Why is mock care not a good proxy for predicting hand contamination during patient care?
Why is mock care not a good proxy for predicting hand contamination during patient care?
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DOI：
10.1016/j.jhin.2020.11.016
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发表时间：
2021-01-13
影响因子：
6.9
通讯作者：
Noakes, C. J.
中科院分区：
文献类型：
--
作者：
King, M. F.;Wilson, A. M.;Noakes, C. J.
背景资料：医护人员（HCW）的行为，如他们与表面和手卫生时刻接触的顺序，是了解疾病transmiss.Aim的重要：提出一种方法，用于记录序列的HCW行为在模拟与实际程序，并评估差异用于感染风险建模和工作人员training.Methods：三种类型的护理程序下观察模拟和实际设置：静脉滴注护理、观察护理和医生查房。接触和手部卫生行为被记录在实时使用手持平板电脑或摄像机。调查结果：实际的病人护理表现出70%以上的表面接触比模拟护理。它也比模拟护理长2.4分钟，但在患者接触方面相等。平均而言，医生查房需要7.5分钟（模拟护理需要2.5分钟），而辅助护士观察护理需要4.9分钟（模拟护理需要2.4分钟）。注册护士进行模拟IV护理需要3.2分钟，实际IV护理需要3.8分钟;这意味着接触人数增加了44%。在51%的实际护理事件和37%的模拟护理事件中，在接触患者之前进行手部卫生;相比之下，提供实际护理的工作人员中有15%在接触患者离开房间后进行手部卫生，而模拟护理的比例为22%。病房内的整体触摸次数是手部卫生的适度预测因素。使用一个模型来预测表面接触金黄色葡萄球菌、大肠杆菌和诺如病毒的手部污染，模拟护理低估了手部微生物约30%。(C)2021年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Healthcare worker (HCW) behaviours, such as the sequence of their contacts with surfaces and hand hygiene moments, are important for understanding disease transmission.Aim: To propose a method for recording sequences of HCW behaviours during mock vs actual procedures, and to evaluate differences for use in infection risk modelling and staff training.Methods: Procedures for three types of care were observed under mock and actual settings: intravenous (IV) drip care, observational care and doctors' rounds on a respiratory ward in a university teaching hospital. Contacts and hand hygiene behaviours were recorded in real-time using either a handheld tablet or video cameras.Findings: Actual patient care demonstrated 70% more surface contacts than mock care. It was also 2.4 min longer than mock care, but equal in terms of patient contacts. On average, doctors' rounds took 7.5 min (2.5 min for mock care), whilst auxiliary nurses took 4.9 min for observational care (2.4 min for mock care). Registered nurses took 3.2 min for mock IV care and 3.8 min for actual IV care; this translated into a 44% increase in contacts. In 51% of actual care episodes and 37% of mock care episodes, hand hygiene was performed before patient contact; in comparison, 15% of staff delivering actual care performed hand hygiene after patient contact on leaving the room vs 22% for mock care. The number of overall touches in the patient room was a modest predictor of hand hygiene. Using a model to predict hand contamination from surface contacts for Staphylococcus aureus, Escherichia coli and norovirus, mock care underestimated micro-organisms on hands by approximately 30%. (C) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.