BACKGROUND Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning. DESIGN/METHODS The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure). RESULTS We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully. CONCLUSION Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015.

中文翻译：

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基于框架的结构化实施方法的有效性：医院清洁有效方法研究 (REACH) 试验。


背景技术在医院清洁中实施可持续的实践改变已被证明是减少医疗保健相关感染的持续挑战。本研究的目的是开发一种可靠的基于框架的方法来实施和定量评估医院清洁中循证实践变革的实施情况。设计/方法 研究医院清洁的有效方法 (REACH) 试验是一项务实的、阶梯式楔形随机试验，针对 2016 年至 2017 年在 11 家澳大利亚医院实施的环境清洁捆绑包进行。使用结构化的多步骤方法，我们调整了综合促进卫生服务研究实施行动 (i-PARIHS) 框架，支持在 11 种不同且复杂的环境中严格和量身定制的清洁捆绑干预措施的实施。为了评估该策略的有效性，我们检查了干预后清洁束排列，计算为分数（实施衡量标准），以及使用紫外线 (UV) 凝胶标记收集的清洁性能审核数据（结果衡量标准）。结果 我们成功实施了该捆绑包，并观察到清洁实践和绩效的改进，无论医院规模、干预持续时间以及员工和组织基线准备情况等背景问题如何。束对齐得分和基线清洁性能之间存在正相关。随着干预持续时间的推移，这种情况逐渐减少，因为基线分数较低的医院能够成功实施实践变革。 结论 使用基于结构化框架的方法可以在不同的环境中务实且成功地实施临床试验，并有助于对实践变化进行定量评估。试验注册 澳大利亚新西兰临床试验注册中心 ACTRN12615000325505，于 2015 年 9 月 4 日注册。