探索长期护理机构中手部卫生依从性的决定因素：使用 Flottorp 实践决定因素综合清单的定性研究。
Exploring determinants of hand hygiene compliance in LTCFs: a qualitative study using Flottorps' integrated checklist of determinants of practice.
机构信息
Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
出版信息
Antimicrob Resist Infect Control. 2021 Jan 14;10(1):14. doi: 10.1186/s13756-021-00882-2.
BACKGROUND
Elderly residents in long-term care facilities (LTCFs) are vulnerable to healthcare-associated infections. Although hand hygiene is a leading measure for preventing infection, the compliance of healthcare workers is low. The aim of this study is to identify determinants that influence hand hygiene compliance of nursing staff in LTCFs. This information on determinants can eventually be used to develop a tailored implementation strategy for LTCFs.
METHODS
This is an explorative, descriptive study using qualitative methods. We performed semi-structured focus group discussions with 31 nurses and nurse assistants from five Dutch LTCFs. Our focus group discussions continued until no new information could be identified from the data. We used Flottorps' comprehensive checklist for identifying determinants of practice (the TICD checklist) to guide data collection and analysis. The audiotapes were transcribed verbatim and two authors independently analysed the transcripts with Atlas.ti software.
RESULTS
LTCFs for the elderly have setting specific determinants that are decisive in explaining hand hygiene compliance. Most of these determinants are related to the residents with whom nurses build close relationships and for whom they want to create a homelike atmosphere. Residents can complicate the provision of care with unpredictable behaviour, being unwilling to receive care or use shared facilities. Our study also discovered setting-transcending determinants related to knowledge, professional interactions, guidelines, and incentives/resources.
CONCLUSIONS
Nurses in LTCFs are constantly pursuing a balance between working hygienically, responding adequately to acute care needs, and maintaining a homelike environment for their residents. As a result, setting-specific determinants affect hand hygiene compliance, as do the known determinants that are important in other care settings. To improve compliance in LTCFs, interventions should be selected on a theoretical base while linking these determinants to change interventions.
TRIAL REGISTRATION
Registration number 50-53000-98-113, Compliance With Hand Hygiene in Nursing Homes: Go for a Sustainable Effect (CHANGE) on ClinicalTrials.gov. Date of registration 28-6-2016.
背景
长期护理机构（LTCF）中的老年居民易发生医疗保健相关感染。尽管手部卫生是预防感染的主要措施，但医护人员的依从性较低。本研究旨在确定影响 LTCF 护理人员手部卫生依从性的决定因素。这些决定因素的信息最终可用于为 LTCF 制定有针对性的实施策略。
方法
这是一项使用定性方法进行的探索性、描述性研究。我们对来自荷兰 5 家 LTCF 的 31 名护士和护士助理进行了半结构式焦点小组讨论。我们的焦点小组讨论持续进行，直到从数据中无法再识别出新的信息。我们使用 Flottorp 的全面实践决定因素清单（TICD 清单）来指导数据收集和分析。录音带被逐字转录，两位作者使用 Atlas.ti 软件独立分析了转录本。
结果
老年人长期护理机构具有决定其手部卫生依从性的特定环境决定因素。这些决定因素大多与护士建立亲密关系的居民有关，护士希望为他们营造一个类似家庭的氛围。居民的不可预测行为、不愿意接受护理或使用共享设施会使护理变得复杂。我们的研究还发现了与知识、专业互动、指南和激励/资源相关的超越环境的决定因素。
结论
LTCF 中的护士一直在努力在保持卫生、充分应对急性护理需求以及为居民营造家庭般的环境之间取得平衡。因此，特定环境的决定因素会影响手部卫生的依从性，而在其他护理环境中很重要的已知决定因素也是如此。为了提高 LTCF 中的依从性，干预措施应在选择基于理论的同时将这些决定因素与改变干预措施联系起来。
试验注册
注册号 50-53000-98-113，在 ClinicalTrials.gov 上的标题为《改善护理院临床医护人员手部卫生依从性的可持续干预（CHANGE）》。注册日期 2016 年 6 月 28 日。
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