Lacey Gerard, Showstark Mary, Van Rhee James
School of Computer Science and Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
Physician Assistant Online Program, Yale School of Medicine, New Haven, CT, USA.
J Med Educ Curric Dev. 2019 Aug 5;6:2382120519867681. doi: 10.1177/2382120519867681. eCollection 2019 Jan-Dec.
Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.
A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire.
The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed ( = 0.79, < .001) and the total time spent training ( = 0.75, < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.
This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care-associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.
手部卫生对患者安全至关重要，但手部卫生在数量和质量方面的表现往往不尽人意。对于其他临床技能，培训至熟练掌握是常见做法，但文献中尚未报道基于熟练程度的手部卫生培训项目。本研究制定了一项基于熟练程度的培训项目，以根据世界卫生组织（WHO）的指南提高手部卫生质量，并评估达到熟练所需的培训量。该培训是作为医师助理在线项目学生为期5天入职培训的一部分进行的。
共有42名学生在5天内使用模拟器客观测量手部卫生技术。当学生在不到42秒的时间内展示WHO技术的所有6个步骤时，即达到熟练程度。学生们还完成了干预后问卷调查。
平均每次培训时长为2.5分钟，包括4.5次手部卫生练习。平均每位学生完成5次培训（每天1次），总计17分钟。共有40%（17名）学生在5天内达到熟练程度。熟练程度与完成的培训练习次数（r = 0.79，P < .001）和总培训时间（r = 0.75，P < .001）密切相关。线性回归预测，需要32次手部卫生练习或总计23分钟的培训才能达到熟练程度。
这是第一项为手部卫生质量制定培训至熟练掌握项目并估计所需培训量的研究。鉴于手部卫生质量对预防医疗保健相关感染（HAIs）的重要性，医学教育项目应考虑对手部卫生技术采用基于熟练程度的培训。
