University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
PLoS One. 2021 Oct 28;16(10):e0258662. doi: 10.1371/journal.pone.0258662. eCollection 2021.
We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.
我们旨在应用患者安全系统工程倡议 (SEIPS) 模型，以提高世界卫生组织 (WHO) 手卫生 (HH) 指南在医疗保健系统中的有效性和可持续性。我们的横断面、混合方法研究于 2018 年 11 月至 2020 年 8 月在埃塞俄比亚吉姆马的一家三级保健医院吉姆马大学医学中心 (JUMC) 进行，包括三个阶段：基线评估、干预和随访评估。我们进行了问卷调查，以了解 HH 知识和态度，进行了访谈以确定 SEIPS 框架内的 HH 障碍和促进因素，并观察了 JUMC 卫生保健工作者 (HCWs) 执行 WHO 的 HH 五个时刻。然后，我们根据 WHO 指南和基线评估的结果实施了 HH 干预措施。随后在新冠肺炎大流行期间进行了 HH 随访观察。250 名 HCWs 完成了问卷调查，平均知识得分 61.4%，态度得分表明他们同意 HH 可促进患者安全。访谈参与者提到了 HH 的多个障碍，包括 HH 材料的短缺和位置、培训不足、感染预防控制团队的存在、以及高工作量。我们发现基线 HH 合规率为 9.4%，随访合规率为 72.1%。与基线相比，随访时的合规率大幅提高，这可能是由于我们的 HH 干预措施和新冠肺炎疫情的影响。尽管 HH 知识水平较低，但 HCWs 仍表现出对患者安全的积极性。利用 SEIPS 模型有助于确定特定机构的障碍，为超出 WHO 指南的针对性干预措施提供信息，以提高 HH 工作的有效性和可持续性。
