University of Paris, INSERM IAME, U1137, Team DeSCID, Paris, France.
Infectious Diseases Department, Central Institute of Valais Hospitals, Sion, Switzerland.
Antimicrob Resist Infect Control. 2022 Feb 23;11(1):42. doi: 10.1186/s13756-022-01074-2.
Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. A significant correlation between alcohol-based handrub consumption (AHRC) and observed HH compliance rates has been established. In France, publicly reported AHRC displayed a large heterogeneity across healthcare facilities (HCFs). We aimed to describe programmes for promoting HH in the top and medium AHRC scorers and to assess factors and drivers leading to a high AHRC score in a panel of French HCFs.
We performed a nationwide qualitative comparative case study based on in-depth semi-structured interviews in 16 HCFs with high, 4-year AHRC scores, and a sample of seven university hospitals (UHs) with medium AHRC scores. Infection Prevention and Control Team (IPC) members (n = 62), quality managers/chief executive officers (n = 23) and frontline workers (n = 6) were interviewed, using a grounded theory approach and an iterative thematic approach.
Ninety-one interviews were performed. There was a large heterogeneity in IPC structures and objectives, with specific patterns associated with high AHRC that were more organisational than technical. Four areas emerged: (1) strong cohesive team structure with supportive and outcome-oriented work attitude, (2) IPC structure within the organization, (3) active support from the institution, (4) leadership and role model. Among high AHRC scorers, a good core IPC organisation, a proactive and flexible management, a frequent presence in the clinical wards, and working in a constructive safety climate were prominent.
We highlighted that IPC structure and activity is heterogeneous, with organisational and behavioural characteristics associated with high AHRC score. Beyond technical challenge, our work underlines the importance of strong structure of the IPC and behavioural approaches in implementing key IPC programmes.
手部卫生（HH）是预防医源性感染的最重要措施。已经证实，酒精擦手液消耗（AHRC）与观察到的 HH 依从率之间存在显著相关性。在法国，报告的 AHRC 在医疗机构（HCFs）之间存在很大的异质性。我们旨在描述在 AHRC 得分较高和中等的 HCFs 中促进 HH 的方案，并评估导致法国 HCFs 中 AHRC 得分较高的因素和驱动因素。
我们进行了一项全国范围的定性比较案例研究，对 16 家 AHRC 得分高（4 年）的 HCF 和 7 家中等 AHRC 得分的大学医院（UH）样本进行了深入的半结构化访谈。采用扎根理论方法和迭代主题方法，对感染预防和控制团队（IPC）成员（n=62）、质量经理/首席执行官（n=23）和一线工作人员（n=6）进行了访谈。
共进行了 91 次访谈。IPC 结构和目标存在很大的异质性，与 AHRC 较高相关的特定模式更具组织性而非技术性。有四个领域出现：（1）具有支持性和以结果为导向的工作态度的强大凝聚力团队结构，（2）组织内的 IPC 结构，（3）机构的积极支持，（4）领导力和榜样作用。在 AHRC 得分较高的人群中，良好的核心 IPC 组织、积极主动和灵活的管理、频繁出现在临床病房以及在建设性的安全氛围中工作是突出的。
我们强调 IPC 结构和活动是异质的，与 AHRC 得分较高相关的是组织和行为特征。除了技术挑战之外，我们的工作还强调了 IPC 结构和行为方法在实施关键 IPC 方案中的重要性。
