A Practical Guide to Using Time-and-Motion Methods to Monitor Compliance With Hand Hygiene Guidelines: Experience From Tanzanian Labor Wards.
A Practical Guide to Using Time-and-Motion Methods to Monitor Compliance With Hand Hygiene Guidelines: Experience From Tanzanian Labor Wards.
复制标题
DOI：
10.9745/ghsp-d-20-00221
复制
发表时间：
2020-12-23
期刊：
影响因子：
--
通讯作者：
Graham WJ
中科院分区：
文献类型：
--
作者：
Gon G;Ali SM;Aunger R;Campbell OM;de Barra M;de Bruin M;Juma M;Nash S;Tajo A;Westbrook J;Woodd S;Graham WJ
了解手部卫生行为在医院是至关重要的。我们开发了出生时手工具，并提供了有关其设计和实施的信息，以捕捉医护人员手卫生的复杂模式，包括手摩擦/洗手、手套使用和再污染。关键信息时间和运动方法是获取手部卫生遵从性的好方法；例如，它们可以限制观察者的偏见。我们描述了我们如何设计出生时手工具、工具格式及其元素、其实现组件、工具的性能以及对数据分析的影响。使用该工具的优势包括更简单的培训，在评估手部卫生依从性时更少的观察者判断，以及提高监测多种行为的能力。 背景：低资源产房的助产士手部卫生依从性的高质量证据有限。世界卫生组织手卫生观察表被广泛用于直接观察行为，但它不支持捕获复杂的行为模式。我们开发了出生时手工具，用于直接观察研究助产士中手摩擦/洗手、手套使用、再污染及其决定因素的复杂模式。在病人数量可变或患者并发症不可预测的病房，如急诊科、手术病房或流行病期间的分流和隔离病房，了解这些行为尤其关键。在这里，我们提供关于出生时手工具的设计和实施的详细信息，特别关注低资源环境。我们根据现有的指导方针、非结构化的观察和基于与合作者的咨询和试验结果的迭代改进，开发了出生时手工具。我们用袋熊软件设计了这个工具，它支持收集多维的时间和运动数据。我们对工具性能的分析集中在观察者之间的一致性和收敛的有效性，以及数据结构对数据分析的影响。出生时的手工具包含各种手部动作和上下文相关信息。手部动作包括分娩和分娩过程中的相关程序；手部卫生或手套动作；以及其他类型的触摸。在现场实施过程中，我们使用了该工具对助产士进行持续观察。观察者间一致性良好(kappa范围：0.7-0.9)，该工具显示出收敛的效度。使用出生时手工具是获得有关遵守手卫生程序的有用信息的一种可行方式。该工具可以在简单的培训后使用，并允许收集有关复杂卫生行为模式的可靠信息。未来的研究应该探索使用这个工具来观察在其他环境和其他类型的病房中的分娩病房的行为。
Understanding hand hygiene behaviors is critical in hospitals. We developed the HANDS at birth tool—and provide information on its design and implementation–to capture the complex patterns of health care workers’ hand hygiene including hand rubbing/washing, glove use, and recontamination. Key Messages Time-and-motion methods are a good way of capturing hand hygiene compliance; for example, they can limit observer bias. We describe how we designed the HANDS at Birth tool, the tool format and its elements, its implementation components, the tool’s performance, and the implications for data analysis. The advantages of using this tool include simpler training, less observer judgment in assessing hand hygiene compliance, and improved ability to monitor multiple behaviors. Background: Good-quality evidence on hand hygiene compliance among birth attendants in low-resource labor wards is limited. The World Health Organization Hand Hygiene Observation Form is widely used for directly observing behaviors, but it does not support capturing complex patterns of behavior. We developed the HANDS at Birth tool for direct observational studies of complex patterns of hand rubbing/washing, glove use, recontamination, and their determinants among birth attendants. Understanding these behaviors is particularly critical in wards with variable patient volumes or unpredictable patient complications, such as emergency departments, operating wards, or triage and isolation wards during epidemics. Here we provide detailed information on the design and implementation of the HANDS at Birth tool, with a particular focus on low-resource settings. We developed the HANDS at Birth tool from available guidelines, unstructured observation, and iterative refinement based on consultation with collaborators and pilot results. We designed the tool with WOMBAT software, which supports collecting multidimensional time-and-motion data. Our analysis of the tool’s performance centered on interobserver agreement and convergent validity and the implications of the data structure for data analysis. The HANDS at Birth tool encompasses various hand actions and context-relevant information. Hand actions include procedures relevant during labor and delivery; hand hygiene or glove actions; and other types of touch. During field implementation, we used the tool for continuous observation of the birth attendant. Interobserver agreement was good (kappa range: 0.7–0.9), and the tool showed convergent validity. Using the HANDS at Birth tool is a feasible way to obtain useful information about compliance with hand hygiene procedures. The tool could be used after simple training and allows for collection of reliable information about the complex pattern of hygiene behaviors. Future studies should explore using this tool to observe behavior in labor wards in other settings and in other types of wards.