Creedon Sile A
Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland.
J Adv Nurs. 2005 Aug;51(3):208-16. doi: 10.1111/j.1365-2648.2005.03490.x.
This paper reports a study of healthcare workers' handwashing/hand hygiene practices from a behavioural perspective.
Hospital acquired infection poses a very real and serious threat to all who are admitted to hospital. Pathogens are readily transmitted on healthcare workers' hands, and hand hygiene substantially reduces this transmission. Evidence-based guidelines for healthcare workers' hand hygiene practices exist, but compliance with these is internationally low.
A quasi-experimental design with a convenient sample was used. The Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation Health Education Theory was used as the theoretical framework, and the data were collected in 2001. Healthcare workers' handwashing practices (observation of behaviour, n = 314) and their predisposition (attitudes, beliefs and knowledge) towards compliance with hand hygiene guidelines (questionnaire, n = 62) were studied. Nurses, doctors, physiotherapists and care assistants involved in direct patient care in the study unit participated in the study. The interventional hand hygiene programme aimed to predispose healthcare workers to adopt hand hygiene behaviour (poster campaign and educational handout), reinforce (feedback on pretest results) and enable the behaviour (provision of an alcohol hand rub beside each patients bedside).
Implementation of the multifaceted interventional behavioural hand hygiene programme resulted in an overall improvement in compliance with hand hygiene guidelines (51-83%, P < 0.001). Furthermore, healthcare workers believed that their skin condition improved (P < 0.001). An increase in knowledge about handwashing guidelines was also found.
In order to be effective, efforts to improve compliance with handwashing guidelines must be multifaceted. Alcohol hand rubs (with emollients) need to be provided at each patient's bedside. Issues surrounding healthcare workers' skin irritation need to be addressed urgently.
本文从行为学角度报告了一项关于医护人员洗手/手部卫生习惯的研究。
医院获得性感染对所有入院患者构成了非常现实和严重的威胁。病原体很容易通过医护人员的手传播，而手部卫生能大幅减少这种传播。虽然存在针对医护人员手部卫生习惯的循证指南，但在国际上对这些指南的依从性较低。
采用方便抽样的准实验设计。以教育诊断与评价健康教育理论中的前置因素、强化因素、促成因素作为理论框架，并于2001年收集数据。研究了医护人员的洗手习惯（行为观察，n = 314）及其对遵守手部卫生指南的倾向（态度、信念和知识，问卷调查，n = 62）。参与研究科室直接患者护理工作的护士、医生、物理治疗师和护理助理参与了该研究。干预性手部卫生计划旨在使医护人员倾向于采取手部卫生行为（张贴海报和发放教育资料）、强化（反馈预测试结果）并促成该行为（在每个患者床边提供酒精擦手液）。
多方面的干预性手部卫生行为计划的实施使遵守手部卫生指南的情况总体得到改善（从51%提高到83%，P < 0.001）。此外，医护人员认为他们的皮肤状况有所改善（P < 0.001）。还发现了有关洗手指南知识的增加。
为了取得成效，提高遵守洗手指南的努力必须是多方面的。需要在每个患者床边提供含润肤剂的酒精擦手液。围绕医护人员皮肤刺激的问题需要紧急解决。
