Mindful Hand Hygiene to Reduce Infections Among Veterans While Enhancing ProviderWell-Being

注意手部卫生，减少退伍军人的感染，同时提高提供者的福祉

• 批准号: 10308157
• 负责人: Michael Todd Greene
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308157
• 关键词: Address; Adherence; Adopted; Anxiety; Area; Attention; Awareness; COVID-19 pandemic; Caring; Client satisfaction; Clinical; Cognitive; Control Groups; Decision Making; Disease Outbreaks; Education; Elements; Ensure; Environment; Evidence based practice; Face; Fatigue; Focus Groups; Future; Goals; Hand; Health Personnel; Health system; Healthcare; Healthcare Systems; Hospital Administration; Hospitals; Human Resources; Hygiene; Infection; Infection prevention; Intervention; Interview; Judgment; Light; Malpractice; Measures; Medical center; Mental Depression; Methodology; Methods; Nurses; Outcome; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Physicians; Pilot Projects; Provider; Psyche structure; Quality of Care; Quality of life; Randomized; Regulation; Reporting; Risk; Safety; Site; Stress; Structure; Symptoms; Techniques; Testing; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; Workload; adherence rate; burnout; care providers; career; clinical practice; cost; disease transmission; effectiveness evaluation; experience; falls; health care service organization; health care settings; healthcare-associated infections; improved; innovation; member; mindfulness; mindfulness intervention; multi-component intervention; novel; patient safety; prevent; provider adherence; psychological distress; success; tool; treatment arm

Background: More and more providers face cumulative stress and burdens arising from increasing regulations, administrative and clerical duties, clinical workloads, malpractice lawsuits, and less time with patients. As a result, stress, fatigue, psychological distress, depression, burnout, and career dissatisfaction among providers are prevalent. In addition to impacting providers directly, poor well-being can negatively impact healthcare organizations and reduce quality of care, patient safety and patient satisfaction. Additionally, provider burnout, stress, and workload have been associated with poorer hand hygiene adherence, which can increase the risk of healthcare-associated infection (HAI). Hand hygiene is a key element of preventing HAI, yet maintaining healthcare provider adherence to this basic practice remains challenging. Achieving optimal hand hygiene adherence requires minimizing cognitive biases, such as perceived low odds of spreading infections by not properly performing hand hygiene. Unfortunately, cognitive bias is a known barrier to clinician decision-making. Mindfulness is an approach that can help clinicians shed preconceived biases through nonjudgmental awareness and more broadly facilitate improvements in patient safety. Significance: A hand hygiene-based mindfulness intervention targeted at Veterans Health Administration (VHA) providers could improve hand hygiene practices and thereby enhance patient outcomes. Additionally, incorporating brief mindfulness practices during moments of hand hygiene has the potential to directly improve provider well-being. Innovation and Impact: While targeted interventions and bundled approaches to improve hand hygiene adherence and reduce HAI have been implemented, interventions incorporating introspective techniques, such as mindfulness, are limited. In a recent single-site pilot study, team members of this proposed study found that a brief mindfulness intervention improved hand hygiene and mindful attention among physicians. The proposed study will expand on this pilot work by more broadly testing the hand hygiene-based mindfulness intervention with both physicians and nurses, and by including a specific focus on provider well-being. The goal is to optimize provider hand hygiene adherence, improve provider well-being and enhance the quality and safety of care delivered to Veterans. Specific Aims: We have three specific aims: 1) To evaluate the effectiveness of a hand hygiene-based mindfulness intervention on provider hand hygiene adherence, duration, and perceptions. 2) To evaluate the effectiveness of a hand hygiene-based mindfulness intervention on measures of provider mindfulness and well-being. 3) To identify the barriers, facilitators, and perceptions of a hand hygiene-based mindfulness intervention in the hospital. Methodology: We will conduct a randomized controlled mixed-methods trial at 2 diverse VHA hospitals. Physicians and nurses randomized to the intervention arm will receive mindfulness education and tools to prompt mindfulness during hand hygiene. Measures of hand hygiene (adherence, duration, and perceptions) and measures of provider mindfulness and well-being will be collected and compared between the intervention and control groups. Next Steps/Implementation: We will work with our proposed partners to review our study findings, modify our intervention as needed, and disseminate our findings through the various partnership channels. At the conclusion of this project, we will have a hand hygiene-based mindfulness intervention package that we can subsequently work to deploy more broadly across VHA hospitals to improve the safety of Veterans and the well-being of those providing their healthcare.

背景：越来越多的供应商面临着日益增加的压力和负担， 法规，行政和文书工作，临床工作量，医疗事故诉讼，以及减少与 患者因此，压力，疲劳，心理困扰，抑郁，倦怠和职业不满 在供应商中很普遍。除了直接影响供应商外，不良的福祉也会产生负面影响。 影响医疗机构，降低护理质量、患者安全和患者满意度。此外，本发明还 提供者的倦怠、压力和工作量与手部卫生依从性较差有关， 增加医疗相关感染（HAI）的风险。手卫生是预防HAI的关键因素， 然而，保持健康护理提供者遵守这一基本实践仍然具有挑战性。实现最佳 坚持手部卫生要求尽量减少认知偏差，如认为传播的可能性低， 不正确执行手部卫生导致感染。不幸的是，认知偏差是临床医生的一个已知障碍， 决策的正念是一种方法，可以帮助临床医生摆脱先入为主的偏见， 非判断性意识，更广泛地促进患者安全性的改善。 意义：针对退伍军人健康管理局的基于手的正念干预 (VHA)提供者可以改善手部卫生习惯，从而提高患者的治疗效果。此外，本发明还 在手部卫生的时刻结合简短的正念练习有可能直接改善 提供者的福祉。 创新和影响：虽然有针对性的干预措施和捆绑方法可以改善手部卫生 坚持和减少HAI已经实施，干预措施包括内省技术， 是有限的。在最近的一项单点试点研究中，这项拟议研究的团队成员发现， 简短的正念干预改善了医生的手部卫生和正念注意力。拟议 一项研究将通过更广泛地测试基于手的正念干预来扩展这项试点工作 与医生和护士，并包括一个具体的重点提供者的福祉。目标是 优化供应商手部卫生依从性，改善供应商健康状况，提高 照顾退伍军人。 具体目标：我们有三个具体目标：1）评估基于手推的有效性。 正念干预对提供者手部卫生依从性、持续时间和感知的影响。2)评价 基于手的正念干预对供应商正念措施的有效性， well-being. 3)识别障碍，促进者，以及基于手的正念的感知 在医院的干预。 方法：我们将在2家不同的VHA医院进行随机对照混合方法试验。 随机分配到干预组的医生和护士将接受正念教育和工具， 手卫生期间的快速正念。手部卫生措施（坚持性、持续时间和感知） 提供者的正念和幸福的措施将被收集和比较之间的干预 与对照组 后续步骤/实施：我们将与建议的合作伙伴一起审查我们的研究结果，修改我们的 我们将根据需要采取干预措施，并通过各种伙伴关系渠道传播我们的调查结果。在 这个项目的结论，我们将有一个基于手的正念干预包，我们可以 随后在VHA医院更广泛地部署，以改善退伍军人的安全， 为他们提供医疗服务的人的幸福。