"The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions
"The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions
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DOI：
10.1186/s13012-019-0943-x
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发表时间：
2019-12-23
影响因子：
7.2
通讯作者：
Reisinger, Heather Schacht
中科院分区：
文献类型：
--
作者：
Goedken, Cassie Cunningham;Livorsi, Daniel J.;Reisinger, Heather Schacht
实施科学专家将冠军定义为“支持、营销和推动实施，克服干预可能在组织中引起的冷漠或阻力。“许多医院使用指定的临床冠军-通常被称为“手卫生（HH）冠军”-通常是为了提高手卫生的依从性。我们对退伍军人健康管理局（VHA）的感染控制团队如何使用术语“HH冠军”以及他们如何定义角色进行了人种学检查。方法在美国10个地理上分散的VHA设施中，与感染控制团队和直接参与手卫生的一线工作人员进行人种学研究。2014年6月至2017年9月，对医院流行病学家、感染预防专家、多药耐药微生物（MDRO）项目协调员、质量改进专家和一线工作人员进行了个人和团体半结构化访谈。该团队使用基于归纳和演绎主题组成的密码本的主题内容分析内容对成绩单进行编码。结果共有173名医护人员参加了采访，从10个VHA设施。每个机构的所有手部卫生计划都使用术语HH冠军来定义其手部卫生计划的核心要素。虽然大多数人将HH冠军的作用描述为提供点对点辅导，提供正式和非正式教育以及促进手部卫生，但大多数人还包括手部卫生监督。实施战略的这种混淆导致了HH冠军的相互矛盾的责任。与会者描述了HH冠军角色的其他障碍，包括竞争优先级、人员配置层次结构和角色更替。结论：医疗保健系统应考虑狭义地将手卫生倡导者的角色定义为一个专门的个体，其使命是克服阻力并提高手部卫生依从性，并将其与“依从性审核员”的角色区分开来。“恢复实施战略的传统应用可能会导致手部卫生的全面改善，并减少医疗保健获得性感染的传播。
Background Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. Methods An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. Results A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. Conclusions Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.