Clean Hands Accessible and Manageable for Patients (CHAMPs): A technology-based self-management intervention to improve patient hand hygiene and reduce hand contamination among older adults.

患者可及且可管理的清洁双手 (CHAMP)：一种基于技术的自我管理干预措施，旨在改善患者手部卫生并减少老年人的手部污染。

• 批准号: 10703466
• 负责人: Shanina C Knighton
• 金额: $ 64.71万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703466
• 关键词: Acute; Address; Admission activity; Adult; Advocacy; Age; Auditory; Beds; Behavior; Biomedical Engineering; Biometry; Cessation of life; Clinical; Cognitive; Collaborations; Colony-forming units; Communicable Diseases; Communities; Cost Analysis; Dependence; Disease; Disease Outbreaks; Elderly; Elements; Enhancement Technology; Environment; Equipment; Equity; Ethnic Origin; Failure; Friends; Germ; Goals; Group Hospitalization; Hand; Hand functions; Health; Healthcare; Hospitalization; Hospitals; Hygiene; Infection; Infection Control; Infection prevention; Inpatients; Institution; Intervention; Long-Term Care; Measures; Mechanics; Medical Device; Methods; Motion; Motivation; Nurses; Outcome; Participant; Patients; Perception; Personal Satisfaction; Physical Efforts; Policies; Prevention; Process; Public Hospitals; Quality of Care; Race; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Research Personnel; Risk; Safety; Scientist; Self Management; Sensory; Sepsis; Strategic Planning; Surface; System; Technology; Testing; Time; Touch sensation; Training; United States National Institutes of Health; Update; Upper Extremity; Visual; Work; acute care; age related; cost; cost effectiveness; dexterity; disability; experience; fall risk; frailty; health disparity; healthcare-associated infections; high risk; implementation evaluation; implementation outcomes; implementation science; improved; infection rate; infection risk; manufacture; microbial; multi-drug resistant pathogen; new technology; novel; pathogen; patient engagement; patient oriented; pilot test; prevent; primary outcome; translational potential; transmission process; treatment as usual; trial comparing; user-friendly; verbal

PROJECT SUMMARY/ABSTRACT Our long-term goal to establish sustainable, patient-centered interventions at the patient level to engage patients in safety and prevention by offsetting barriers such as physical and sensory limitations that prohibit them from actively helping themselves. Unfortunately, older adults are at highest risk for infections and yet while hand hygiene is the single most important way to prevent the spread of infection, mechanisms for older adults to minimize their own risk for infections is often overlooked. Many contamination elements exist in hospital settings and for older adults they will encounter high-touch surfaces and medical devices that harbor pathogens that lead to infections. However, without assistance, hand-hygiene practice rates are poor among hospitalized older adults’ due to frailty, limited dexterity and mobility, cognitive limitations, and risk of falling, which prohibits their independent use of visible hand- hygiene products (e.g., wall dispensers, towelettes, in-room sinks). New solutions are necessary. Therefore, in this proposal, we have updated our investigator-developed, technology-enhanced patient hand hygiene system. Clean Hands Accessible and Manageable for Patients (CHAMPs), our investigator-developed and pilot tested bed rail-affixed hand-sanitizing dispenser, which features verbal, auditory and visual reminders to remind patients to clean their hands. The safe and easily accessible motion-sensing system with usage tracking requires very little physical effort, as users need only to be able to freely move their upper extremities and reach over to the bed rail to clean their hands when prompted (e.g. before meal times). Our pilot results among both a small group of older adults and in a high-tech simulated environment demonstrated both efficacy and feasibility of the intervention. In this 4-year project, we propose a large heterogeneous randomized controlled trial (RCT) comparing two groups of hospitalized adults ≥ 65 years in two public hospitals, one group receives CHAMPs (n=125) and the other is the usual-care (UC) group (n=125). Our research team consists of early and late stage investigators who have a successful record of working together and are ready to address the following aims: (1) to determine the effect of CHAMPs as a method to improve hand- hygiene behavior and reduce patients’ hand contamination, (2) assess the implementation of our intervention, (3) examine factors that influence outcomes associated with our intervention and (4) costs and cost-effectiveness of CHAMPs. The primary outcome is hand contamination as measured by presence, type, and quantity of colony- forming units located on participants’ hands. Our preliminary results offer promise that the CHAMPs technology-enhanced intervention may be an effective approach to engage patients in infection prevention as a solution to reduce colonization and infection rates among older adults. Our proposal aligns with all four goals of NIH/NIA’s 2020-2025 strategic plan, which is to improve the health, well-being, and independence of adults as they age and to prevent or reduce the burden of age-related diseases, disorders, and disabilities.

项目概要/摘要 我们的长期目标是在患者层面建立可持续的、以患者为中心的干预措施，以吸引患者参与 通过消除阻碍他们的身体和感官限制等障碍来实现安全和预防 积极帮助自己。不幸的是，老年人感染的风险最高，但在手部工作时 卫生是防止感染传播的最重要的方法，也是老年人预防感染的机制 最大限度地降低自身感染风险常常被忽视。医院内存在多种污染因素 对于老年人来说，他们会遇到含有病原体的高接触表面和医疗设备 从而导致感染。然而，如果没有援助，住院患者的手部卫生实践率很低 老年人由于身体虚弱、灵活性和活动能力有限、认知能力有限以及跌倒的风险， 禁止他们独立使用可见的手部卫生产品（例如壁挂式分配器、毛巾、室内 水槽）。新的解决方案是必要的。因此，在这个提案中，我们更新了我们的研究者开发的， 技术增强的患者手部卫生系统。干净的双手可供患者使用和管理 (CHAMPs)，我们的研究人员开发并进行了试点测试的床轨固定式洗手液分配器， 具有口头、听觉和视觉提醒功能，提醒患者清洁双手。安全又轻松 具有使用跟踪功能的可访问运动传感系统只需要很少的体力劳动，因为用户只需要 能够在提示时自由活动上肢并伸到床栏上清洁双手 （例如用餐前）。我们在一小群老年人和高科技模拟中进行了试点结果 环境证明了干预措施的有效性和可行性。在这个为期 4 年的项目中，我们提出了 比较两组≥ 65 岁住院成人的大型异质随机对照试验 (RCT) 在两家公立医院，一组接受 CHAMP（n=125），另一组是常规护理（UC）组（n=125）。 我们的研究团队由早期和后期研究人员组成，他们拥有成功的合作记录 并准备好实现以下目标：（1）确定 CHAMP 作为改善手部方法的效果 卫生行为并减少患者的手污染，(2) 评估我们干预措施的实施情况， (3) 检查影响与我们的干预相关的结果的因素，以及 (4) 成本和成本效益 冠军。主要结果是手部污染，通过菌落的存在、类型和数量来衡量。 形成单元位于参与者的手上。我们的初步结果承诺 CHAMP 技术强化干预可能是让患者参与感染预防的有效方法 减少老年人定植和感染率的解决方案。我们的建议符合以下所有四个目标 NIH/NIA 的 2020-2025 年战略计划，旨在改善成年人的健康、福祉和独立性 它们会衰老并预防或减轻与年龄相关的疾病、失调和残疾的负担。