背景:已知手部卫生可以减少与医疗保健相关的感染。然而,在医疗保健提供者中,它仍然是次优的。在这项研究中,我们使用以行为为中心的设计方法来探索坎帕拉都会区医疗保健提供者的手卫生促进者和威慑者,乌干达。
方法:我们在19个医疗机构(HCFs)中进行了一项成组性的定性研究,作为整群随机试验的一部分。该研究使用了19次半结构化和18次关键线人访谈来收集有关手部卫生状况以及手部卫生的促进者和威慑力量的数据。研究助理逐字转录,并使用Nvivo14.0辅助的主题框架。进行分析。我们使用了厚厚的描述和说明性的报价来提高我们发现的可信度和可信度。
结果:约47.4%的HCFs拥有足够的手部卫生基础设施,57.9%未报告患者护理期间手部卫生的总体依从性.手部卫生的物理促进者是不断提醒的存在,例如轻推,而生物学包括患者接触的频率和临床工作的性质。唯一的生物威慑是HCFs的繁重工作量。执行大脑促进者包括工作场所健康风险的知识,感染预防和控制(IPC)指南,和积极的态度。消极的态度是行政大脑对手部卫生的威慑。认可,奖励,对感染的恐惧是唯一有动机的大脑促进者。行为设置促进者包括接近功能性手部卫生基础设施,活跃的IPC委员会的存在,良好的领导,以及手部卫生用品的预算。行为设定威慑力量包括非功能性和不接近手部卫生基础设施和供应不足。
结论:该研究显示,在患者护理的关键时刻,手卫生依从性低,手卫生基础设施不足。手部卫生的阻碍因素包括繁重的工作量,消极的态度,供应不足,非功能性,距离洗手站很远。主持人包括不断的提醒,害怕感染,患者接触的频率和临床工作的性质,积极的态度,了解IPC指南,认可和奖励,良好的领导,手卫生用品预算的可用性,手卫生用品和基础设施以及活跃的IPC委员会的可用性和接近度。
背景:编号为ISRCTN98148144的ISRCTN注册表。该试验于2020年11月23日注册。
BACKGROUND: Hand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda.
METHODS: We conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings.
RESULTS: About 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies.
CONCLUSIONS: The study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees.
BACKGROUND: ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.