Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial

标准预防措施（SP）是一套基本的行动，包括手部卫生和使用 个人防护设备和尖锐物安全装置，每个医疗保健提供者都应该在 与每位患者的每次接触，以预防患者医疗保健相关感染（HAI）和职业性 血液传播病原体暴露。尽管有完善的、长期的指导方针和通常的培训， 没有可靠的实践，护士自我报告的依从性（他们有最大比例的直接 急性护理中的患者接触）低于50%。HAI是一个严重的公共卫生问题， 每年约有200万名患者，估计造成99，000人死亡， 25名注册护士中有1人暴露于病原体。一种可能改善SP依从性的有前景的机制 是模拟培训，一种新兴的和有效的教育方法，以提高医护人员的 性能本研究将测试旨在提高供应商绩效的模拟干预措施 预防HAI和职业性血源性病原体暴露。 该项目的目的是“模拟改善感染预防和患者安全：SIPPS”， 试验”的目的是：1）确定模拟培训对护士知识的影响，观察SP依从性， HAI和护士血源性病原体暴露率; 2）确定患者安全文化是否会改变 培训对观察到的SP依从性和知识的影响; 3）确定最大持续时间 模拟干预对SP依从性临床表现的影响（可持续性）。我们的研究目标， 方法论、措施规范和模拟实施计划的创新性指导， 概念框架（人的因素框架）和实施模式（综合框架， 执行研究）。我们将进行一项为期5年的分组随机分组干预试验， 临床原位（即，在现场、操作、临床环境中进行）模拟培训干预， 包括来自两个城市两所医院共12个单位约336名直接护理注册护士 states.将收集和汇总独特的调查、直接观察、焦点小组和二级数据， 回答我们的研究问题。该项目将得到世界一流的专业知识和资源的支持， 学术和临床环境致力于通过模拟研究提高患者安全。结果将 在一个现场工具包中传播，包括特殊教育课程和视频培训。住院病人， 包括妇女和少数民族、老年人、市中心居民和慢性病患者- AHRQ的优先事项 人群-服务于受益于改善遵守标准预防措施，卫生保健工作者将 受益于增强的“真实的世界”培训和支持，以减少他们接触血液传播的病原体。 最终，从这一优先研究中获得的知识将告知关键利益攸关方， 模拟培训在患者安全和推进国家医疗保健改善目标方面发挥作用。

Standard precautions (SP) are a fundamental set of actions, including hand hygiene and use of personal protective equipment and sharps safety devices, that every healthcare provider should perform in every contact with every patient to prevent patient healthcare associated infections (HAIs) and occupational blood-borne pathogen exposures. Despite well established, longstanding guidelines and usual training, SP are not reliably practiced, with self-reported adherence among nurses (who have the largest proportion of direct patient contact in acute care) less than 50%. HAIs are a substantial public health problem affecting approximately 2 million patients annually, resulting in 99,000 estimated deaths and occupational blood-borne pathogen exposures to 1 in 25 registered nurses. One promising mechanism that may improve SP adherence is simulation training, an emerging and effective educational approach to enhance healthcare workers' performance. This study will test a simulation intervention designed to improve provider performance of SP and prevent HAIs and occupational blood-borne pathogen exposures. The aims of this project, “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial,” are to: 1) determine the effect of simulation training on nurse knowledge, observed SP adherence, and HAI and nurse blood-borne pathogen exposure rates; 2) determine whether patient safety culture modifies the effect of training on observed SP adherence and knowledge; and 3) determine maximal duration (sustainability) of the simulation intervention on clinical performance of SP adherence. Our research objectives, methodology, specification of measures, and simulation implementation plan are innovatively guided by both a conceptual framework (Human Factors Framework) and implementation model (Consolidated Framework for Implementation Research). We will conduct a 5-year group-randomized, group-interventional trial to test a clinical in-situ (i.e., taking place in a live, operational, clinical setting) simulation training intervention and include approximately 336 direct care registered nurses from a total of 12 units from two hospitals in two states. Unique survey, direct observation, focus group, and secondary data will be collected and aggregated to answer our research questions. This project will be supported by the expertise and resources from world-class academic and clinical settings committed to advancing patient safety through simulation research. Results will be disseminated in an in-situ toolkit to include a SP curriculum and video training. Hospitalized patients, including women and minorities, the elderly, inner city residents, and the chronically ill - AHRQ priority populations - serve to benefit from improved adherence to standard precautions, and health care workers will benefit from enhanced “real world” training and support to reduce their exposure to blood-borne pathogens. Ultimately, knowledge gained from this prioritized research will inform key stakeholders of the vital role that simulation training performs in patient safety and in advancing national aims for healthcare improvement.