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: 9894741
• 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/9894741
• 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）： “手部卫生是防止传染性生物体传播的最重要的措施”（VHA 指令 2010-006，MRSA 预防倡议）。尽管手部卫生协议在预防感染方面具有重要地位，但其遵守率仍远低于目标水平。该项目将通过开发一套基于证据的有效策略来推进手部卫生合规干预措施的科学发展。尽管许多人主张将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干预措施的最佳组合。 因此，感染预防计划继续使用各种手部卫生干预措施，但没有明确的证据表明哪些单独或组合的成分最有效。 CREATE 项目 2 的两个具体目标和相关假设包括： 1) 确定手部卫生干预策略的组合，以优化手部卫生依从性，并可以形成用于 VHA 实施的循证手部卫生包。 假设 1：干预措施组合比单一干预措施更能提高依从率。 目标 1 将进行为期 30 个月的整群随机对照试验，将顺序测试三种个人手部卫生干预措施——作为行动环境提示的手部卫生使用点提醒标志、个人洗手液和医护人员手部培养——以确定提高手部卫生依从性的最佳干预措施组合。该试验将在 10 家 VA 医院的 59 个医院单位进行，以测试个体的效果，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 和个人层面实施手部卫生干预措施的促进因素和障碍。 假设 2：促进因素和障碍将围绕环境因素（例如领导支持水平和感染控制计划的组织）而定。 目标 2 将需要 定性过程评估，包括对有目的地选择的地点进行实地考察、半结构化访谈和观察，以检查干预措施的障碍和促进因素，并为作为一项国家举措在其他地点实施和扩大干预措施提供背景洞察。