Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN.
Am J Infect Control. 2013 Nov;41(11):965-70. doi: 10.1016/j.ajic.2013.05.005. Epub 2013 Jul 25.
Hospital-acquired infections are a major patient safety issue. We examined staff members' knowledge, attitudes, reported and observed adherence to guidelines, and perceptions of barriers to use of contact precautions.
A survey and nonparticipant observation study was used to examine knowledge, attitudes, perceptions, and actual behavior of staff on 3 medical/surgical units at a 600-bed Magnet-designated academic medical center (MDAMC) and a 110-bed community medical center (CMC) in the southeastern United States.
Correct knowledge answers ranged from 75% (CMC) to 100% (MDAMC). CMC participants were less likely to perceive time as a barrier (5% vs 25%; P = .050); more MDAMC participants were motivated by supervisors' recognition (87% vs 33%; P = .001). No statistically significant differences existed between groups on reported behaviors. Upon observation, fewer CMC participants demonstrated 4 of 5 evidence-based contact precaution behaviors compared with MDMC participants (P < .001). Hand hygiene before glove application was similarly low at both sites.
Despite a decade of focus on improving patient safety, low adherence to evidence-based practice guidelines for implementation of contact precautions remains. Ongoing efforts are needed both at the system and practitioner level to improve practice adherence.
医院获得性感染是一个主要的患者安全问题。我们调查了医务人员的知识、态度、报告和观察到的对指南的遵守情况，以及对使用接触预防措施的障碍的看法。
在东南部的一家 600 床位的 Magnet 指定的学术医疗中心（MDAMC）和一家 110 床位的社区医疗中心（CMC）的 3 个医疗/外科病房，使用调查和非参与观察研究来检查员工的知识、态度、看法和实际行为。
正确的知识回答范围从 75%（CMC）到 100%（MDAMC）。CMC 的参与者认为时间是一个障碍的可能性较小（5%对 25%；P =.050）；更多的 MDAMC 参与者受到主管认可的激励（87%对 33%；P =.001）。报告的行为在两组之间没有统计学上的显著差异。观察到的结果是，与 MDMC 参与者相比，较少的 CMC 参与者表现出 5 项基于证据的接触预防行为中的 4 项（P <.001）。在这两个地点，戴手套前进行手部卫生的情况也同样较低。
尽管十年来一直关注提高患者安全，但接触预防措施实施的循证实践指南的低遵守率仍然存在。需要在系统和从业人员层面上持续努力，以提高实践的遵守率。
