Eldridge Noel E, Woods Susan S, Bonello Robert S, Clutter Kay, Ellingson Leann, Harris Mary Ann, Livingston Barbara K, Bagian James P, Danko Linda H, Dunn Edward J, Parlier Renee L, Pederson Cheryl, Reichling Kim J, Roselle Gary A, Wright Steven M
Department of Veterans Affairs, Veterans Health Administration, National Center for Patient Safety, Washington, DC 20420, USA.
J Gen Intern Med. 2006 Feb;21 Suppl 2(Suppl 2):S35-42. doi: 10.1111/j.1525-1497.2006.00361.x.
The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement.
To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO.
Six Sigma Project with pre-post design.
Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals.
Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire.
Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products.
The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.
疾病控制与预防中心（CDC）于2002年发布了《医疗机构手卫生指南》。2003年，医疗保健机构认证联合委员会（JCAHO）将遵守CDC指南确立为2004年的一项全国患者安全目标。该目标一直持续到2006年。CDC强调使用酒精擦手液（ABHRs）而非肥皂和水是提高依从性的一个契机，但该指南包含40多条具体实施建议。
运用六西格玛方法审视手卫生实践，并提高对JCAHO要求的CDC手卫生建议的依从性。
采用前后设计的六西格玛项目。
在3家医院的4个重症监护病房工作的医生、护士和其他工作人员。
观察到的对10项必需的手卫生实践的依从性、每100个患者日每月使用的ABHR量，以及通过问卷调查报告的工作人员对手卫生的态度和看法。
基于总共4000多次观察，观察到的依从性从47%提高到了80%。3个重症监护病房（ICU）每100个患者日使用的ABHR量分别增加了97%、94%和70%；增加的用量持续了9个月。使用问卷调查的自我报告依从性没有变化。工作人员报告称，ABHR的使用增加，对手卫生实践和产品的满意度提高。
六西格玛方法有效地组织了一组专业人员的知识、意见和行动，以在4个ICU中实施CDC基于证据的手卫生实践。开发了几种工具以供广泛使用。
