Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes

患者安全氛围对感染预防实践以及医护人员和患者结果的影响

• 批准号: 9339338
• 负责人: Amanda Jane Hessels
• 金额: $ 10.8万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9339338
• 关键词: Impact; Patient; Safety; Climate; Infection

PROJECT SUMMARY Aligned with critical research gaps identified as a priority for the National Occupational Research Agenda (NORA) Healthcare and Social Assistance (HCSA) sector over the next decade, this proposed study will address NORA strategic goals to: Promote safe and healthy workplaces and optimize safety culture in healthcare organizations; Reduce sharps injuries and their impacts among all healthcare personnel; and STOP transmission of infectious diseases in HCSA settings among workers, patients and visitors. This NIOSH Mentored Research Scientist Development Award supports the first step in a program of research that addresses three intertwined and important public health problems: 1) high rates of healthcare worker (HCW) blood-borne pathogen exposures; 2) high rates of patient healthcare associated infections (HAI); and 3) low levels of standard precaution adherence. The specific project aims are to: 1) describe the direction and magnitude of relationships among patient safety climate and self-reported and observed standard precaution adherence; 2) identify the relationship between standard precaution adherence and HCW blood-borne pathogen exposure and HAI; and 3) determine the direct and indirect relationships among patient safety climate, observed and reported standard precaution adherence, and HCW and HAI outcomes. To achieve these aims we will conduct a multi-site, cross-sectional study in a sample of 1600 hospital based nurses from 100 units in 50 U.S. hospitals and collect surveys on patient safety climate and standard precaution adherence, observational standard precaution adherence data, and existing unit level data on HCW blood-borne pathogen exposures and HAIs. Using novel tools developed and pilot tested by the PI we will recruit and train hospital based staff on observational surveillance methodology to foster the NORA Research to Practice (r2P) goals. We will pool data from these four sources and use advanced multilevel modeling, accounting clustering, and important hospital and nurse potential confounders to determine whether hospital units with better patient safety climate have better standard precaution adherence and also have better HCW and patient outcomes. Findings from this study may identify modifiable features of the safety climate that impede or facilitate the uptake of evidence-based recommendations for standard precaution behaviors, and are associated with better HCW and patient outcomes. Potential implications of this study include developing a model for surveillance methodology and training and generating actionable knowledge for institutional, governmental, and academic stakeholders of important and modifiable features of the patient safety climate to improve HCW and patent safety. To our knowledge, this study will be the first to examine these relationships, aligned with NORA strategic goals. To accomplish this study a carefully constructed career development plan will be implemented aligned with the NORA research priority to prepare highly trained scientists to address occupational safety and health critical issues. The long term goal of the plan is to prepare the candidate as a successful independent investigator with expertise in organizational factors that influence HCW behaviors and occupational health and patient safety outcomes. The immediate goals of the training plan are to provide the candidate with an opportunity to 1) engage in intensive and extensive training focused on occupational health and safety, survey methodology, advanced quantitative methods, and dissemination and translational science skills, and 2) conduct an independent research project examining the relationships among patient safety climate, standard precaution adherence and adverse HCW and patient outcomes. The Principal Investigator will be guided by a team of mentors and collaborators that include senior scientists and faculty with extensive experience in Occupational Health and Safety, Infection Prevention and Epidemiology, Survey methodology and Biostatistics, and support from two national professional organizations.

项目总结 与被确定为国家职业研究议程优先事项的关键研究差距保持一致 (NORA)医疗和社会援助(HCSA)部门在未来十年，这项拟议的研究将 解决Nora的战略目标：促进安全和健康的工作场所，优化安全文化 减少所有医护人员的锐器伤害及其影响；并停止 在HCSA环境中，传染病在工作人员、患者和来访者之间的传播。这个NIOSH 指导研究科学家发展奖支持研究计划的第一步，该计划 解决三个相互交织的重要公共卫生问题：1)医疗工作者(HCW)比率高 血液传播病原体暴露；2)患者医疗保健相关感染(HAI)率高；3)低 遵守标准预防措施的水平。 具体项目的目标是：1)描述患者安全之间关系的方向和大小 气候与自我报告和遵守标准预防措施的遵守情况；2)确定 标准预防措施依从性和HCW血液传播病原体暴露和HAI；以及3)确定 患者安全氛围、观察到的和报告的标准预防措施之间的直接和间接关系 坚持，以及HCW和HAI的结果。为了实现这些目标，我们将进行多点、横断面 对美国50家医院100个单位的1600名驻院护士进行抽样调查 患者安全氛围和标准预防措施遵守情况、观察性标准预防措施遵守情况数据、 和现有单位一级关于HCW血液传播病原体暴露和人类免疫缺陷病毒感染的数据。使用开发的新工具 和试点测试，我们将招聘和培训医院为基础的工作人员观察监测 促进Nora研究实践(R2P)目标的方法论。我们将汇集这四个来源的数据 并使用先进的多层次建模、会计聚类和重要医院和护士潜力 确定患者安全环境更好的医院单位是否有更好的标准的混杂因素 预防措施的坚持，也有更好的HCW和患者结局。 这项研究的结果可能会确定安全氛围的可改变特征，这些特征会阻碍或促进 接受基于证据的标准预防行为建议，并与更好的 Hcw和患者结局。这项研究的潜在意义包括开发一种监测模型 方法和培训，并为机构、政府和学术机构生成可操作的知识 患者安全环境的重要和可修改特征的利益相关者，以改善HCW和专利 安全。据我们所知，这项研究将是第一次检查这些关系，与Nora保持一致 战略目标。 为了完成这项研究，将实施一项精心编制的职业发展计划，与 Nora研究优先培养训练有素的科学家以解决职业安全和健康的关键问题 问题。该计划的长期目标是使候选人成为一名成功的独立调查员 具有影响职业健康和患者健康的组织因素的专业知识 安全结果。培训计划的直接目标是为应聘者提供机会 1)参加以职业健康和安全为重点的集中和广泛的培训，调查 方法论、高级量化方法以及传播和翻译科学技能，以及2) 进行独立研究项目，检查患者安全环境之间的关系； 标准预防依从性和不良的HCW和患者结局。首席调查员将是 由导师和合作者组成的团队指导，其中包括具有广泛经验的资深科学家和教职员工 职业健康与安全、感染预防与流行病学、调查方法学方面的经验 和生物统计学，并得到两个国家专业组织的支持。