背景:当传染病威胁在特别脆弱或资源稀缺的环境中活跃或迫在眉睫时,什么是感染预防和控制的最佳培训方法尚不确定。
方法:进行了范围审查,以查找和总结有关培训方式的相关信息,多项研究设计中报告的临床工作人员IPC培训计划的可复制性和有效性。符合条件的环境受冲突影响或被归类为低收入或中低收入的国家(世界银行2022分类)。LILACS和Scopus的搜索术语是在专家工作组的输入下开发的。最初发现的文章是独立进行双重筛选的,提取了特别是关于感染威胁的数据,培训成果,需求评估和教学模式。进行了前后引文搜索以找到其他研究。叙述性摘要描述了培训计划的成果和方面。开发了定制的质量评估工具,以描述每项研究是否可以为相关脆弱环境中制定特定的未来培训计划提供信息,基于六个关于可复制性的问题和八个关于其他偏见的问题。
结果:包括编号为29的研究,几乎所有(n=27)都是事后设计,两个是审判。纳入的研究中实现可复制性的信息较低(平均得分为3.7/6)。几乎所有研究都报告了结果的显着改善,表明主要的研究设计(pre-post)不足以评估低偏倚的改善。任何这样的培训都是有益的,或者这种发表偏见阻止了报道不太成功的干预措施,从而提供了翔实的概述。
结论:许多可能的培训形式和方法可能会导致工人知识的提高,预防和控制感染的技能和/或实践。由于描述不完整,因此难以证明支持任何特定培训格式或方法的明确证据,缺乏有关培训不成功的文件,和一些最小偏倚的研究设计(实验试验)。我们的结果表明,有一个重要的机会来设计实验,可以提供赞成或反对特定训练方法的见解。可以制定随机对照试验的“睡眠”协议,然后在未来发生相关事件时迅速应用,通过对知识等结果的评估,实践,技能,信心,和意识。
BACKGROUND: It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings.
METHODS: A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases.
RESULTS: Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview.
CONCLUSIONS: It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. \"Sleeping\" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.