Stress Clinical Trial
Official title:
Stress at Work and Infectious Risk in Patients and Caregivers
In hospitals, the improvement of working conditions is often considered secondarily to
patient satisfaction. Previous studies, showing statistically significant relationships,
suggested the impact of hospital departments' organization (staff / patient ratio, bed
distribution, caregiver's assignment), of the work environment, and the working conditions on
the infectious risk at the hospital departments. In addition, organizational hospital
constraints and the organization of care could equally have a major impact on the physical
and psychological health of care workers (stress, fatigue, job satisfaction). To date,
available data suggest that determinants of occupational stress and fatigue are
multifactorial.
This research aims to develop an interdisciplinary approach to link two phenomena that are
often studied independently while they are closely intertwined: working conditions and
infectious risk in hospitals departments. Their main objective is to study the relationship
between stress and caregiver fatigue at the work, organizational determinants and infectious
risk for patients (healthcare-associated infections: HAIs) and for caregivers (blood exposure
accidents: BEAs). The secondary objective is to analyze how the individual characteristics of
the staff, the characteristics of their employment, and the overall organization in the
hospital departments where they work interact to explain their physical and psychological
state of health, on the one hand, and their behavior face to work (absenteeism, turnover and
hand hygiene) on the other hand. The ultimate goal of this research is to be able to propose
organizational strategies aimed at both reducing the probability of occurrence of
healthcare-associated infections and preventing occupational risks for caregivers.
STRIPPS is an etiologic, multi-center cohort study in the Ile-de-France region aiming to
study better understands the complex relationship between the work organization, the stress
ant and the caregiver fatigue and infectious risk in the hospital departments.
It will be conducted in 5 volunteer hospitals, with 7 to 8 hospital departments selected at
random in each center and meeting eligibility inclusion criteria. The envisaged recruitment
is approximately 20 staff per hospital department, enabling a total of about 150 staff to be
included per center, totaling 750 surveyed caregivers.
The five voluntary centers will designate at least one local correspondent or referent among
the hygiene team, the human resources (HR) department and the department of medical
information system (DMI). The hygiene referent is the privileged correspondent. He will be
part of the scientific committee and will help the investigators in the organization of the
study within the hospital departments that will be drawn to participate. The HR and DMI
referents are appointed to facilitate the collection of anonymous and aggregated data from
the HR and PMSI databases planned for the study.
After obtaining regulatory authorizations, the eligible hospital departments of each hospital
center will be drawn at random. Prior to the draw, hygiene referents of each hospital will
prepare a list with all eligible hospital departments. Hospital departments will be selected
using simple random sampling without replacement as follows in each list, the services will
be numbered from 1 to n and 8 numbers between 1 and n will be chosen randomly using a
computer. It will have a total of 5 lists (one list per hospital center) and 8 randomly
selected numbers per list for a total of 40 randomly selected services. Similarly, visit days
and survey start schedules will be drawn at random for the passage of an epidemiologist
investigator recruited by the coordinating team. Two survey dates, between one Monday and one
Friday of each week, and one survey start schedule, will be drawn at random for each work
shift in every participating hospital department, during the entire inclusion period.
Information meetings with the staff of the selected participating hospital departments and
the communication by display will be organized by the investigators. A 15-day period will be
left between the last information meeting held in the service and the closest date drawn for
the start of the inclusion visits.
Based on a prospective data collection and using a qualitative-quantitative approach this
study will provide some elements to better understand the complex relationship between the
work organization, the stress and the caregiver fatigue, and infectious risk in the hospital
departments (for patients and caregivers). This is an approach that relies on a conceptual
model with several hypotheses to test. The conceptual diagram envisaged in our study has been
based on the James Reason's model of accident causation. Indeed, it considers a multi-level
interrelation of many factors ranging from organizational climate root causes to infectious
risk. This equally includes contributory factors related to caregivers themselves, the care
team, work environment as well as immediate causes related to care practices. Thus, for
example, the infectious risk such as blood exposure accidents (for caregivers) or
healthcare-associated infections (for patients) could be explained by several relationships
between a wide range of factors: behavioral changes in care workers such as a decreased
adherence with infection control measures as hand hygiene, stress and fatigue of caregivers,
an excessive workload, a high nurse turnover or their absenteeism, the work schedules, as
well as, by individual factors such as, the work experience, age, and the organizational
climate as root causes.
In this research the following factors will be taken into account:
- at the organizational level: the type and size of hospital departments (in number of
beds and in number of caregivers), the hourly organization of the staff, the number of
caregivers by professional category for each shift in 24h;
- at the hospital department level: nurse absenteeism and turnover rates, safety culture,
healthcare-associated infections rates, the rate of blood exposure accidents among
caregivers, hand hygiene compliance rates;
- at the level of caregivers: age, sex, personal situation, number of young children,
occupation, the position held, work experience, work schedules, stress and fatigue
levels, blood exposure accidents, excessive work-related commitment, the social support
from coworkers and from supervisors, current state of health, absences due to health
reasons including absences due to accidents at work or for work-related illness, etc.
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