改善神经重症监护病房循证沐浴实践的实施策略
Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU.
作者信息
Reynolds Staci Sue, Sova Chris, McNalty Bridget, Lambert Suzanne, Granger Bradi
机构信息
Duke University Hospital (Drs Reynolds and Granger, Mr Sova, and Mss McNalty and Lambert) and Duke University School of Nursing (Drs Reynolds and Granger), Durham, North Carolina.
出版信息
J Nurs Care Qual. 2019 Apr/Jun;34(2):133-138. doi: 10.1097/NCQ.0000000000000347.
BACKGROUND
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful.
PURPOSE
Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU.
METHODS
An observational pre-/postdesign was used.
RESULTS
Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing.
CONCLUSIONS
This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.
背景
有证据支持使用葡萄糖酸氯己定（CHG）擦浴布进行每日擦浴，以减少可预防的医院获得性中心静脉导管相关血流感染（CLABSI）。然而，这种做法的实施并不一致。文献支持采用多方面策略来促进实施，但对于哪些策略最为成功尚存在差距。
目的
以格罗尔和温辛实施模型为指导，本研究的目的是确定使用量身定制的多方面策略是否会改善每日CHG擦浴的实施情况，并降低大型神经重症监护病房（ICU）的CLABSI发生率。
方法
采用观察性前后设计。
结果
实施后，感染率下降（P = 0.031）。在所有过程指标中也观察到了具有统计学意义的改善：擦浴记录、护理知识以及对CHG擦浴重要性的认知。
结论
本研究通过使用量身定制的多方面实施策略，增加基于证据的护理措施在感染预防实践中的应用，有助于缩小研究与实践之间的差距。
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