title: Reducing healthcare-associated infections in an ambulatory dialysis unit: Identification and alignment of work system factors.
abstract: BACKGROUND
  Patients undergoing hemodialysis have experienced a 43% increase in rate of hospitalization due to infection during the past 20 years. Research in other industries has shown that safe systems are achieved by considering the entire system to enable performance specifications to be met.
  
  
  METHODS
  A sociotechnical systems framework was applied through the Macroergonomic Analysis and Design method to evaluate a 54-chair ambulatory dialysis unit to decrease healthcare-associated infections. Fifty-seven system discrepancies across 6 healthcare-associated infection risk factors were identified. A multicomponent intervention was developed to address 44 of the variances across 4 of the risk factors.
  
  
  RESULTS
  Access-related bloodstream infections and access site infections did not improve. Bacterial surface contamination decreased. Process measures for the individual components of the intervention demonstrated varying adherence to the intervention.
  
  
  CONCLUSIONS
  Inconsistent compliance with interventions is hypothesized to be due to organizational and external environment factors.
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC. Electronic address: Vicki.R.Lewis@hfehss.com.
authors.forename: Vicki R
authors.initials: VR
authors.lastname: Lewis
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Clark
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC.
authors.forename: Natalie
authors.initials: N
authors.lastname: Benda
authors.affiliation: MedStar Health Research Institute, Washington, DC.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hardwick
mesh_terms: D000554:Ambulatory Care Facilities; D016470:Bacteremia / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003141:Communicable Diseases; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D003625:Data Collection; D019983:Guideline Adherence; D006748:Hospital Departments; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008019:Life Style; D058996:Quality Improvement; D006435:Renal Dialysis / Q000009:adverse effects
keywords: Access site infection; Access-related blood stream infection; Sociotechnical systems; Surface contamination