在大流行期间，养老院实施 COVID-19 感染控制最佳实践。
Implementation of COVID-19 infection control best practices in nursing homes amid the pandemic.
机构信息
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America.
Department of Medicine, Penn State College of Medicine, 90 Hope Drive, Mail Code A145, Hershey, PA, 17033, United States of America.
出版信息
BMC Health Serv Res. 2024 Aug 17;24(1):941. doi: 10.1186/s12913-024-11407-z.
BACKGROUND
The COVID-19 pandemic has claimed around 170,000 lives among nursing home residents and staff in the United States through April 2023. In a cluster randomized controlled trial (RCT) with 136 nursing homes, we delivered training to improve COVID-19 infection control best practices. We sought to assess the implementation of infection control practices in participating nursing homes.
METHODS
Concurrent with the delivery of the RCT (January-November 2021), we surveyed nursing home administrators (NHAs, n = 38) at baseline and 6-month follow-up. Using validated items from the Centers for Disease Control and Prevention (CDC), the surveys inquired about 80 infection control best-practice activities (yes/no). The survey also asked seven scales corresponding to inner setting factors that may have impacted implementation. We assessed changes in infection control practices and inner setting factors between baseline and 6-month follow-up.
RESULTS
Overall, the implementation of 11 best practices changed over time. NHAs reported an increase in the availability of informational materials for residents and families (84% vs. 100%, p = 0.031), the use of alcohol-based hand sanitizer over soap (76% vs. 97%, p = 0.008), and the development of contingency plans for increased postmortem care (53% vs. 82%, p = 0.013). The implementation of four best-practice visitation policies and three communal restrictions decreased between baseline and 6-month follow-up (all p < 0.05). Regarding inner setting factors, only culture stress (perceived strain, stress, and role overload) increased between surveys (mean scores: 3.14 vs. 3.58, p = 0.004).
CONCLUSION
This study was among the first to report changes in implementing COVID-19 infection control best practices in nursing homes amid the pandemic. Culture stress was an important inner setting factor that may have impacted implementation activities.
TRIAL REGISTRATION
NCT04499391 DATE OF REGISTRATION: August 3rd, 2020.
背景
截至 2023 年 4 月，美国的养老院居民和工作人员中约有 17 万人死于 COVID-19。在一项针对 136 家养老院的集群随机对照试验 (RCT) 中，我们提供了培训以改善 COVID-19 感染控制最佳实践。我们旨在评估参与养老院的感染控制实践的实施情况。
方法
在 RCT 实施的同时（2021 年 1 月至 11 月），我们在基线和 6 个月随访时调查了养老院管理员 (NHAs，n=38)。使用疾病控制与预防中心 (CDC) 的验证项目，调查询问了 80 项感染控制最佳实践活动（是/否）。该调查还询问了与可能影响实施的内在环境因素相对应的七个量表。我们评估了感染控制实践和内在环境因素在基线和 6 个月随访之间的变化。
结果
总体而言，11 项最佳实践的实施随时间发生了变化。NHAs 报告说，为居民和家庭提供信息材料的可用性增加（84%对 100%，p=0.031），使用酒精基洗手液而不是肥皂（76%对 97%，p=0.008），以及为增加死后护理制定应急计划（53%对 82%，p=0.013）。四项最佳实践探视政策和三项公共限制的实施在基线和 6 个月随访之间减少（所有 p<0.05）。关于内在环境因素，只有文化压力（感知压力、压力和角色过载）在两次调查之间增加（平均分数：3.14 对 3.58，p=0.004）。
结论
这项研究是在大流行期间报告养老院实施 COVID-19 感染控制最佳实践变化的首批研究之一。文化压力是一个重要的内在环境因素，可能影响实施活动。
试验注册
NCT04499391 注册日期：2020 年 8 月 3 日。
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