Applying Healthcare Failure Method Effect Analysis (HFMEA) To Improve Infection Control Practices at the Neurology Intensive Care Unit at the American University of Beirut Medical Center (AUBMC)

Abstract

Healthcare-associated infections (HAIs) are a major concern due to their significant impact on patient safety. Globally, compliance with Infection Prevention and Control (IPC) policies, particularly hand hygiene and the proper use of Personal Protective Equipment (PPE), is the main risk factor for HAIs. At the American University of Beirut Medical Center, Intensive Care Unit (ICU), HAIs incidence poses a significant concern. Compliance with hand hygiene practices is reported to be 56% before patient contact and 44% after patient contact in the second quarter of 2025 in the Neurology ICU. Hence, the purpose of this quality improvement project is to identify the potential failures in the IPC processes among healthcare workers and housekeeping staff in the Neurology ICU at the American University of Beirut Medical Center (AUBMC) using the widely recognized Healthcare Failure Method and Effect Analysis (HFMEA) risk tool to identify the failures in the process and to propose targeted interventions to improve IPC practice and ultimately reduce HAIs. The reporting follows the standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines. A multidisciplinary team was formed, and a naturalistic observation approach was used to assess the IPC practices, namely hand hygiene and PPE use, among staff working in the neurology unit. A total of 56 personnel were observed over two months. Nine major failure modes were identified across different staff categories. The highest risk was skipping hand hygiene before room entry (RPN =448), followed by incorrect doffing sequence (RPN=378), and insufficient hand hygiene duration (PRN=252). Root cause analysis highlighted contributing factors that extend beyond knowledge gaps, to include also behavioral normalization and system-related factors. Targeted recommendations were proposed for possible implementation to improve IPC quality. The successful use of the HFMEA approach in this project not only helped in risk identification but also reinforced a culture of continuous quality improvement to optimize patient safety.