Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.
BMJ Qual Saf. 2024 Jun 19;33(7):419-431. doi: 10.1136/bmjqs-2023-016230.
Relatively little is known about the cognitive processes of healthcare workers that mediate between performance-shaping factors (eg, workload, time pressure) and adherence to infection prevention and control (IPC) practices. We taxonomised the cognitive work involved in IPC practices and assessed its role in how pathogens spread.
Forty-two registered nurses performed patient care tasks in a standardised high-fidelity simulation. Afterwards, participants watched a video of their simulation and described what they were thinking, which we analysed to obtain frequencies of macrocognitive functions (MCFs) in the context of different IPC practices. Performance in the simulation was the frequency at which participants spread harmless surrogates for pathogens (bacteriophages). Using a tertiary split, participants were categorised into a performance group: high, medium or low. To identify associations between the three variables-performance groups, MCFs and IPC practices-we used multiblock discriminant correspondence analysis (MUDICA).
MUDICA extracted two factors discriminating between performance groups. Factor 1 captured differences between high and medium performers. High performers monitored the situation for contamination events and mitigated risks by applying formal and informal rules or managing their uncertainty, particularly for sterile technique and cleaning. Medium performers engaged more in future-oriented cognition, anticipating contamination events and planning their workflow, across many IPC practices. Factor 2 distinguished the low performers from the medium and high performers who mitigated risks with informal rules and sacrificed IPC practices when managing tradeoffs, all in the context of minimising cross-contamination from physical touch.
To reduce pathogen transmission, new approaches to training IPC (eg, cognitive skills training) and system design are needed. Interventions should help nurses apply their knowledge of IPC fluidly during patient care, prioritising and monitoring situations for risks and deciding how to mitigate risks. Planning IPC into one's workflow is beneficial but may not account for the unpredictability of patient care.
对于医疗工作者在表现形成因素（例如工作量、时间压力）与感染预防和控制（IPC）实践的依从性之间起中介作用的认知过程，我们知之甚少。我们对 IPC 实践中涉及的认知工作进行了分类，并评估了其在病原体传播方式中的作用。
42 名注册护士在标准化高保真模拟中执行患者护理任务。之后，参与者观看了他们模拟的视频，并描述了他们的想法，我们对这些想法进行了分析，以确定不同 IPC 实践中宏观认知功能（MCF）的频率。模拟中的表现是指参与者传播无害病原体替代物（噬菌体）的频率。使用三级划分，参与者被归类为表现良好、中等或差的三个组别。为了确定表现组、MCF 和 IPC 实践这三个变量之间的关联，我们使用了多块判别对应分析（MUDICA）。
MUDICA 提取了两个区分表现组的因素。因素 1 捕捉到了高绩效者和中等绩效者之间的差异。高绩效者监测污染事件，并通过应用正式和非正式规则或管理其不确定性来减轻风险，特别是在无菌技术和清洁方面。中等绩效者更多地从事面向未来的认知，预测污染事件并规划他们的工作流程，涉及许多 IPC 实践。因素 2 将低绩效者与中绩效者和高绩效者区分开来，中绩效者和高绩效者通过非正式规则来减轻风险，并在尽量减少物理接触引起的交叉污染的情况下牺牲 IPC 实践。
为了减少病原体传播，需要新的 IPC 培训方法（例如认知技能培训）和系统设计。干预措施应该帮助护士在患者护理过程中灵活应用他们的 IPC 知识，优先考虑和监测风险情况，并决定如何减轻风险。将 IPC 规划到工作流程中是有益的，但可能无法考虑到患者护理的不可预测性。
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