1999, the experimental group received risk-adjusted infection rates with national comparative data, and the control group received only risk-adjusted infection rates without comparative data. In 2000, hospitals in both groups received risk-adjusted infection rates accompanied by national data. RESULTS: In 1999, the device-associated infection rates were significantly higher in the control group compared with the experimental group. In the control group, the device-associated infection rates were significantly higher than the national comparative CDC rates; in the experimental group, the device-associated infection rates were not significantly different from the national comparative CDC rates. In 2000, the control group device-associated infection rates were not significantly different from the experimental group. The observed rates in both groups were not significantly different from the CDC rates. CONCLUSIONS: Study results suggest that infection rate outcomes may be reduced when national comparative data are provided. The study may serve as an infection control surveillance model for VA hospital networks.