Kettelhut Valeriya, Van Schooneveld Trevor, McClay James, Fruhling Ann, Dempsey Kathryn
UNMC, Omaha, NE, USA.
University of Nebraska at Omaha, Omaha, NE USA.
J Infect Prev. 2017 Mar;18(2):72-77. doi: 10.1177/1757177416667288. Epub 2016 Sep 19.
Unreliable compliance with infection prevention procedures necessitates an analysis of contributing factors.
A retrospective study explored utility of 3236 nursing hygiene notes in the electronic healthcare record system (EHR). This 2012-2013 study identified defects in the chlorhexidine (CHG) bathing practice for a hospital unit.
The overall compliance with CHG bathing was 22.99%. Patients with length of stay less than 3 days, in most cases, did not have documentation for CHG bathing. Patient refusal to bathe was the most prevalent documented reason (66%) of the unsuccessful initial and repeated offers to bathe. The regular staff were statistically less successful in convincing patients to bathe. The 1455 notes produced by the regular staff (n = 10) demonstrated a significantly higher failure rate (56.08%) to execute this procedure in comparison with 1770 notes documented by the 246 temporary staff (31.19% failure rate) ( value <0.001) .
This analysis yielded three main insights: lack of the CHG documentation in a large number of short admissions; inconsistent use of CHG baths; and presence of workarounds due to patient refusals to bathe. The study concluded that EHR structured and unstructured data can unlock the opportunity for identifying hidden defects and inform decision-makers about the need for change.
对感染预防程序的依从性不可靠，因此有必要分析促成因素。
一项回顾性研究探讨了电子健康记录系统（EHR）中3236份护理卫生记录的效用。这项2012 - 2013年的研究发现了某医院科室洗必泰（CHG）沐浴操作中的缺陷。
CHG沐浴的总体依从率为22.99%。住院时间少于3天的患者在大多数情况下没有CHG沐浴的记录。患者拒绝沐浴是首次及反复提出沐浴建议未成功的最常见记录原因（66%）。从统计学角度来看，正式员工说服患者沐浴的成功率较低。正式员工（n = 10）记录的1455份记录显示，执行该程序的失败率（56.08%）显著高于246名临时员工记录的1770份记录（失败率31.19%）（ 值<0.001）。
该分析得出了三个主要结论：大量短期住院患者缺乏CHG记录；CHG沐浴的使用不一致；以及由于患者拒绝沐浴而存在变通方法。该研究得出结论，EHR的结构化和非结构化数据能够为识别潜在缺陷提供机会，并让决策者了解变革的必要性。
