Moret Leïla, Tequi Brigitte, Lombrail Pierre
Public Health Department, University Hospital, Nantes, France.
Am J Infect Control. 2004 Nov;32(7):384-90. doi: 10.1016/j.ajic.2004.02.004.
Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and self-assessment methods.
Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for 1 day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%).
Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations.
Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW. A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.
在一家大型大学医院实施手部卫生促进计划要求我们找到一种合适的方法来评估医护人员的手部卫生习惯。本研究旨在比较直接观察法和自我评估法。
由经过培训的审核员对25个护理单元的206名医护人员（医生、护士和助理护士）的手部卫生习惯进行为期1天的直接观察。一周后，1050名医护人员填写了一份关于他们洗手指征依从性的自我评估问卷（参与率为83%）。
患者护理后自我报告的总体依从率（SRR）与观察到的依从率（OBR）相似（74%）。根据护理类型，SRR和OBR之间的差异不显著，但护士更换输液袋和助理护士提供护理时除外。医生和助理护士往往系统性地高估他们的依从性，而护士往往低估他们对手部卫生建议的依从性。
平均依从率高于文献报道，但因患者护理活动和医护人员职业不同而有所差异。将实施一项强化在职教育计划，尤其针对医生和医学生。自我评估法使用方便且成本低廉，取得了令人鼓舞的结果。南特大学医院正在开展一项基础广泛、常规的自我评估计划，但在实施该计划之前，必须进一步确认这些自我评估指标的可重复性。
