The Examination of Infection Prevention and Crowding in the Emergency Department

描述（由申请人提供）：医疗保健相关感染（HAIs）是美国的主要死亡原因，尽管在很大程度上是可以预防的。通过使用基于指南的感染预防程序，例如，在放置侵入性装置期间使用无菌技术，以及在患者护理期间保持手部卫生，可显著减少卫生致死事件。在急诊科（ED）护理环境中，每年放置数百万侵入性设备，并且存在许多手部卫生机会。近年来，由于急诊科拥挤问题日益严重，急诊科的HAI预防变得更加重要。急诊科拥挤是一个主要的患者安全问题，与显著的死亡率和较差的护理质量有关。在急诊科拥挤的时候，病人的需求往往在资源不足的情况下满足。患者通常在拥挤、不安全的环境中接受人手不足的医疗保健提供者的护理，这可能会影响基于指南的护理。然而，没有研究检查在ED拥挤的情况下预防感染。在Donabedian医疗质量框架的指导下，本研究旨在确定ED拥挤与患者接受基于指南的感染预防过程的关系，即导尿管、外周静脉导管和中心静脉导管放置时的无菌技术，以及护理时的手部卫生。拟议的研究将在曼哈顿北部一家城市三级医院的急诊科进行。直接观察感染预防过程将代表所有班次和天

DESCRIPTION (provided by applicant): Healthcare associated infections (HAIs) are a leading cause of death in the United States, despite being largely preventable. HAIs can be significantly reduced through the use of guideline-based infection prevention processes, e.g., aseptic technique during the placement of invasive devices and hand hygiene during patient care. In the emergency department (ED) care setting, millions of invasive devices are placed each year and numerous opportunities for hand hygiene exist. In recent years, HAI prevention in the ED has become more paramount given the growing problem of ED crowding. ED crowding is a major patient safety concern associated with significant mortality and poor care quality. During times of ED crowding, patients' needs are often met with insufficient resources. Patients commonly receive care from understaffed healthcare providers in cramped, unsafe settings, which likely affect guideline-based care. However, no study has examined infection prevention in the context of ED crowding. Guided by Donabedian's framework of healthcare quality, this study aims to determine the relationship between ED crowding and patients' receipt of guideline-based infection prevention processes, i.e., aseptic technique during urinary catheter, peripheral venous catheter, and central venous catheter placement, and hand hygiene during care. The proposed study will be conducted in the ED of an urban, tertiary hospital in northern Manhattan. Direct observations of infection prevention processes will be representative of all shifts and days of the week. Processes data will be recorded on psychometrically sound checklists, which reflect current evidence- based guidelines. Checklists include those developed by the World Health Organization and adapted from hospital policies. Observers will undergo rigorous testing throughout the course of the study to ensure high levels of inter-rater reliability (kappa >0.9). More than 900 observation periods will be included in analyses. Checklist data will be aggregated during each observation period and an adherence score will be calculated. Adherence scores will be the main variable of interest. ED crowding will be the primary predictor variable and will be measured using a validated, standardized instrument at the start of each observation period. Depending on the distribution and spread of data, a multivariate linear or logistic regression model will be used to analyze the relationship between ED crowding and patients' receipt of guideline-based infection prevention care. The short term goal of this study is to demonstrate the need for improved infection prevention in the ED, with the ultimate goal of facilitating interventions that improve evidence-based practices and prevent HAI. As such, this study is well aligned with the National Institute of Nursing Research's goal of disease prevention. Further, the receipt of this award will attest to NINR's mission to train the future generation of nurse scientists. The applicant is a BSN to PhD student eager to become a nurse scientist and improve care quality in the ED.