Artikel
RCT of a theoretically informed intervention for decontamination in dentistry
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Autoren
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P. Elouafkaoui
- Scottish Dental Clinical Effectiveness Programme, University of Dundee, Dundee, UK
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J. Clarkson
- Scottish Dental Clinical Effectiveness Programme, University of Dundee, Dundee, UK
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D. Stirling
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
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L. Young
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
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A. Templeton
- Scottish Dental Clinical Effectiveness Programme, University of Dundee, Dundee, UK
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S. Rutherford
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
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C. Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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T. Methodology Group
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
| Veröffentlicht: | 10. Juli 2012 |
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Gliederung
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Background: In Scotland, 180 million instruments are decontaminated annually in dental primary care but compliance with guidance recommendations is suboptimal, increasing the risk of healthcare acquired infections. Passive dissemination of guidance has little effect and robust evidence from trials of different implementation interventions is needed.
Objectives: In comparison to postgraduate education alone, does postgraduate education coupled with theory-based, individualised, in-practice support visits increase the implementation of guidance for the decontamination of instruments in dental primary care?
Methods: 104 practices were randomised to either receive a postgraduate education course or the course together with an in-practice visit from a support team. The support team’s implementation strategy involved identifying behaviours that were in accordance with guidance; setting goals and action plans; and providing prompts or reminders if required. The primary outcome was the proportion of practices performing all 13 key decontamination behaviours at 12 months.
Results: The proportion of practices performing all key behaviours increased significantly: 11% course alone versus 31% for course and practice visits (odds ratio 3.5; 95% CI 1.2 to 10.5; p-value 0.023). Decluttering of workspace (64% vs. 83%) and drying of instruments (57% vs. 72%) were the major changes in practice behaviour. There was a general improvement from baseline.
Discussion: This study provides robust evidence to demonstrate the size of effects related to in-practice visits which are now established within primary dental care in Scotland.
Implications for guideline developers/users: Generating robust experimental evidence on the effectiveness of an implementation strategy can increase the likelihood of its adoption into policy.
