Building an Optimal Hand Hygiene Bundle: A Mixed Methods Approach

建立最佳的手部卫生组合：混合方法

• 批准号: 9892982
• 负责人: Heather Schacht Reisinger
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892982
• 关键词: Acute; Adoption; Advocate; Area; Caring; Cessation of life; Cues; Data; Effectiveness; Elements; Evaluation; Guidelines; Hand; Health Personnel; Health care facility; Hospital Units; Hospitals; Hygiene; Individual; Infection; Infection Control; Infection prevention; Infectious Agent; Intervention; Interview; Leadership; Literature; Measures; Methods; Nosocomial Infections; Patient Care; Pattern; Prevention; Prevention program; Process; Protocols documentation; Public Health; Randomized Controlled Trials; Reporting; Research; Research Design; Review Literature; Science; Site; Site Visit; Structure; Surveys; Testing; Time; base; care systems; contextual factors; effective intervention; efficacy testing; evidence base; improved; insight; methicillin resistant Staphylococcus aureus; patient safety; prevent; programs; response; scale up; systematic review; transmission process; vector transmission; ward; web site; working group

DESCRIPTION (provided by applicant): "Hand hygiene is the single most important measure to prevent transmission of infectious organisms" (VHA Directive 2010-006, MRSA Prevention Initiative). Despite its fundamental place in infection prevention, compliance rates with hand-hygiene protocols remain substantially below target levels. This project will advance the science of hand-hygiene compliance interventions by developing an evidence-based bundle of effective strategies. While many have advocated for a multifaceted bundle as the most effective approach to improving hand-hygiene compliance, no studies have systematically identified an optimal combination of interventions. As such, infection prevention programs continue to use a variety of hand-hygiene interventions without clear evidence of which components in isolation or combination are most effective. The two specific aims and associated hypotheses of CREATE Project 2 include: 1) Identify combinations of hand-hygiene intervention strategies that optimize hand-hygiene compliance and that could form an evidence-based hand-hygiene bundle for VHA implementation. Hypothesis 1: Combinations of interventions will increase compliance rates more than single interventions. Aim 1 will entail a 30-month cluster-randomized controlled trial that will sequentially test three individual hand-hygiene interventions - hand-hygiene point-of-use reminder signs to serve as an environmental cue to action, individual hand sanitizers, and health care worker hand cultures - to identify an optimal combination of interventions to increase hand-hygiene compliance. The trial will be conducted in 59 hospital units in 10 VA hospitals in order to test the efficacy of individual and then sequentially added interventions to determine their incremental impact on hand-hygiene compliance. 2) Identify institutional, organizational, ward/ICU, and individual level facilitators and barriers to implementing hand-hygiene interventions. Hypothesis 2: Facilitators and barriers will pattern around contextual factors suc as level of leadership support and organization of infection control programs. Aim 2 will entail a qualitative process evaluation that includes site visits to purposefully selected sites, semi-structured interviews, and observations to examine barriers and facilitators to the interventions and develop contextual insight for implementing and scaling-up the intervention at additional sites as a national initiative.

描述（由申请人提供）： “手部卫生是预防传染性微生物传播的最重要措施”（VHA指令2010-006，MRSA预防倡议）。尽管手部卫生在预防感染方面具有根本性的地位，但遵守手部卫生规程的比率仍然大大低于目标水平。该项目将通过制定一套基于证据的有效策略来推进手部卫生合规干预科学。虽然许多人主张多方面的捆绑作为提高手部卫生依从性的最有效方法，但没有研究系统地确定了干预措施的最佳组合。 因此，感染预防计划继续使用各种手卫生干预措施，但没有明确的证据表明哪种成分单独或组合最有效。 CREATE项目2的两个具体目标和相关假设包括：1）确定优化手部卫生的手部卫生干预策略组合 合规性，并可以形成一个基于证据的手卫生捆绑VHA 实施. 假设1：干预措施的组合将比单一干预措施更能提高依从率 干预措施。 目标1将包括一项为期30个月的随机分组对照试验，该试验将依次测试三种单独的手卫生干预措施-手卫生使用点提醒标志，作为行动的环境提示，个人洗手液和卫生保健工作者手培养-以确定干预措施的最佳组合，以提高手卫生依从性。该试验将在10家VA医院的59个医院单位进行，以测试个体干预措施的有效性，然后依次添加干预措施，以确定其对手部卫生依从性的增量影响。 2)确定机构、组织、病房/ICU和个人层面的促进者和障碍， 实施手部卫生干预措施。 假设2：促进者和障碍将围绕情境因素形成模式， 领导支持和组织感染控制计划。 目标2将要求 定性过程评价，包括对有目的地选择的地点进行实地访问、半结构化访谈和观察，以审查干预措施的障碍和促进因素，并为在其他地点实施和扩大干预措施作为国家举措提供背景见解。