Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger T V
Department of Internal Medicine, University of Geneva Hospitals, and Institute of Social and Preventive Medicine, University of Geneva, Switzerland.
Lancet. 2000 Oct 14;356(9238):1307-12. doi: 10.1016/s0140-6736(00)02814-2.
Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.
We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.
We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).
The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
手部卫生可预防医院内的交叉感染，但对推荐方法的依从性通常较差。我们试图通过实施一项全院范围的计划来促进手部卫生，特别强调在床边使用酒精类手部消毒剂。同时，我们对医院感染情况进行了监测。
在瑞士日内瓦的一家教学医院实施手部卫生运动之前和期间，我们监测了常规患者护理过程中手部卫生的总体依从情况。从1994年12月至1997年12月，每年进行两次全院范围的观察性调查，共进行了七次。次要观察指标为医院感染率、耐甲氧西林金黄色葡萄球菌（MRSA）的感染率以及手部消毒剂的消耗量。
我们观察到超过20000次手部卫生机会。依从性从1994年的48%逐步提高到1997年的66%（p<0.001）。虽然使用肥皂和水洗手的次数保持稳定，但在研究期间手部消毒的频率大幅增加（p<0.001）。在对已知的依从性差的风险因素进行调整后，这一结果没有变化。护士和护理助理的手部卫生情况有显著改善，但医生的依从性仍然较差。在此期间，总体医院感染率下降（从1994年的16.9%降至1998年的9.9%；p=0.04），MRSA传播率下降（从每10000患者日2.16次降至0.93次；p<0.001），1993年至1998年期间，酒精类手部消毒剂的消耗量从每1000患者日3.5升增加到15.4升（p<0.001）。
该运动使手部卫生的依从性得到持续改善，同时医院感染和MRSA传播有所减少。床边使用抗菌手部消毒剂的推广在很大程度上促进了依从性的提高。
