Koo Evonne, McNamara Sara, Lansing Bonnie, Olmsted Russell N, Rye Ruth Anne, Fitzgerald Thomas, Mody Lona
Divisions of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, MI.
Infection Prevention and Control, Trinity Health, Livonia, MI.
Am J Infect Control. 2016 Nov 1;44(11):1241-1246. doi: 10.1016/j.ajic.2016.03.016. Epub 2016 Aug 20.
The purpose of this study was to assess effectiveness of an interactive educational program in increasing knowledge of key infection prevention and control (IPC) principles with emphasis on indwelling device care, hand hygiene, and multidrug-resistant organisms (MDROs) among nursing home (NH) health care personnel (HCP).
We conducted a multimodal randomized controlled study involving HCP at 12 NHs. Ten comprehensive and interactive modules covered common IPC topics. We compared intervention and control scores to assess differences in pretest scores as a result of field interventions, pre- and post-test scores to assess knowledge gain, and magnitude of knowledge gain based on job categories.
We conducted over 200 in-services across 10 topics at six intervention sites over 36 months. There were 4,962 tests returned over the course of the study, ranging from 389-633 per module. Participants were mostly female certified nursing assistants (CNAs). Score improvement was highest for modules emphasizing hand hygiene, urinary catheter care, and MDROs (15.6%, 15.9%, and 22.0%, respectively). After adjusting for cluster study design, knowledge scores were significantly higher after each educational module, suggesting the education delivery method was effective. When compared with CNAs, nursing and rehabilitation personnel scored significantly higher in their knowledge tests.
Our intervention significantly improved IPC knowledge in HCP, especially for those involved in direct patient care. This increase in knowledge along with preemptive barrier precautions and active surveillance has enhanced resident safety by reducing MDROs and infections in high-risk NH residents.
本研究的目的是评估一项交互式教育计划在增加养老院医护人员对关键感染预防与控制（IPC）原则的了解方面的有效性，重点是留置设备护理、手卫生和多重耐药菌（MDROs）。
我们在12家养老院对医护人员进行了一项多模式随机对照研究。十个全面且交互式的模块涵盖了常见的IPC主题。我们比较了干预组和对照组的分数，以评估现场干预导致的预测试分数差异、预测试和后测试分数以评估知识增益，以及基于工作类别的知识增益幅度。
在36个月内，我们在六个干预地点就10个主题开展了200多次在职培训。在研究过程中，共收回4962份测试卷，每个模块的测试卷数量从389份到633份不等。参与者大多是女性注册护理助理（CNA）。强调手卫生、导尿管护理和MDROs的模块分数提高幅度最高（分别为15.6%、15.9%和22.0%）。在对整群研究设计进行调整后，每个教育模块后的知识分数显著更高，表明教育交付方法是有效的。与CNA相比，护理和康复人员在知识测试中的得分显著更高。
我们的干预显著提高了医护人员的IPC知识，特别是对于那些参与直接患者护理的人员。这种知识的增加以及预防性屏障预防措施和主动监测通过减少高危养老院居民中的MDROs和感染，提高了居民的安全性。
