Bischoff W E, Reynolds T M, Sessler C N, Edmond M B, Wenzel R P
Department of Internal Medicine, Medical College of Virginia, Campus of Virginia Commonwealth University, Richmond 23298-0663, USA.
Arch Intern Med. 2000 Apr 10;160(7):1017-21. doi: 10.1001/archinte.160.7.1017.
Under routine hospital conditions handwashing compliance of health care workers including nurses, physicians, and others (eg, physical therapists and radiologic technicians) is unacceptably low.
To investigate the efficacy of an education/ feedback intervention and patient awareness program (cognitive approach) on handwashing compliance of health care workers; and to compare the acceptance of a new and increasingly accessible alcohol-based waterless hand disinfectant (technical approach) with the standard sink/soap combination.
A 6-month, prospective, observational study.
One medical intensive care unit (ICU), 1 cardiac surgery ICU, and 1 general medical ward located in a 728-bed, tertiary care, teaching facility.
Medical caregivers in each of the above settings.
Implementation of an education/ feedback intervention program (6 in-service sessions per each ICU) and patient awareness program, followed by a new, increasingly accessible, alcohol-based, waterless hand antiseptic agent, initially available at a ratio of 1 dispenser for every 4 patients and subsequently 1 for each patient.
Direct observation of hand-washing for 1575 potential opportunities monitored over 120 hours randomized for both time of day and bed locations.
Baseline handwashing compliance before and after defined events was 9% and 22% for health care workers in the medical ICU and 3% and 13% for health care workers in the cardiac surgery ICU, respectively. After the education/feedback intervention program, handwashing compliance changed little (medical ICU, 14% [before] and 25% [after]; cardiac surgery ICU, 6% [before] and 13% [after]). Observations after introduction of the new, increasingly accessible, alcohol-based, waterless hand antiseptic revealed significantly higher handwashing rates (P<.05), and handwashing compliance improved as accessibility was enhanced-before 19% and after 41% with 1 dispenser per 4 beds; and before 23% and after 48% with 1 dispenser for each bed.
Education/feedback intervention and patient awareness programs failed to improve handwashing compliance. However, introduction of easily accessible dispensers with an alcohol-based waterless handwashing antiseptic led to significantly higher handwashing rates among health care workers.
在常规医院环境下，包括护士、医生及其他人员（如物理治疗师和放射技师）在内的医护人员的洗手依从性低得令人无法接受。
调查教育/反馈干预及患者意识提升项目（认知方法）对医护人员洗手依从性的效果；并比较新型且日益普及的酒精基无水手部消毒剂（技术方法）与标准水槽/肥皂组合的接受度。
一项为期6个月的前瞻性观察性研究。
位于一家拥有728张床位的三级护理教学机构中的一个内科重症监护病房（ICU）、一个心脏外科ICU和一个普通内科病房。
上述各环境中的医护人员。
实施教育/反馈干预项目（每个ICU进行6次在职培训课程）及患者意识提升项目，随后引入一种新型且日益普及的酒精基无水手部抗菌剂，最初每4名患者配备1个 dispenser，随后为每名患者配备1个。
在120小时内，对1575个潜在洗手机会进行直接观察，观察时间和床位均随机安排。
在特定事件前后，内科ICU医护人员的基线洗手依从性分别为9%和22%，心脏外科ICU医护人员的基线洗手依从性分别为3%和13%。在教育/反馈干预项目实施后，洗手依从性变化不大（内科ICU，之前为14%，之后为25%；心脏外科ICU，之前为6%，之后为13%）。在引入新型且日益普及的酒精基无水手部抗菌剂后，观察到洗手率显著提高（P<0.05），且随着可及性的提高，洗手依从性得到改善——每4张床配备1个 dispenser 时，之前为19%，之后为41%；每张床配备1个 dispenser 时，之前为23%，之后为48%。
教育/反馈干预及患者意识提升项目未能提高洗手依从性。然而,引入易于获取的装有酒精基无水洗手液的 dispenser 可显著提高医护人员的洗手率。
