Implementing daily chlorhexidine gluconate (CHG) bathing in VA settings: The human factors engineering to prevent resistant organisms (HERO) project.
Implementing daily chlorhexidine gluconate (CHG) bathing in VA settings: The human factors engineering to prevent resistant organisms (HERO) project.
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DOI：
10.1016/j.ajic.2020.12.012
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发表时间：
2021-06
影响因子：
4.9
通讯作者：
Safdar, Nasia
中科院分区：
文献类型：
--
作者：
Knobloch, Mary Jo;Musuuza, Jackson S.;McKinley, Linda;Zimbric, Michele L.;Baubie, Kelsey;Hundt, Ann Schoofs;Carayon, Pascale;Hagle, Mary;Pfeiffer, Christopher D.;Galea, Marinella D.;Crnich, Christopher J.;Safdar, Nasia
关键词：
每日使用葡萄糖酸氯己定（CHG）已被证明可降低医疗相关感染的风险。我们旨在评估使用人为因素方法将CHG沐浴纳入常规实践。我们评估了退伍军人健康管理局非重症监护室（ICU）环境中的实施情况。我们的多病例研究方法包括来自4个退伍军人健康管理局的非ICU单位。在患者安全系统工程倡议的指导下，我们进行了焦点小组和访谈，以捕捉日常CHG洗澡的障碍和促进因素。我们通过观察和皮肤CHG浓度来测量依从性。每日CHG的障碍包括时间、对抗生素耐药性增加的担忧、工作流程和产品问题。促进因素包括倡导者的参与和单位分担责任。我们发现在病人教育、手部卫生和在管道和引流管上使用氯己定方面存在不足。来自脊髓损伤单位的患者中CHG皮肤浓度水平最高。这些装置使用2%氯化葡萄糖浸渍湿巾和4%氯化葡萄糖溶液/肥皂进行消毒。实施CHG洗浴的非ICU必须考虑人为因素和工作系统障碍，以确保吸收和持续的实践改变。精心策划的推广和促进共同责任的单位文化是遵守每日CHG洗澡的关键。成功的执行需要注意工作人员的教育和遵守情况的衡量。
Daily use of chlorhexidine gluconate (CHG) has been shown to reduce risk of healthcare-associated infections. We aimed to assess moving CHG bathing into routine practice using a human factors approach. We evaluated implementation in non-intensive care unit (ICU) settings in the Veterans Health Administration. Our multiple case study approach included non-ICU units from 4 Veterans Health Administration settings. Guided by the Systems Engineering Initiative for Patient Safety, we conducted focus groups and interviews to capture barriers and facilitators to daily CHG bathing. We measured compliance using observations and skin CHG concentrations. Barriers to daily CHG include time, concern of increasing antibiotic resistance, workflow and product concerns. Facilitators include engagement of champions and unit shared responsibility. We found shortfalls in patient education, hand hygiene and CHG use on tubes and drains. CHG skin concentration levels were highest among patients from spinal cord injury units. These units applied antiseptic using 2% CHG impregnated wipes vs 4% CHG solution/soap. Non-ICUs implementing CHG bathing must consider human factors and work system barriers to ensure uptake and sustained practice change. Well-planned rollouts and a unit culture promoting shared responsibility are key to compliance with daily CHG bathing. Successful implementation requires attention to staff education and measurement of compliance.
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DOI：
10.1056/nejmoa1113849
发表时间：
2013-02-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Climo MW;Yokoe DS;Warren DK;Perl TM;Bolon M;Herwaldt LA;Weinstein RA;Sepkowitz KA;Jernigan JA;Sanogo K;Wong ES
通讯作者：
Wong ES
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1016/j.jamcollsurg.2007.12.054
发表时间：
2008-08-01
影响因子：
5.2
作者：
Edmiston, Charles E., Jr.;Krepel, Candace J.;Towne, Jonathan B.
通讯作者：
Towne, Jonathan B.
影响因子：
158.5
作者：
Huang, Susan S.;Septimus, Edward;Platt, Richard
通讯作者：
Platt, Richard
影响因子：
3.2
作者：
Carayon, Pascale;Wetterneck, Tosha B.;Gurses, Ayse P.
通讯作者：
Gurses, Ayse P.