Pessoa-Silva Carmem Lúcia, Dharan Sasi, Hugonnet Stéphane, Touveneau Sylvie, Posfay-Barbe Klara, Pfister Riccardo, Pittet Didier
Infection Control Program, Department of Internal, University of Geneva Hospitals, Geneva, Switzerland.
Infect Control Hosp Epidemiol. 2004 Mar;25(3):192-7. doi: 10.1086/502376.
To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care.
The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland.
Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves.
One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination.
These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.
评估新生儿护理期间医护人员手部细菌污染的动态变化。
瑞士日内瓦一家大型急症护理教学医院的20张床位的新生儿病房。
进行结构化观察。当医护人员进行手部卫生清洁时护理序列开始，当活动改变或再次进行手部卫生清洁时护理序列结束。以酒精为基础的擦手剂是手部卫生清洁的标准程序。在手部卫生清洁前后以及护理序列结束时获取优势手五个指尖的印记。使用回归方法根据护理类型、护理持续时间和手套使用情况对最终细菌计数进行建模。
观察了149个护理序列。共生皮肤菌群占所有培养阳性标本的72.4%（n = 360）。鉴定出的其他微生物有肠杆菌科（n = 55，13.8%）；金黄色葡萄球菌（n = 10，2.5%）；以及真菌（n = 7，1.8%）。皮肤接触、呼吸道护理和更换尿布与细菌计数增加独立相关；使用手套并不能完全保护医护人员的手部免受细菌污染。
这些数据证实，在新生儿护理期间，手部会逐渐被共生菌群和潜在病原体污染，并确定了手部污染风险较高的活动。这些数据还强化了在护理序列结束后、开始不同任务之前以及摘除手套后进行手部卫生清洁的必要性。
