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：越来越多的提供者面临着日益增加的压力和负担。 法规、行政和文书职责、临床工作量、医疗事故诉讼以及更少的时间 患者。结果，压力、疲劳、心理困扰、抑郁、倦怠和职业不满 供应商之间普遍存在这种情况。除了直接影响提供者之外，不良的福祉还会产生负面影响 影响医疗保健组织并降低护理质量、患者安全和患者满意度。此外， 提供者的倦怠、压力和工作量与手部卫生依从性较差有关，这可能会导致 增加医疗保健相关感染 (HAI) 的风险。手部卫生是预防 HAI 的关键因素， 然而，保持医疗保健提供者遵守这一基本做法仍然具有挑战性。达到最佳状态 坚持手部卫生需要最大限度地减少认知偏差，例如认为传播几率较低 因未正确执行手部卫生而感染。不幸的是，认知偏差是临床医生的一个已知障碍 决策。正念是一种可以帮助临床医生摆脱先入为主的偏见的方法 非判断性意识，更广泛地促进患者安全的改善。 意义：针对退伍军人健康管理局的基于手部卫生的正念干预 (VHA) 提供者可以改善手部卫生习惯，从而改善患者的治疗效果。此外， 在手部卫生时加入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：通过有针对性的干预措施和捆绑方法来改善手部卫生 已经实施了坚持遵守和减少 HAI 的干预措施，其中包括内省技术，例如 作为正念，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。拟议的 研究将通过更广泛地测试基于手部卫生的正念干预来扩展这项试点工作 与医生和护士一起，并特别关注提供者的福祉。目标是 优化提供者手部卫生的遵守情况，改善提供者的福祉并提高医疗服务的质量和安全性 为退伍军人提供护理。 具体目标：我们有三个具体目标：1) 评估基于手部卫生的有效性 对提供者手部卫生依从性、持续时间和认知的正念干预。 2）评估 基于手部卫生的正念干预对提供者正念测量的有效性 福利。 3) 确定基于手部卫生的正念的障碍、促进因素和看法 医院进行干预。 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 在手部卫生期间及时注意。手部卫生措施（依从性、持续时间和认知） 将收集提供者正念和幸福感的测量值，并在干预之间进行比较 和对照组。 后续步骤/实施：我们将与拟议的合作伙伴合作，审查我们的研究结果，修改我们的 根据需要进行干预，并通过各种合作伙伴渠道传播我们的调查结果。在 该项目结束后，我们将制定一个基于手部卫生的正念干预方案，我们可以 随后努力在 VHA 医院进行更广泛的部署，以提高退伍军人和社区的安全 那些提供医疗保健的人的福祉。