Building an Optimal Hand Hygiene Bundle: A Mixed Methods Approach

描述(由申请人提供)： “手卫生是防止传染病传播的唯一最重要的措施”(VHA指令2010-006，MRSA预防倡议)。尽管它在感染预防中处于基础地位，但手卫生方案的遵从率仍然大大低于目标水平。该项目将通过制定一套以证据为基础的有效战略来推进手卫生遵从性干预的科学。虽然许多人主张将多方面捆绑作为改善手卫生遵从性的最有效方法，但还没有研究系统地确定干预措施的最佳组合。因此，感染预防方案继续使用各种手部卫生干预措施，但没有明确证据表明哪些成分单独或组合最有效。创建项目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，并可形成用于VHA实施的循证手部卫生捆绑。假设1：联合干预措施比单一干预措施更能提高遵从率。目标1将需要一项为期30个月的整群随机对照试验，按顺序测试三种单独的手卫生干预措施--作为行动环境提示的手卫生点提醒标志、个人洗手液和医护人员手培养--以确定提高手卫生遵从性的最佳干预组合。这项试验将在10家退伍军人医院的59个医院单元中进行，以测试个别干预措施的有效性，然后按顺序增加干预措施，以确定其对手卫生遵从性的增量影响。2)确定机构、组织、病房/重症监护病房和个人层面的促进者和实施手卫生干预措施的障碍。假设2：促进者和障碍将围绕上下文因素形成，如领导水平、支持和感染控制计划的组织。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访问、半结构化访谈和观察，以检查干预措施的障碍和促进者，并为作为国家倡议在更多地点实施和扩大干预措施提供背景洞察力。

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.