Human Factors Engineering Applications for Infection Prevention and Control

1. Human Factors Engineering Applications for Infection Prevention and Control Hugo Sax, MD University of Geneva Hospitals and Faculty of Medicine hugo.sax@hcuge.ch Hosted by Paul Webber paul@webbertraining.com Sponsored by: www.gojo.com www.webbertraining.com April 19, 2011

2. Warning: Listening to this talk might result in addiction and frequent hilarious observations.

3. Warning: Listening to this talk might result in addiction and frequent hilarious observations. www.baddesigns.com

4. Part One >> Human Factors as a Field

5. Frederick Winslow Taylor (1856–1915) Time-motion studies ‘Scientific management’ 1881 US National Tennis Champion

6. Time-motion studies 1885Frank and Lilian Gilbreth

7. Frankfurt Kitchen 1926 by Margarete Schütte-Lihotzky

9. WW 2

10. Transportation Electronics/computers Consumer products Architecture Environmental design Energy systems Fields of Application Medical devices Organizational design Management Manufacturing Office automation

11. Aging Sports Oil field operations Health Recreation Fields of Application Mining Forensics Nuclear Industry Speach Synthesis Farming Education

12. Human Factors and Ergonomics Society (*1955) IF 2009: 1.458

14. Part Two >> Some Human Factors principles and their application to infection control

15. Healthcare Systems Nuclear Industry High Hazard Industries Aviation Future of Our Planet

16. “Latent errors or system failures pose the greatest threat to safety in a complex system because they lead to operator errors. They arefailures built into the system and present long before the active error. Latent errorsare difficult for the people working in the system to see since they may be hidden in computers or layers of management and people become accustomed to working around the problem.” Kohn L, Corrigan J, Donaldson M. Washington, DC: Institute of Medicine, National Academy Press; 1999.

17. Pubmed-listed publications: “human engineering” AND infection control 1991 - 2010 N=120 <1991: 32

18. Fred Dust, IDEO @ TEDxBerkeley, April 3 2010

19. Morin A. Levels of consciousness and self-awareness: A comparison and integration of various neruocognitive views. Conscious Cogn 2006;15:358

20. Process Tools Environment

21. Human ‘Machine’ Model Output Input Processing Processing Input Output

22. Human ‘Machine’ Model Output Input Good FIT Processing Processing Input Output

23. Task: Shaving

25. ✘ 4 handrub dispenser location 2 3 2 3 1 1 4 1

26. 1 3 2 4 2 3 4 ✘ 1

27. Development of an evaluation tool for ergonomic alcohol-based handrub dispenser placement bed 3 bed 1 bed 2 Finding 43% occasions a walk of > 5 meters was undertaken at hand hygiene opportunity Conclusion Transition starting points represent ideal locations to handrub while walking D D D D D D door D b waste material D door D medication preparation bay Observer D =Dispensers Pérez CR, Pugin J, Sax H. ICAAC 2009/K517

28. Human-tech Political Organizational Team Neuro-psychological Vicente K. The Human Factor: revolutionizing the way we live with thechnology. Vintage Canada 2003 Physical

29. Stage Model of Human Information Processing Attention Resources Long-term Memory Selection Working Memory Cognition Sensory Processing Short Term Memory Store Response Selection Response Execution Perception System Environment (feedback) Wickens, Holland. 2000 (3rd ed.; Prentice Hall)

30. Stage Model of Human Information Processing Attention Resources Long-term Memory Selection Working Memory Cognition Sensory Processing Short Term Memory Store Response Selection Response Execution Perception System Environment (feedback) Wickens, Holland. 2000 (3rd ed.; Prentice Hall)

31. Physics Psychology Perception Based on experience, mental models & Context Light Intensity Wave length Sensation Eye functions

32. Top down We depend on the quality of the signal. Bottom up We see / hear what we expect to see / hear. Expectations Context

33. Top down We depend on the quality of the signal. Signal-to-noise ratio Got it? Got it? Got it?

34. Top down We depend on the quality of the signal. Bottom up We see / hear what we expect to see / hear. Expectations Context

35. 17:06:09 (KLM first officer) – Ah roger, sir, we're cleared to the Papa Beacon flight level nine zero, right turn out zero four zero until intercepting the three two five and we're now (at take-off ??). 17:06:13 (Captain) - We gaan. (We're going)17:06:19 (Tenerife control tower) - OK Bottom up We see / hear what we expect to see / hear. Expectations Context

37. Stage Model of Human Information Processing Attention Resources Long-term Memory Selection Working Memory Cognition Sensory Processing Short Term Memory Store Response Selection Response Execution Perception System Environment (feedback) Wickens, Holland. 2000 (3rd ed.; Prentice Hall)

38. Experiment

39. ➋ The ‘Door Study’ ➊ ➌ Daniel T. Levin, Daniel J. Simons, Bonnie L. Angelone, Christopher F. Chabris. Memory for centrally attended changing objects in an incidental real-world change detection paradigm. British Journal of Psychology 2002;93(3):289-302

40. Stage Model of Human Information Processing Attention Resources Long-term Memory Selection Working Memory Cognition Sensory Processing Short Term Memory Store Response Selection Response Execution Perception System Environment (feedback) Wickens, Holland. 2000 (3rd ed.; Prentice Hall)

41. Experiment

42. CIAFBIKGBDNABBCUKCNNUSA

43. CIA FBI KGB DNA BBC UK CNN USA

44. Chunking enhances memory Miller GA. The magical number seven plus or minus two: some limits on our capacity for processing information. Psychol Rev 1956;63:81-97

45. 7 ± 2 items

46. Before touching a patient Before a clean/aseptic task After body fluid exposure risk After touching a patient After touching the patient surroundings

47. Before Before After After After Sax et al. My five moments for hand hygiene. JHI 2007 / AJIC 2009

48. Stage Model of Human Information Processing Attention Resources Long-term Memory Selection Working Memory Cognition Sensory Processing Short Term Memory Store Response Selection Response Execution Perception System Environment (feedback) Wickens, Holland. 2000 (3rd ed.; Prentice Hall)

49. Infection control and prevention suffers from a action/feedback disconnect