Mindful Hand Hygiene to Reduce Infections Among Veterans While Enhancing ProviderWell-Being

注意手部卫生，减少退伍军人的感染，同时提高提供者的福祉

• 批准号: 10308157
• 负责人: Michael Todd Greene
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308157
• 关键词: Address; Adherence; Adopted; Anxiety; Area; Attention; Awareness; COVID-19 pandemic; Caring; Client satisfaction; Clinical; Cognitive; Control Groups; Decision Making; Disease Outbreaks; Education; Elements; Ensure; Environment; Evidence based practice; Face; Fatigue; Focus Groups; Future; Goals; Hand; Health Personnel; Health system; Healthcare; Healthcare Systems; Hospital Administration; Hospitals; Human Resources; Hygiene; Infection; Infection prevention; Intervention; Interview; Judgment; Light; Malpractice; Measures; Medical center; Mental Depression; Methodology; Methods; Nurses; Outcome; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Physicians; Pilot Projects; Provider; Psyche structure; Quality of Care; Quality of life; Randomized; Regulation; Reporting; Risk; Safety; Site; Stress; Structure; Symptoms; Techniques; Testing; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; Workload; adherence rate; burnout; care providers; career; clinical practice; cost; disease transmission; effectiveness evaluation; experience; falls; health care service organization; health care settings; healthcare-associated infections; improved; innovation; member; mindfulness; mindfulness intervention; multi-component intervention; novel; patient safety; prevent; provider adherence; psychological distress; success; tool; treatment arm

Background: More and more providers face cumulative stress and burdens arising from increasing regulations, administrative and clerical duties, clinical workloads, malpractice lawsuits, and less time with patients. As a result, stress, fatigue, psychological distress, depression, burnout, and career dissatisfaction among providers are prevalent. In addition to impacting providers directly, poor well-being can negatively impact healthcare organizations and reduce quality of care, patient safety and patient satisfaction. Additionally, provider burnout, stress, and workload have been associated with poorer hand hygiene adherence, which can increase the risk of healthcare-associated infection (HAI). Hand hygiene is a key element of preventing HAI, yet maintaining healthcare provider adherence to this basic practice remains challenging. Achieving optimal hand hygiene adherence requires minimizing cognitive biases, such as perceived low odds of spreading infections by not properly performing hand hygiene. Unfortunately, cognitive bias is a known barrier to clinician decision-making. Mindfulness is an approach that can help clinicians shed preconceived biases through nonjudgmental awareness and more broadly facilitate improvements in patient safety. Significance: A hand hygiene-based mindfulness intervention targeted at Veterans Health Administration (VHA) providers could improve hand hygiene practices and thereby enhance patient outcomes. Additionally, incorporating brief mindfulness practices during moments of hand hygiene has the potential to directly improve provider well-being. Innovation and Impact: While targeted interventions and bundled approaches to improve hand hygiene adherence and reduce HAI have been implemented, interventions incorporating introspective techniques, such as mindfulness, are limited. In a recent single-site pilot study, team members of this proposed study found that a brief mindfulness intervention improved hand hygiene and mindful attention among physicians. The proposed study will expand on this pilot work by more broadly testing the hand hygiene-based mindfulness intervention with both physicians and nurses, and by including a specific focus on provider well-being. The goal is to optimize provider hand hygiene adherence, improve provider well-being and enhance the quality and safety of care delivered to Veterans. Specific Aims: We have three specific aims: 1) To evaluate the effectiveness of a hand hygiene-based mindfulness intervention on provider hand hygiene adherence, duration, and perceptions. 2) To evaluate the effectiveness of a hand hygiene-based mindfulness intervention on measures of provider mindfulness and well-being. 3) To identify the barriers, facilitators, and perceptions of a hand hygiene-based mindfulness intervention in the hospital. Methodology: We will conduct a randomized controlled mixed-methods trial at 2 diverse VHA hospitals. Physicians and nurses randomized to the intervention arm will receive mindfulness education and tools to prompt mindfulness during hand hygiene. Measures of hand hygiene (adherence, duration, and perceptions) and measures of provider mindfulness and well-being will be collected and compared between the intervention and control groups. Next Steps/Implementation: We will work with our proposed partners to review our study findings, modify our intervention as needed, and disseminate our findings through the various partnership channels. At the conclusion of this project, we will have a hand hygiene-based mindfulness intervention package that we can subsequently work to deploy more broadly across VHA hospitals to improve the safety of Veterans and the well-being of those providing their healthcare.

背景：越来越多的提供商面临累积压力和因增加而产生的负担 法规，行政和文书职责，临床工作负载，渎职诉讼以及更少的时间 患者。结果，压力，疲劳，心理困扰，沮丧，倦怠和职业不满意 在提供者中，普遍存在。除了直接影响提供者外，良好的幸福感可能会负面 影响医疗保健组织并降低护理质量，患者安全和患者满意度。此外， 提供者的倦怠，压力和工作量与较差的手卫生依从性有关，这可以 增加医疗保健相关感染（HAI）的风险。手卫生是预防HAI的关键要素 然而，维持医疗保健提供者遵守这种基本实践仍然具有挑战性。实现最佳 手卫生的依从性需要最大程度地减少认知偏见，例如感知到的传播几率 通过无法正确执行手动卫生的感染。不幸的是，认知偏见是临床医生的已知障碍 决策。正念是一种可以帮助临床医生通过先入为主的偏见的方法 非判断性意识，更广泛地促进了患者安全的改善。 意义：针对退伍军人卫生管理的基于手卫生的正念干预 （VHA）提供者可以改善手动卫生实践，从而改善患者的预后。此外， 在卫生时刻结合简短的正念练习有可能直接改善 提供者的福祉。 创新和影响：有针对性的干预措施和捆绑的方法以改善手动卫生 已经实施了依从性和减少HAI，包括内省技术的干预措施，例如 正念是有限的。在最近的一项单点试点研究中，这项拟议研究的团队成员发现 简短的正念干预改善了医生的手卫生和正念的关注。提议 研究将通过更广泛地测试基于手动卫生的正念干预来扩展这项飞行员工作 与医生和护士一起，并包括对提供商福祉的特定关注。目标是 优化提供商的手卫生依从性，改善提供商的福祉并提高质量和安全性 护理交付给退伍军人。 具体目的：我们有三个具体目的：1）评估基于卫生的有效性 对提供者手动卫生的遵守，持续时间和看法的正念干预。 2）评估 基于卫生的正念干预提供者正念和 福利。 3）确定对基于卫生的正念的障碍，促进者和看法 干预医院。 方法论：我们将在两家VHA医院进行随机对照混合方法试验。 随机分配给干预部门的医师和护士将获得正念教育和工具 卫生过程中迅速的正念。手卫生的度量（依从性，持续时间和感知） 在干预措施之间将收集和比较提供者的正念和福祉的措施 和对照组。 下一步/实施：我们将与建议的合作伙伴一起审查我们的研究结果，修改我们的 根据需要进行干预，并通过各种合伙渠道传播我们的发现。在 结论该项目，我们将拥有一个基于手动卫生的正念干预软件包 随后努力在VHA医院进行更广泛的部署，以提高退伍军人的安全和 提供医疗保健的人的福祉。