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医療関連感染症と感染管理の実践に関する医療従事者の視点：サウジアラビアのアシール地域におけるビデオ反射的エスノグラフィー研究
Healthcare workers' perspectives on healthcare-associated infections and infection control practices: a video-reflexive ethnography study in the Asir region of Saudi Arabia.
PMID: 32678049 DOI: 10.1186/s13756-020-00756-z.
抄録
背景:
医療関連感染症（HAI）は世界的な公衆衛生問題です。サウジアラビアのビジョン2030の実現に向けて、HAI管理を通じた予防医療の推進が重要な課題となっている。本研究では、サウジアラビアの第三次医療従事者（HCW）のHAIと感染対策に関する視点を探る。
BACKGROUND: Healthcare-associated infections (HAIs) are a global public health problem. For the fulfillment of Saudi Arabia's Vision 2030, the promotion of preventive care medicine through HAI management is a crucial issue. This study explores the perspectives of Saudi tertiary healthcare workers (HCWs) on HAIs and infection control measures.
方法:
量的データを評価し、HCW の HAI に関する知識、感染管理対策に対する態度と実践を明らかにした。40 人の医師と看護師から質的データを収集するために、半構造化インタビューを使用した。インタビューは音声録音され、口頭で書き起こした。さらに、病棟や集中治療室での日常的な無菌処置の様子をビデオ撮影し、その映像を感染管理チームとビデオの関係者で議論した。この議論はビデオ撮影され、記録された。インタビューデータとビデオの反射的な議論の両方をテーマ別分析を用いて分析した。量的データは、クルスカル・ワリス検定とロジスティック回帰分析を用いて分析した。
METHODS: Quantitative data were assessed to determine HCWs' knowledge of HAI and their attitudes towards and practice of infection control measures. Semi-structured interviews were used to collect qualitative data from 40 doctors and nurses. The interviews were audio-recorded and transcribed verbatim. Further, routine sterile procedures in the wards and intensive care units were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was videographed and transcribed. Both interview data and reflective discussion of the video were analysed using thematic analysis. The quantitative data were analysed using the Kruskal-Wallis test and logistic regression analysis.
結果:
RESULTS: Kruskal-Wallis test revealed no difference in mean knowledge, attitude, or practice scores between nurses/ doctors or the genders. There was a significant difference in knowledge score and practice scores between the Intensive care unit & the Paediatric ward /infection control department with the maximum scores in knowledge and practice among participants from the intensive care unit. Logistic regression analysis for dependent variables (knowledge and attitude) and independent variables like age, gender, designation, and departments was not significant. The qualitative data yielded four themes: knowledge of HAI and infection control, infection control measures in practice, a shortfall in infection control measures and HAI, and required implementation. Video-reflexive ethnography (VRE) revealed lapses in handwashing practice and proper usage of personal protective equipment (PPE), especially surgical masks.
結論:
医療・看護学校での研修プログラムの早期導入や、無菌処置中の適切な感染管理方法をビデオで実演することは、HCW にとって非常に有益であろう。サウジアラビアのこの地域で中東呼吸器症候群コロナウイルスが発生した原因として考えられるのは、PPE の使用方法の誤りである。すべての HCW を対象とした集中的な訓練プログラム、厳格な警戒プロトコル、および行動と実践を変えようとする意欲があれば、アウトブレイクの拡大に大きな利益をもたらすであろう。
CONCLUSION: Early introduction of training programmes in medical and nursing schools and video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to HCWs. A possible reason for the outbreak of Middle East Respiratory Syndrome coronavirus in this part of Saudi Arabia could be a lapse in PPE usage. Intensive training programs for all the HCWs, strict vigilant protocols, and a willingness to change behaviour and practice, will significantly benefit the spread of outbreaks.