The Examination of Infection Prevention and Crowding in the Emergency Department

急诊科感染预防与拥挤情况检查

• 批准号: 8593409
• 负责人: Eileen Juliana Carter
• 金额: $ 4.22万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8593409
• 关键词: Academic Medical Centers; Accident and Emergency department; Address; Adherence; Admission activity; Affect; Area; Award; Caring; Catheters; Cause of Death; Client satisfaction; Crowding; Data; Devices; Discipline of Nursing; Disease; Doctor of Philosophy; Ensure; Evidence based practice; Future; Future Generations; Goals; Guidelines; Hand; Health Personnel; Healthcare; Hospitals; Hygiene; Individual; Infection; Infection prevention; Institute of Medicine (U.S.); Interruption; Intervention; Joints; Left; Length; Linear Regressions; Logistic Regressions; Measures; Mentors; Methods; Mission; Modeling; Morbidity - disease rate; Muscle Cramp; National Institute of Nursing Research; Nurses; Outcome Measure; Patient Care; Patients; Peripheral; Policies; Presbyterian Church; Prevention Research; Process; Public Health; Quality of Care; Recommendation; Research; Research Training; Resources; Scientist; Students; Techniques; Testing; Time; Training; United States; United States Dept. of Health and Human Services; Universities; Venous; World Health Organization; base; care seeking; career; computerized data processing; disorder prevention; evidence base; evidence based guidelines; health care quality; improved; instrument; interest; meetings; mortality; patient safety; prevent; public health relevance; shift work; sound; urinary

DESCRIPTION (provided by applicant): Healthcare associated infections (HAIs) are a leading cause of death in the United States, despite being largely preventable. HAIs can be significantly reduced through the use of guideline-based infection prevention processes, e.g., aseptic technique during the placement of invasive devices and hand hygiene during patient care. In the emergency department (ED) care setting, millions of invasive devices are placed each year and numerous opportunities for hand hygiene exist. In recent years, HAI prevention in the ED has become more paramount given the growing problem of ED crowding. ED crowding is a major patient safety concern associated with significant mortality and poor care quality. During times of ED crowding, patients' needs are often met with insufficient resources. Patients commonly receive care from understaffed healthcare providers in cramped, unsafe settings, which likely affect guideline-based care. However, no study has examined infection prevention in the context of ED crowding. Guided by Donabedian's framework of healthcare quality, this study aims to determine the relationship between ED crowding and patients' receipt of guideline-based infection prevention processes, i.e., aseptic technique during urinary catheter, peripheral venous catheter, and central venous catheter placement, and hand hygiene during care. The proposed study will be conducted in the ED of an urban, tertiary hospital in northern Manhattan. Direct observations of infection prevention processes will be representative of all shifts and days of the week. Processes data will be recorded on psychometrically sound checklists, which reflect current evidence- based guidelines. Checklists include those developed by the World Health Organization and adapted from hospital policies. Observers will undergo rigorous testing throughout the course of the study to ensure high levels of inter-rater reliability (kappa >0.9). More than 900 observation periods will be included in analyses. Checklist data will be aggregated during each observation period and an adherence score will be calculated. Adherence scores will be the main variable of interest. ED crowding will be the primary predictor variable and will be measured using a validated, standardized instrument at the start of each observation period. Depending on the distribution and spread of data, a multivariate linear or logistic regression model will be used to analyze the relationship between ED crowding and patients' receipt of guideline-based infection prevention care. The short term goal of this study is to demonstrate the need for improved infection prevention in the ED, with the ultimate goal of facilitating interventions that improve evidence-based practices and prevent HAI. As such, this study is well aligned with the National Institute of Nursing Research's goal of disease prevention. Further, the receipt of this award will attest to NINR's mission to train the future generation of nurse scientists. The applicant is a BSN to PhD student eager to become a nurse scientist and improve care quality in the ED.

描述（由申请人提供）：医疗保健相关感染（HAI）是美国的主要死亡原因，尽管在很大程度上是可以预防的。HAI可以通过使用基于指南的感染预防过程来显著减少，例如，植入侵入性器械时的无菌技术和患者护理期间的手部卫生。在急诊科（艾德）护理环境中，每年放置数百万个侵入性设备，并且存在许多手部卫生的机会。近年来，鉴于艾德拥挤问题日益严重，艾德中的HAI预防变得更加重要。 艾德拥挤是一个主要的病人安全问题与显着的死亡率和护理质量差。在艾德拥挤的时期，患者的需求常常因资源不足而得不到满足。患者通常在狭窄、不安全的环境中接受人手不足的医疗保健提供者的护理，这可能会影响基于指南的护理。然而，没有研究探讨感染预防的背景下，艾德拥挤。 在Donabedian的医疗质量框架的指导下，本研究旨在确定艾德拥挤与患者接受基于指南的感染预防过程之间的关系，即，导尿管、外周静脉导管和中心静脉导管放置过程中的无菌技术，以及护理过程中的手卫生。拟定研究将在曼哈顿北方的一家城市三级医院的艾德急诊室进行。对感染预防过程的直接观察将代表所有班次和天数， 周 过程数据将被记录在心理测量学上健全的检查表上，该检查表反映了当前基于证据的指南。清单包括世界卫生组织制定的清单，并根据医院政策进行了调整。在整个研究过程中，观察员将接受严格的测试，以确保高水平的评分员间可靠性（kappa >0.9）。分析将包括900多个观察期。将在每个观察期内汇总检查表数据，并计算依从性评分。依从性评分将是主要关注变量。艾德拥挤将是主要预测变量，并将在每个观察期开始时使用经验证的标准化工具进行测量。根据数据的分布和传播，将使用多变量线性或逻辑回归模型分析艾德拥挤与患者接受基于指南的感染预防护理之间的关系。 本研究的短期目标是证明需要改善艾德感染预防，最终目标是促进干预措施，改善循证实践和预防HAI。因此，这项研究与国家护理研究所的疾病预防目标是一致的。此外，获得这个奖项将证明NINR的使命，以培养未来一代的护士科学家。申请人是一个BSN博士生渴望成为一名护士科学家，提高护理质量的ED。