Healthcare assistants’ role in preventing healthcare-associated infections: Human factors approach to environmental cleaning gaps 2
| Friday, August 28, 2026 |
| 10:40 AM - 11:00 AM |
| Tāwhirimātea 1 |
Overview
Ann Whitfield & Sam Woodsford
Speaker
Mrs Ann Whitfield
Clinical Nurse Consultant Infection Prevention & Control
Te Whatu Ora
Healthcare Assistants’ Role in Preventing Healthcare-Associated Infections: A Human Factors Approach to Environmental Cleaning Gaps
Abstract
Rationale:
Environmental hygiene is a critical component of preventing healthcare-associated infections (HAIs), with contaminated environments and equipment contributing to pathogen transmission. Healthcare Assistants (HCAs) are central to cleaning practices. However, their role is often under-defined within complex healthcare systems. Using a Systems Engineering Initiative for Patient Safety (SEIPS) framework, this study examined how work system factors influence HCA cleaning practices and HAI risk.
Methodology:
A mixed-methods service evaluation was undertaken in a New Zealand hospital. Infection Prevention and Control (IPC) environmental audit data were analysed across 15 cleaning elements. A gap analysis was conducted using the SEIPS model to assess interactions between people (HCAs), tasks (cleaning processes), tools and technologies (cleaning products), environment (clinical settings), and organisational factors (policies, training, and governance). Document review and stakeholder engagement explored role clarity, training provision, and understanding of infection risks. Findings informed a targeted improvement programme, including a consolidated “Cleaning Best Practice” guideline, education resources, and system-level role clarification.
Significant Results:
Baseline audit compliance was low, with variability in practice and uncertainty regarding cleaning responsibilities. HCAs reported limited formal IPC training and low awareness of the impact of environmental hygiene on HAIs. SEIPS analysis identified key system barriers, including unclear role boundaries, competing workflow demands, and limited access to structured education. Following implementation of targeted interventions, compliance improved to over 40% areas assessed over seven months, with increased role clarity and engagement in cleaning practices.
Conclusions:
HCA cleaning practices are shaped by interacting system factors rather than individual performance alone. Applying a human factors approach enabled identification of latent system weaknesses and supported sustainable improvements in environmental hygiene.
Recommendations:
Healthcare organisations should adopt human factors frameworks such as SEIPS to design IPC interventions, ensuring clear role definition, accessible training, and alignment between workflow, resources, and organisational priorities to reduce HAI risk.
Environmental hygiene is a critical component of preventing healthcare-associated infections (HAIs), with contaminated environments and equipment contributing to pathogen transmission. Healthcare Assistants (HCAs) are central to cleaning practices. However, their role is often under-defined within complex healthcare systems. Using a Systems Engineering Initiative for Patient Safety (SEIPS) framework, this study examined how work system factors influence HCA cleaning practices and HAI risk.
Methodology:
A mixed-methods service evaluation was undertaken in a New Zealand hospital. Infection Prevention and Control (IPC) environmental audit data were analysed across 15 cleaning elements. A gap analysis was conducted using the SEIPS model to assess interactions between people (HCAs), tasks (cleaning processes), tools and technologies (cleaning products), environment (clinical settings), and organisational factors (policies, training, and governance). Document review and stakeholder engagement explored role clarity, training provision, and understanding of infection risks. Findings informed a targeted improvement programme, including a consolidated “Cleaning Best Practice” guideline, education resources, and system-level role clarification.
Significant Results:
Baseline audit compliance was low, with variability in practice and uncertainty regarding cleaning responsibilities. HCAs reported limited formal IPC training and low awareness of the impact of environmental hygiene on HAIs. SEIPS analysis identified key system barriers, including unclear role boundaries, competing workflow demands, and limited access to structured education. Following implementation of targeted interventions, compliance improved to over 40% areas assessed over seven months, with increased role clarity and engagement in cleaning practices.
Conclusions:
HCA cleaning practices are shaped by interacting system factors rather than individual performance alone. Applying a human factors approach enabled identification of latent system weaknesses and supported sustainable improvements in environmental hygiene.
Recommendations:
Healthcare organisations should adopt human factors frameworks such as SEIPS to design IPC interventions, ensuring clear role definition, accessible training, and alignment between workflow, resources, and organisational priorities to reduce HAI risk.
Biography
Ann Whitfield is a Registered Nurse with 30 years’ experience, including 20 plus years in senior IPC leadership. She is IPC Lead at a New Zealand tertiary hospital and an ACIPC Board Director and Fellow. Her work spans national programmes, governance, and system improvement. She is completing a Master’s in Human Factors and Patient Safety.
Sam Woodsford is a Clinical Nurse Specialist in Infection Prevention and Control (IPC) and the Regional Hand Hygiene Co-ordinator for the Health NZ Waikato Region. With a Postgraduate Certificate in Health Science focused on communicable diseases and ten years of nursing experience, including nearly five years dedicated to IPC, Sam works across clinical practice, education, and quality improvement to drive IPC principles and change.
