基于框架的结构化方法在实施中的效果：研究医院清洁有效方法（REACH）试验。
Effectiveness of a structured, framework-based approach to implementation: the Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial.
机构信息
School of Public Health, University of Queensland, 288 Herston Road, Herston, Queensland, 4006, Australia.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
出版信息
Antimicrob Resist Infect Control. 2020 Feb 18;9(1):35. doi: 10.1186/s13756-020-0694-0.
BACKGROUND
Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning.
DESIGN/METHODS: The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure).
RESULTS
We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully.
CONCLUSION
Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change.
TRIAL REGISTRATION
Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015.
背景
在医院清洁中实施可持续的实践变革已被证明是减少医疗相关感染的持续挑战。本研究的目的是开发一种基于可靠框架的方法，以实施和定量评估医院清洁中基于证据的实践变革的实施情况。
设计/方法：REACH 试验是一项实用的、阶梯式随机试验，研究了在 2016 年至 2017 年期间在 11 家澳大利亚医院实施的环境清洁包。我们采用了一种结构化的多步骤方法，对综合促进卫生服务研究实施（i-PARIHS）框架进行了改编，以支持在 11 个不同且复杂的环境中对清洁包干预措施进行严格和定制的实施。为了评估该策略的有效性，我们检查了干预后清洁包的对齐程度，该对齐程度计算为得分（实施措施），并使用紫外线（UV）凝胶标记收集了清洁性能审核数据（结果衡量标准）。
结果
我们成功地实施了该捆绑包，并观察到清洁实践和性能的改善，无论医院规模、干预持续时间以及基线时的员工和组织准备情况等背景因素如何。基线时捆绑包的对齐程度评分与清洁性能之间存在正相关关系。随着干预的持续，这种相关性减弱，因为基线得分较低的医院能够成功实施实践变革。
结论
使用结构化的基于框架的方法可以在不同的环境中进行实用和成功的临床试验实施，并有助于对实践变革进行定量评估。
试验注册
澳大利亚新西兰临床试验注册中心 ACTRN12615000325505，于 2015 年 9 月 4 日注册。
Zotero 插件