科特的八步变革模型用于提高重症监护病房的手卫生依从性：一项为期41个月的前瞻性纵向质量改进研究。
Kotter's 8-step change model to improve hand hygiene compliance in intensive care unit: A 41-month prospective longitudinal quality improvement study.
作者信息
Hu Fen, Wang Ying, Cao Rui, Hu Chang, Feng Bilong, Li Jin, Ding Xinbo, Ma Jing, Li Huilin, Wang Pei, Xu Ying, Xu Dandan, Pei Juanjuan, Zhu Xiaoping, Chen Jie, Liang Ke, Peng Zhiyong, Kashani Kianoush, Hu Bo, Yuan Yufeng
机构信息
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Clinical Research Center for Critical Care Medicine, Wuhan, Hubei, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei, China.
Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei, China.
出版信息
Intensive Crit Care Nurs. 2025 Apr;87:103877. doi: 10.1016/j.iccn.2024.103877. Epub 2024 Nov 18.
BACKGROUND
Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter's Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU).
METHODS
KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).
RESULTS
This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %-50.83 %) to 87.75 % (95 % CI, 85.53 %-89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 ‰-3.53 ‰) and CAUTI (0.96 ‰-4.26 ‰) remained consistently low.
CONCLUSION
Utilizing KCM systematically alters healthcare providers' perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel.
IMPLICATIONS FOR CLINICAL PRACTICE
The Kotter's change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.
背景
尽管有大量研究评估了捆绑式干预措施以提高手卫生依从性（HHC），但依从率仍维持在不理想的水平。我们的目标是运用科特变革模型（KCM）来提高HHC，并在重症监护病房（ICU）的医务人员中进行全面的过程评估。
方法
2018年3月至2021年8月期间，在武汉大学中南医院ICU实施KCM，并对HHC进行了41个月的纵向监测。主要结局关注HHC的月度绝对变化。次要结局包括不同阶段的HHC特征、不同手卫生时机和职业的HHC变化趋势、中心静脉导管相关血流感染（CLABSI）和导尿管相关尿路感染（CAUTI）的季度发生率。
结果
本研究包括20222次手卫生行为和24195次机会。总体HHC为83.58%（95%CI，83.11%-84.04%）。实施KCM后，HHC从35.71%（95%CI，22.99%-50.83%）飙升至87.75%（95%CI，85.53%-89.67%），增幅达145.73%。HHC增长最快的是在接触患者后，从35.29%升至89.8%。尽管每年患者数量增加且治疗复杂性提高，但CLABSI的季度发生率（0‰-3.53‰）和CAUTI的季度发生率（0.96‰-4.26‰）一直保持在较低水平。
结论
系统地运用KCM改变了医护人员对手卫生的认知，营造了一种倡导并维持ICU人员提高HHC的环境。
对临床实践的启示
科特变革模型可以成为医疗机构系统地改善和维持医护人员手卫生依从性的有效框架，进而有助于减少医疗相关感染。
Zotero 插件