When staff handle staph: user-driven versus expert-driven communication of infection control guidelines

Health care-associated infections cause thousands of preventable deaths each year. Therefore, it is crucial that health care workers (HCWs) adhere to infection control guidelines. Although most HCWs are aware of the rationale for guidelines, adherence is generally poor, which might be caused by the guidelines’ expert-driven character. Whereas traditional, paper-based guidelines have a strong focus on scientific validation, regulation, and legislation, HCWs’ information need is rather action-oriented. Based on extensive user-centered research involving HCWs (comprised of eight studies including Card Sort, scenario testing with thinking aloud, prototyping, interviewing, etc), a multimodal website was developed that presents evidence-based guidelines as answers to questions that reflect HCWs’ practical informational needs. Evaluation studies showed that the website outperformed the traditional, paper-based guidelines with regard to efficiency (time for task completion decreased significantly from six to two minutes), effectiveness (successful task completion rate increased significantly from 50% to 90%), and user satisfaction. The website appeared to ‘empower’ HCWs since it allowed them to take decisions for daily work practice, and thereby reduced infection control professionals’ workload. Since a website in itself is not enough to change HCWs’ behavioral intention to adhere to the guidelines, the factors that affect adoption of the website in daily work practice were investigated next to the determinants of intention to adhere. These factors were considered during the implementation phase of the website. The studies that together composed the user-centered design process of the website are described in a dissertation (thesis defense October 2nd, 2009). This dissertation provides the methodological steps and design principles necessary to communicate user-driven guidelines via a website and suggests how to optimally implement this website in daily work practice, in order to enhance effective and efficient risk- and crisis communication. Methicillin Resistant Staphylococcus aureus (also known as “hospital bacteria”) served as a case study for this dissertation research, but the thesis might also serve as a manual for the communication of guidelines regarding all types of infectious diseases, such as Mexican flu (H1N1)). This is subject of future research. Furthermore, future studies will concentrate on the development of e-learning strategies for HCWs and incorporating an advanced dialogue system into the website.