Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Am J Infect Control. 2012 Mar;40(2):138-43. doi: 10.1016/j.ajic.2011.04.332. Epub 2011 Aug 23.
Previous research demonstrates that organizational culture (OC) and knowledge, attitudes, and practices of health care personnel are associated with the overall success of infection control programs; however, little attention has been given to the relationships among these factors in contributing to the success of quality improvement programs.
Cross-sectional surveys assessing OC and knowledge, attitudes, and practices related to methicillin-resistant Staphylococcus aureus (MRSA) were distributed to 16 medical centers participating in a Veterans Affairs MRSA prevention initiative in 2 time periods. Factor analysis was performed on the OC survey responses, and factor scores were generated. To assess associations between OC and knowledge, attitudes, and practices of health care personnel, regression analyses were performed overall and then stratified by job type.
The final analyzable sample included 2,314 surveys (43% completed by nurses, 9% by physicians, and 48% by other health care personnel). Three OC factors emerged accounting for 53% of the total variance: "Staff Engagement," "Overwhelmed/Stress-Chaos," and "Hospital Leadership." Overall, higher Staff Engagement was associated with greater knowledge scores, better hand hygiene practices, fewer reported barriers, and more positive attitudes. Higher Hospital Leadership scores were associated with better hand hygiene practices, fewer reported barriers, and more positive attitudes. Conversely, higher Overwhelmed/Stress-Chaos scores were associated with poorer reported prevention practices, more barriers, and less positive attitudes. When these associations were stratified by job type, there were significant associations between OC factors and knowledge for nurses only, between OC factors and practice items for nurses and other health care personnel, and between OC factors and the barriers and attitudes items for all job types. OC factors were not associated with knowledge and practices among physicians.
Three OC factors-Staff Engagement, Overwhelmed/Stress-Chaos, and Hospital Leadership-were found to be significantly associated with individual health care personnel knowledge, attitudes, and self-reported practices regarding MRSA prevention. When developing a prevention intervention program, health care organizations should not only focus on the link between OC and the knowledge, attitudes, and practices of health care personnel, but also target programs based on health care personnel type to maximize their effectiveness.
先前的研究表明，组织文化（OC）以及医护人员的知识、态度和实践与感染控制项目的整体成功息息相关；然而，在促成质量改进项目成功的因素中，人们对这些因素之间的关系关注甚少。
在两个时间点，向参与退伍军人事务部耐甲氧西林金黄色葡萄球菌（MRSA）预防计划的 16 家医疗中心分发了评估 OC 以及与 MRSA 相关的知识、态度和实践的横断面调查。对 OC 调查结果进行因子分析，并生成因子得分。为了评估 OC 与医护人员的知识、态度和实践之间的关联，我们总体上进行了回归分析，然后按职业类型进行了分层。
最终分析样本包括 2314 份调查（43%由护士填写，9%由医生填写，48%由其他医护人员填写）。出现了 3 个 OC 因子，占总方差的 53%：“员工参与”、“不堪重负/压力混乱”和“医院领导”。总体而言，较高的“员工参与”与较高的知识得分、更好的手部卫生实践、较少报告的障碍以及更积极的态度相关。较高的“医院领导”得分与更好的手部卫生实践、较少报告的障碍以及更积极的态度相关。相反，较高的“不堪重负/压力混乱”得分与较差的预防实践、更多的障碍以及较不积极的态度相关。当按职业类型对这些关联进行分层时，仅在护士中发现 OC 因子与知识之间存在显著关联，在护士和其他医护人员中发现 OC 因子与实践项目之间存在显著关联，在所有职业类型中发现 OC 因子与障碍和态度项目之间存在显著关联。OC 因子与医生的知识和实践之间无关联。
发现 3 个 OC 因子——“员工参与”、“不堪重负/压力混乱”和“医院领导”与医护人员在 MRSA 预防方面的个人知识、态度和自我报告的实践显著相关。在制定预防干预计划时，医疗机构不仅应关注 OC 与医护人员的知识、态度和实践之间的联系，还应根据医护人员类型来确定计划，以最大限度地提高其有效性。
