Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
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DOI：
10.1186/s12879-017-2180-8
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发表时间：
2017-01-14
影响因子：
3.7
通讯作者：
Safdar N
中科院分区：
文献类型：
--
作者：
Musuuza JS;Roberts TJ;Carayon P;Safdar N
重症监护病房（ICU）患者每天用葡萄糖酸氯己定（CHG）洗澡已被证明可减少医疗保健相关感染和多药耐药生物体的定植。该项目的目的是描述每日CHG洗澡的过程，并确定可能影响其在退伍军人管理局医院ICU的成功采用和可持续性的障碍和促进因素。我们进行了26个半结构化的访谈，方便样本4护士经理（NM），13名注册护士（RN）和9名卫生保健技术人员（HCT）在ICU工作。我们使用定性内容分析来编码和分析数据。使用Dedoose软件促进数据管理和编码。数据的可信度和科学完整性通过两名作者证实编码过程、进行成员检查和对所有决定进行审计跟踪来确保。访谈持续时间为15至39分钟（平均= 26分钟）。确定了洗澡的五个步骤：1）决定洗澡; 2）洗澡的能力; 3）决定使用哪种肥皂; 4）洗澡的委托; 5）洗澡的帮助。洗浴过程导致以下三种结果之一：1）完全洗浴; 2）洗浴中断;以及3）未进行洗浴。在每一个步骤中，结果都受到障碍和促进因素的影响。大多数障碍与感知工作量、患者因素和日程安排有关。促进因素主要是组织因素，如每日CHG洗澡的政策，CHG肥皂的持续供应，以及支持，如提醒护士管理人员进行CHG洗澡。ICU中的患者洗澡是一个复杂的过程，可能会受到许多因素的阻碍和中断。使用氯己定肥皂洗澡的决定仅是洗澡的5个步骤之一，并且在很大程度上受到时间安排/工作量和患者因素的影响，例如临床稳定性、对氯己定过敏、患者拒绝、IV线的存在和一般卫生。解决组织，供应商和患者洗澡障碍的干预措施可以提高每日CHG洗澡协议的依从性。本文的在线版本（doi：10.1186/s12879-017-2180-8）包含补充材料，可供授权用户使用。
Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to reduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project was to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13 registered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU. We used qualitative content analysis to code and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and scientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member checks and keeping an audit trail of all the decisions made. Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1) decision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5) getting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete bath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and facilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators were mainly organizational factors such as the policy of daily CHG bathing, the consistent supply of CHG soap, and support such as reminders to conduct CHG baths by nurse managers. Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors. The decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/workload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and general hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could improve adherence to a daily CHG bathing protocol. The online version of this article (doi:10.1186/s12879-017-2180-8) contains supplementary material, which is available to authorized users.