IBM & ISID Incubator Project: Reducing Hospital Acquired Infections in LMIC(s)

donghuantony
Aug 20, 2018 · 7 min read
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ISID, the International Society for Infectious Diseases, is a non-profit organization that supports health professionals, non-government organizations, and governments around the world to tackle the spread of infectious diseases.

Last year ISID updated a new version of their Guide to Infection Control in the Healthcare Setting in hopes to enable healthcare workers in low resource hospitals with the means to prevent and control the spread of Hospital Acquired Infections (HAIs).

Final Prototype

HAIs: The Problem to Tackle Now

Today, Hospital Acquired Infections (HAIs) remains to be a problem as 1 in 10 patients admitted in a low middle income country (LMIC) will contract an infectious disease.

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Reported by the WHO

This reality is much more severe for Dr. T(Temitope Obadare), a Clinical Microbiologist and Infectious Disease Physician who works at one of the most resourced and well funded university teaching hospitals in Nigeria.

Over the past 3 years, more than 3 in 10 patients admitted into Dr. T’s hospital has contracted a hospital acquired infection.

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Dr. T when asked why IPC is important to him

To lower the rate of HAIs without any funding from the government and his hospital, Dr. T is leading a hands-on IPC (Infection Prevention and Control) effort by telling physicians and nurses to wash their hands before and after coming into contact with a patient, as well as the proper disposal of sharp wastes after surgery and other best practice routines.

Generative Research: IPC on a Day to Day

After conducting initial, background and generative research (secondary research, interviewing stakeholders, and physicians and nurses), we were able to define our core users as hospital workers who had IPC training and hospital workers who didn’t have IPC training.

After interviewing 8 IPC specialists and 2 non-IPC specialized nurses, we aggregated our findings by illustrating the current state of IPC in a low resource hospital setting.

This is a story between our two personas: Ife, the Infection Control Specialist, and Dayo, the Doctor. For reference, pink cheek = Ife and blue cheek = Dayo.

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Part 1: Lack of Localized Content

Ife is conducting a teaching session on waste management & sharps in their hospital for Dayo and other workers because most IPC guidelines (from the WHO, CDC, ISID) are not specific to their hospital’s resource levels & needs. As a result they are rarely applicable. Dayo and his colleagues find this new information very helpful.

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Part 2: Knowledge Gap

A few days later, Dayo encounters a situation: He just finished a surgery and isn’t sure how to dispose of some of the sharpe wastes. While he did find Ife’s talk to be helpful, he simply can’t recall and apply every bit of detail due to the fact that he isn’t specially trained.

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Part 3: Too Much Information

To address his knowledge gap, Dayo calls Ife from his ward with the hospital phone for clarification. However, Ife is currently busy and tells Dayo to check the hospital guide as well as international references in the meantime. Dayo ends up going through several books & papers and ends up more confused.

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Part 4: No Centralization

Because Dayo isn’t confident to make a decision without Ife’s second opinion, he waits and delays his practice. What he doesn’t know is that Ife can’t because she is busy running all over the hospital trying to respond to other doctors’ questions. This is due to the fact that Ife’s knowledge is nowhere but all inside of her brilliant mind.

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Part 5: Lack of Time

At the end of the day, Ife is tired from answering simple questions repeatedly and is disappointed that she couldn’t do the other part of her job: diagnose and treat complex infectious diseases.

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The End: Level of Care Decreases & HAI Remains the Same

As a result, while Ife wasn’t able to make a noticeable impact on the rate of Hospital Acquired Infections, she also compromised her time and the level of care the hospital offered.

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Finding Where it Hurts

Throughout Ife and Dayo’s journey, there was a commonality in the challenges they faced day to day. For Ife, there is only one of her. As a result, she is struggling to manage her time effectively between monitoring IPC best practices and treating complex diseases. Dayo, on the other hand, lacks IPC training and relies heavily on Ife’s in-person expertise.

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How to Make it Better

As a result of the 2 key pain points, our team decided on two key “hills” which are desired user outcomes.

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Key Considerations While Creating

Throughout ideation & prototyping, two key considerations that stuck with us were that whatever we made, it had to be localized and actionable.

In 11 interviews of Infection Control Specialists mainly from Nigeria, India, and Indonesia, 100% of them stressed the need for localized content. As Dr. Mohamed Benbachir said,

“I prefer local procedures as opposed to international procedures, because international ones are mostly theory with general principles”.

The sentiment for applicability remained just as strong, as 73% of the IPC specialists and 100% of the nurses stressed the importance of short and actionable content. As Olivia Waworuntu, an Infectious Disease Doctor said,

“When [doctors and nurses] have questions, they prefer an instant visit from [an Infection Control Specialist].”

Mobile Solution: A Shared Workspace

After 3 iterations and interviews of 11 IPC specialists and 3 non-IPC specialized nurses, we were able to validate our solution as a mobile application that could scale Ife’s expertise in a hospital setting and enable Dayo to more easily access IPC best practices, even without Ife.

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Next, we aggregated our findings by illustrating a new scenario in which our product improves the state of IPC in a low resource hospital setting.

Reminder, this is a story between our two personas: Ife, the Infection Control Specialist, and Dayo, the Doctor. Pink cheek = Ife and blue cheek = Dayo(s).

Part 1: Localized Creation

Ife receives notification that several doctors in the hospital has commented on an ISID chapter and needs clarification. As a result, Ife creates her own short protocol to address the management of sharp wastes in her hospital.

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Dayo Comments
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Ife Creates Protocol

Part 2: Localized Creation

A few days later, after a session in the surgical ward, Dayo and his team of 3 nurses are disposing of needles and sharp materials but they realize that they only have 1 bag and isn’t sure if they should throw all the waste in that bag. Dayo uses the ISID app to search “waste management” and sees an article that Ife wrote called “How to handle sharps” as a top result.

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Dayo Searches for Protocol

Part 3: Actionable

Dayo clicks into Ife’s article and reads it. The article is short with relevant information with a video on top to visualize the content.

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Part 4: Scaling Through Article Pinning

Ife then pins the protocol so the whole hospital can see because she thinks this is information everyone should know.

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Ife Pins Article

Part 5: Alerts & Outbreak Considerations

Recently, there has been an outbreak in the surgical ward because a nurse accidentally punctured herself while trying to recap a used needle. As a result, she passed on the infection onto other nurses and doctors. Ife writes an alert to notify the whole hospital.

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Outbreak Announcement
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Thank You IBM & ISID

This incubator project was part of a 10 week program that myself and 4 other interns were part of. To learn more about my personal contributions & design process on this project, feel free to contact me at DL548@cornell.edu

Final Prototype

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