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.

项目总结/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， 在安全和预防的抵消障碍，如身体和感官的限制，禁止他们 积极帮助自己。不幸的是，老年人感染的风险最高， 卫生是防止感染传播的唯一最重要的方法，老年人的机制， 最大限度地减少自身感染风险的做法往往被忽视。医院存在着多种污染元素 对于老年人来说，他们将遇到高接触表面和携带病原体的医疗设备 导致感染然而，在没有帮助的情况下， 老年人由于身体虚弱，灵活性和移动性有限，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、小毛巾、室内 水槽）。需要新的解决办法。因此，在本提案中，我们更新了我们的制造商开发的， 技术增强型患者手部卫生系统。为患者提供可操作和可管理的洁净手 （CHAMP），我们的自动化开发和试点测试床栏杆贴手消毒分配器， 设有口头、听觉和视觉提醒功能，提醒病人清洁双手。安全和容易 具有使用跟踪的可访问运动感测系统需要很少的体力，因为用户只需要 能够自由地移动他们的上肢，并在提示时到达床栏杆以清洁他们的手 (e.g.用餐时间前）。我们的试验结果既在一小群老年人中， 环境的影响表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，我们提出了一个 一项比较两组≥ 65岁住院成人的大型异质性随机对照试验（RCT） 在两家公立医院中，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，他们有成功的合作记录 并准备解决以下目标：（1）确定CHAMP作为一种方法来改善手- 卫生行为和减少患者的手污染，（2）评估我们的干预措施的实施情况， (3)检查影响与我们的干预措施相关的结果的因素;（4）成本和成本效益 的CHAMP。主要结果是通过菌落的存在、类型和数量来测量手污染- 形成位于参与者手上的单元。我们的初步结果承诺， 技术强化干预可能是让患者参与感染预防的有效方法， 减少老年人中的定植和感染率的解决办法。我们的建议符合所有四个目标， NIH/NIA的2020-2025战略计划，旨在改善成年人的健康，福祉和独立性， 他们的年龄和预防或减少与年龄有关的疾病，失调和残疾的负担。

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.