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

背景：越来越多的提供者面临着越来越多的压力和负担 法规、行政和文书工作、临床工作量、医疗事故诉讼，以及更少的时间 病人。其结果是，压力、疲劳、心理困扰、抑郁、职业倦怠和职业不满 在供应商中很普遍。除了直接影响提供者之外，糟糕的幸福感可能会带来负面影响 影响医疗保健组织，降低护理质量、患者安全和患者满意度。另外， 提供者的职业倦怠、压力和工作量与较差的手卫生依从性有关，这可能 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对这一基本做法的遵守仍然具有挑战性。实现最优 遵守手部卫生要求将认知偏差降至最低，例如感知到的传播几率较低 由于没有正确地进行手部卫生而感染。不幸的是，认知偏差是临床医生的一个已知障碍。 决策。正念是一种方法，可以帮助临床医生通过 不加评判的意识，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以手卫生为基础的正念干预 (VHA)提供者可以改进手部卫生实践，从而提高患者的预后。另外， 在手部卫生的时候结合简短的正念练习有可能直接改善 提供者福祉。 创新和影响：虽然有针对性的干预措施和改善手部卫生的捆绑方法 实施了坚持和减少HAI，采用了内省技术的干预措施，如 作为正念，是有限的。在最近的一项单一地点试点研究中，这项拟议研究的团队成员发现 短暂的正念干预改善了医生的手部卫生和正念注意力。建议数 研究将通过更广泛地测试基于手卫生的正念干预来扩大这一试点工作 与医生和护士合作，并将具体重点放在提供者的福祉上。我们的目标是 优化供应商手部卫生依从性，改善供应商幸福感，增强产品质量安全 提供给退伍军人的护理。 具体目标：我们有三个具体目标：1)评估以手卫生为基础的效果 正念干预对提供者手卫生依从性、持续时间和感知的影响。2)评估 以手卫生为基础的正念干预对提供者正念测量的有效性 幸福。3)确定以手卫生为基础的正念的障碍、促进者和感知 在医院进行干预。 方法：我们将在两家不同的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，以 在保持手部卫生的过程中迅速保持正念。手部卫生措施(依从性、持续时间和感知) 并将收集提供者正念和幸福感的测量结果，并在干预期间进行比较 和对照组。 下一步/实施：我们将与我们提议的合作伙伴合作，审查我们的研究结果，修改我们的 根据需要进行干预，并通过各种伙伴关系渠道传播我们的调查结果。在 总结这个项目，我们将有一个基于手卫生的正念干预包，我们可以 随后，努力在VHA医院更广泛地部署，以改善退伍军人和 那些提供医疗保健的人的福祉。

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.