BACKGROUND Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. METHODS An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. RESULTS A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. CONCLUSIONS Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.

中文翻译：

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“作为倡导者的角色不仅是监督，而且是发声和教育”：手卫生倡导者的矛盾角色。

背景实施科学专家将拥护者定义为“支持、营销和推动实施，克服干预可能在组织中引起的冷漠或阻力”。许多医院聘请指定的临床冠军（通常称为“手卫生 (HH) 冠军”），通常是为了提高手卫生依从性。我们对退伍军人健康管理局 (VHA) 的感染控制团队如何使用“HH 冠军”一词以及他们如何定义这一角色进行了人种学调查。方法 对美国 10 个地理位置分散的 VHA 设施的感染控制团队和直接参与手卫生的一线工作人员进行了一项人种学研究。2014年6月至2017年9月，对医院流行病学家、感染预防人员、多重耐药菌（MDRO）项目协调员、质量改进专家和一线工作人员进行了个人和小组半结构化访谈。团队使用主题内容对笔录进行编码基于由归纳和演绎主题组成的密码本分析内容。结果 共有 173 名医护人员参与了来自 10 个 VHA 机构的访谈。每个设施的所有手部卫生计划均使用“HH 冠军”一词来定义其手部卫生计划的核心要素。虽然大多数人将 HH 冠军的作用描述为提供同伴辅导、提供正式和非正式教育以及促进手部卫生，但大多数人还包括手部卫生监测。这种实施策略的合并导致了 HH 倡导者的相互矛盾的责任。参与者描述了 HH 冠军角色的其他障碍，包括竞争优先事项、人员配置层次结构和角色流动。结论 医疗保健系统应考虑将 HH 冠军的角色狭隘地定义为一个敬业的个人，其使命是克服阻力并提高手部卫生合规性，并将其与“合规审核员”的角色区分开来。回归实施策略的传统应用可能会导致手部卫生的全面改善并减少医疗保健获得性感染的传播。