Effectiveness of a multisite personal protective equipment (PPE)-free zone intervention in acute care.
Effectiveness of a multisite personal protective equipment (PPE)-free zone intervention in acute care.
复制标题
多地点无个人防护装备 (PPE) 区域干预在急性护理中的有效性。
DOI：
10.1017/ice.2019.111
复制
发表时间：
2019
影响因子：
4.5
通讯作者：
Mayer,Jeanmarie
中科院分区：
文献类型：
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作者：
Visnovsky,LindsayD;Zhang,Yue;Leecaster,MollyK;Safdar,Nasia;Barko,Lauren;Haroldsen,Candace;Mulvey,DianeL;Nevers,McKenna;Shaughnessy,Catherine;Stratford,KristinaM;Drews,FrankA;Samore,MatthewH;Mayer,Jeanmarie
目的探讨无个人防护用品(PPE)区域干预对医护人员(HCP)进场手卫生(HH)和个人防护用品穿戴依从性的影响。设计准实验、多中心干预、前后对照研究，在3个急诊机构(2个学术医疗中心、1个退伍军人事务医院)的16个病房(5个内科、6个重症监护室、5个专科监护室)所有病房设置接触防护措施。在两个研究阶段都进行了穿戴个人防护用品和HCP对进入HH依从性的观察。在两个研究阶段都分布了HCP对无PPE区的看法的调查。干预区是无PPE区，其中接触预防室内门槛内的低风险区域由地板上的繁文缛节划定。在这个区域内，HCP不需要佩戴PPE。结果观察到3970个房间进入。HH依从性在干预单位的不同研究阶段之间没有变化(相对风险[RR]，0.92；P=.29)，而在对照组中下降(RR，0.70；P=0.005)；然而，无PPE区域对依从性没有显著影响(P=0.07)。无PPE区域对HH的影响仅对肠道预防措施的房间显著(P=0.008)。个人防护用品的使用在干预前后没有显著差异(P=.15)。HCP对无PPE区持肯定态度；65%的人同意它促进了沟通，66.8%的人同意它允许更频繁地检查患者。结论HCP对无PPE区持肯定态度，它不会对PPE或HH依从性产生负面影响。未来的感染预防干预应考虑影响行为改变的复杂社会技术系统因素。
ObjectiveDetermine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.DesignQuasi-experimental, multicenter intervention, before-and-after study with concurrent controls.SettingAll patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.InterventionA PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.ResultsWe observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.ConclusionsHCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.