Understanding infection outbreaks

The past few years have seen a great deal of media attention in the UK regarding hospital infection control.1, 2 High profile hospital outbreaks involving Clostridium difficile and MRSA have made infection control into a central priority for the UK’s NHS and other healthcare systems worldwide.3 The focus of debates so far has been on improving hygiene within hospitals (e.g. hand washing). Very little work has been conducted on the wider behavioural, social and organisational factors that may also determine infection control outbreaks.4 One possible way forward is to adopt a systems approach in order to probe deeper into the causes of hospital-based infection outbreaks. This type of work has been used to understand the complex interplay of factors that contribute to accidents and disasters (e.g. railway, aviation and construction accidents).5-7

Systems approach

 Hospitals provide good examples of complex large-scale socio-technical systems involving a large diversity of professions spanning a range of roles and specialisms, as well as technologies and artefacts ranging from the latest e-health applications (e.g. electronic patient record systems) to more established physical design components (e.g. wards and buildings). Within systems ergonomics, a number of modelling frameworks exist8 for understanding the dynamic interaction between levels within large-scale socio-technical systems (Fig. 1). The framework has been used to identify the lessons learned from the May 2000 outbreak of E. coli which occurred in Walkerton, Canada.9 These ranged from decisions made at governmental levels (e.g. privatisation initiatives), the action of actors within the system (e.g. failures to take water samples), as well as equipment failures (e.g. shallow water wells). More recently, this type of approach has been used to analyse the main events and contributory factors leading up to the infection outbreaks at Maidstone and Tunbridge Wells NHS Trust.10