1Department of Infectious Diseases and Hospital Epidemiology,University Hospital Zurich,University of Zurich,Zurich,Switzerland.
2Institute for Patient Safety,University Hospital Bonn,Bonn,Germany.
Infect Control Hosp Epidemiol. 2018 Mar;39(3):272-279. doi: 10.1017/ice.2017.326.
OBJECTIVE In this study, we sought to establish a comprehensive inventory of infectious risk moments (IRMs), defined as seemingly innocuous yet frequently occurring care manipulations potentially resulting in transfer of pathogens to patients. We also aimed to develop and employ an observational taxonomy to quantify the frequency and nature of IRMs in acute-care settings. DESIGN Prospective observational study and establishment of observational taxonomy. SETTING Intensive care unit, general medical ward, and emergency ward of a university-affiliated hospital. PARTICIPANTS Healthcare workers (HCWs) METHODS Exploratory observations were conducted to identify IRMs, which were coded based on the surfaces involved in the transmission pathway to establish a structured taxonomy. Structured observations were performed using this taxonomy to quantify IRMs in all 3 settings. RESULTS Following 129.17 hours of exploratory observations, identified IRMs involved HCW hands, gloves, care devices, mobile objects, and HCW clothing and accessories. A structured taxonomy called INFORM (INFectiOus Risk Moment) was established to classify each IRM according to the source, vector, and endpoint of potential pathogen transfer. We observed 1,138 IRMs during 53.77 hours of structured observations (31.25 active care hours) for an average foundation of 42.8 IRMs per active care hour overall, and average densities of 34.9, 36.8, and 56.3 IRMs in the intensive care, medical, and emergency wards, respectively. CONCLUSIONS Hands and gloves remain among the most important contributors to the transfer of pathogens within the healthcare setting, but medical devices, mobile objects, invasive devices, and HCW clothing and accessories may also contribute to patient colonization and/or infection. The INFORM observational taxonomy and IRM inventory presented may benefit clinical risk assessment, training and education, and future research. Infect Control Hosp Epidemiol 2018;39:272-279.
目的 在本研究中，我们旨在建立一个全面的感染风险时刻（IRM）清单，将其定义为看似无害但经常发生的护理操作，这些操作可能导致病原体转移到患者身上。我们还旨在开发和采用观察分类法来量化急性护理环境中 IRM 的频率和性质。
设计 前瞻性观察研究和观察分类法的建立。
地点 一所大学附属医院的重症监护病房、普通内科病房和急诊病房。
参与者 医护人员（HCWs）
方法 进行探索性观察以确定 IRM，根据涉及传播途径的表面对其进行编码，以建立结构化分类法。使用该分类法对所有 3 种环境中的 IRM 进行结构化观察。
结果 在进行了 129.17 小时的探索性观察后，确定的 IRM 涉及 HCW 的手、手套、护理设备、移动物体以及 HCW 的衣物和配饰。建立了一个名为 INFORM（INFectiOus Risk Moment）的结构化分类法，根据潜在病原体转移的来源、载体和终点对每个 IRM 进行分类。我们在 53.77 小时的结构化观察（31.25 小时的主动护理时间）中观察到 1138 个 IRM，总的平均每个主动护理时间有 42.8 个 IRM，在重症监护病房、内科病房和急诊病房中的平均密度分别为 34.9、36.8 和 56.3 个 IRM。
结论 在医疗机构内，手和手套仍然是病原体转移的最重要因素，但医疗器械、移动物体、侵入性器械以及 HCW 的衣物和配饰也可能导致患者定植和/或感染。所提出的 INFORM 观察分类法和 IRM 清单可能有助于临床风险评估、培训和教育以及未来的研究。
传染病控制与医院流行病学 2018 年；39 期：272-279
