The Model Of Healthcare-associated Infection Control In Primary Care Institutions

[Purpose] Exploring the model and to analyze the influencing factors of healthcare-associated infection control in primary care institutions.[Methods] Literature review was used to establish the theory frame of the model of healthcare-associated infection control in primary care institutions,and define the elements concept of the model.the content domain specification and initial pool of instrument items were developed through literature reviews,all the items in the instrument were reviewed and checked for content validity by experts.Based on the principle of cluster random sampling,268 primary care institutions was surveyed,who came from Hubei Province.Based on model development strategy,structural equation model(SEM)was used to test the hypothesized model,and the model fitting exponents RMSEA,CFI,TLI,and WRMR(the fitting index standard RMSEA<0.08;CFI>0.95;TLI> 0.95;WRMR <1 / ? 1)Test model fit.Path analysis was used to evaluate the effectiveness of the model of healthcare-associated infection control in primary care institutions.The multi-indicator and multi-factor model was used to analyze the influencing factors of the model of healthcare-associated infection control in primary care institutions.[Results] 1.The theory frame of the model of healthcare-associated infection control in primary care institutions was established and consisted of four constructs: organizationa,management,training and surveillance.2.The final instrument consisted of four constructs and 24 items was developed.The' survey data revealed that the Cronbach's alpha was higher than 0.85,and indicated that the instrument has a perfect reliability and validity.3.All the hypotheses in this study were tested by SEM,and the model fit indexes were aligned with the theories and to be an acceptable model statistically.The results support that the organization has significantly effects on management,training and surveillance(r=0.311,p<0.01;r=0.365,p<0.01;r=0.103,p=0.047).The results also indicated that significant relationships exist between management and training(r=0.486,p<0.01),and the management and training have significantly effects on surveillance(r=0.315,p<0.012;r=0.219,p<0.048).No significant effect of the management on training was found.4.Used path analysis,evaluate the effectiveness of the model of healthcare-associated infection control in primary care institutions,and select the compliance of hand hygiene and safe injection by medical staff as the outcome variable of the effect evaluation.The model fits well.The results showed that only the management had significantly effects on the compliance of hand hygiene among medical staff(r=0.362,p<0.01).The organizationa,management and training had significantly effects on the compliance of safety injection among medical staff(r=0.176,p=0.026;r=0.445,p<0.01;r=0.388,p<0.01).5.The multi-indicator and multi-factor model was used to analyze the impact of the scale of the model of healthcare-associated infection control in primary care institutions.The results show that there are significant influences on the two key constructs in the management and training of the model of healthcare-associated infection control in primary care institutions in the number of physicians,nurses,the number of beds,the number of actual beds opened,and the number of surgical visits in 2015 in primary care institutions.[Conclusions] This research establishes the theory of the model of healthcare-associated infection control in primary care institutions.Based on the theory model,an instrument is developed that with perfect reliability and validity.All the hypotheses in this study are tested by SEM,and the importance of organization for healthcare-associated infection control is demonstrated in primary care institutions.Training should be used to improve healthcare-associated infection control.The evaluation of the effectiveness of healthcare-associated infection control in primary care institutions,the research find that the degree of management affected the compliance of hand hygiene among medical staff,and the degree of organizationa,management,and training affected the compliance of safe injection among medical staff.In the analysis the influencing factors of healthcare-associated infection control in primary care institutions,when the number of hospital infection professionals is not adequate,the number of physicians or nurses can be appropriately increased to improve the efficiency of hospital infection management.However,the number of personnel should be strictly increased according to the number of hospital beds.[Innovation and Deficiency] Based on Donabedian's "Structure-Process-Outcome" theoretical model,this study integrates the organizationa,management,training and surveillance of healthcare-associated infection control,to establish the model of healthcare-associated infection control in primary care institutions at the first time.It enriches the original healthcare-associated infection control and provides a new idea for the study of healthcare-associated infection control.Meanwhile,this study also analyzes in depth from the aspects of cause and effect the key factors that primary care institutions should pay attention to improve the model of healthcare-associated infection control in primary care institutions.This study has some limitations,that is,only 268 grassroots medical and health institutions in Hubei Province have been studied and cannot represent the national level.The research conclusions should be used with caution in the promotion.