AP-HP, Charles-Foix University Hospital, Observatoire du Risque Infectieux en Gériatrie (Geriatric Infection Risk Monitoring Organization), Ivry sur Seine, France.
J Am Med Dir Assoc. 2012 Jul;13(6):569.e9-17. doi: 10.1016/j.jamda.2012.04.008. Epub 2012 Jun 7.
To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%.
A cluster randomized study was carried out over a 5-month period.
Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs).
The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders.
The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497).
Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis.
Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results.
评估卫生促进计划对降低感染率（主要终点）5%的影响。
一项为期 5 个月的集群随机研究。
法国 50 家有 4345 张床位的养老院（NH）通过分层块随机分配，分为多组分干预组（25 家 NH）或仅评估组（25 家 NH）。
多组分干预针对护理人员，包括实施一套感染预防共识措施。在干预 NH 组织了使用幻灯片的互动教育会议。NH 还提供了强调手部卫生的彩色海报和包括酒精基手部消毒剂等卫生产品的工具包。定期进行知识调查作为提醒。
主要终点是感染病例中分类为明确或可能的尿路感染、呼吸道感染和胃肠道感染的总感染率。分析符合基础设计，并根据意向治疗原则进行。这项研究已注册（NCT01069497）。
纳入并随访了 47 家 NH（4515 名居民）。干预组的首次感染发生率为每 1000 名居民-天 2.11 例，对照组为每 1000 名居民-天 2.15 例；然而，两组之间的差异在未调整（风险比[HR] = 1.00 [95%置信区间（CI）0.89-1.13]；P =.93）或调整（HR = 0.99 [95% CI 0.87-1.12]；P =.86）分析中均无统计学意义。
在护理人员常规实践中，将这种涉及行为改变的干预措施的影响与普遍的环境和背景决定因素分开，往往很复杂，难以解释结果。
