Simulating errors: a training tool for staff entering a cleanroom

Introduction
In 2019, an a priori risk analysis identified critical points in the fabrication process of parenteral nutrition solutions at Brest Hospital. The failure mode “Non-compliant gowning / poor handwashing” had an unacceptable criticality index. The planned corrective action was to create an awareness training tool to improve workers’ hand hygiene and gowning practices.

Materials and methods

A working group (pharmacists, pharmacy intern and pharmacy technician) wrote a script for a short video staging an entry into a cleanroom with 6 frequent and / or asepsis compromising mistakes. A 4-minute film was edited and screened during training sessions. Each session took place in three stages: briefing and film screening (10 minutes), debriefing time (15 minutes), correction of mistakes and a reminder of the asepsis gowning and hygiene procedures to enter a cleanroom (30 minutes). A booklet summarizing the essential points was given to each participant and their satisfaction is assessed in a survey (11 questions). To assess the transfer of knowledge, an audit is then carried out one week after the training, using 32 items based on internal procedures.

Results
36 professionals (9 pharmacists, 7 interns, 12 pharmacy technicians, 6 skilled workers and 2 managers) working in controlled atmosphere area participated in 8 training sessions. 34 of them filled the satisfaction survey. All were satisfied with the training sessions. 88% (n=30) judged that the video medium was very well suited for the training. One week later, 11 entries into cleanroom were audited (pharmacists, technicians, skilled workers). Gowning and simple hand washing were in accordance with procedures for almost all entries (90%). The audit revealed non-compliant surgical hand disinfection (gesture or duration) for 36% (n = 4) of entries.

Discussion-Conclusion
One week after the training, non-conformities concerning hands surgical disinfection are already observed. Consequently an updating of the procedures and a new audit are scheduled. However this new training tool, appreciated by the entire staff, raised a renewed awareness about aseptic gowning and hand hygiene procedures for entry into the cleanroom. This entertaining video can be adapted to suit other training needs within a hospital pharmacy.