How Can Adherence Engineering Kits Help Prevent Spread of Infections?

Frank Drews, MS, PhD, professor of cognitive and neural sciences at the University of Utah, Department of Psychology, discusses ways in which adherence engineering can be applied to prevent infection transmission.

Interview Transcript (slightly modified for readability)

“One way we try to apply [adherence engineering to prevent infection transmission in hospitals is] in the context of central line associate bloodstream infections. In that context, in addition to the great work that has been done on insertion of central lines, we were interested in maintenance activities. Here we talk specifically about dressing changes. As you can see, my work is really human factors based, so we used the tools and the techniques that come out of human factors.

We initially performed a task analysis of dressing changes, what is required in terms of equipment, in terms of cognitive processes, and in terms of planning and so on. We decided that it is a very complicated task despite the fact that many people would say the nurse should just be able to do this task. We identified 25, at minimum steps, and we identified 28 different components of equipment that are required.

What we did after performing this task analysis was to develop a kit that implements some of these principles of adherence engineering, for example, guidance

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[by] guiding people through the process, and using these kits as a demonstration of how successful application of adherence engineering can be [implemented] in the context of infection prevention. We were able, after implementing those kits in a pre-post implementation study, to demonstrate that we had a reduction [in] infections. We were very lucky and I emphasize “luck” as part of it. We actually had zero [central line bloodstream] infections during the study interval. Clearly, the insertion process worked really, really well. But also the maintenance process worked for us very well and it [wasn't until] about 16 months after implementation that we had actually the first central line-associated bloodstream infection.

Instead of having the typical [infections], I think we had prior to implementation 12 [central line-associated bloodstream infections] per year. We actually got lucky for more than a year with zero [new infections]. So again, luck was important because I always think of these issues as things that are controllable and those that are not controllable and we know that a lot of it is not controllable. The kit is one way to exert a little bit more control. It’s a way of structuring behavior and incentivizing certain types of behavior that are desirable in terms of following procedure like for example optimal maintenance, [such as] central line maintenance.”