Whitby Michael, McLaws Mary-Louise, Slater Karen, Tong Edward, Johnson Barbara
Center for Healthcare-Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Am J Infect Control. 2008 Jun;36(5):349-55. doi: 10.1016/j.ajic.2007.07.016.
Hand hygiene (HH) compliance by health care workers has been universally disappointing. Two major programs (Washington and Geneva) have demonstrated interventions that induce sustained improvement. The introduction of alcohol-based hand rub (AHR) together with education also has been reported to improve compliance.
These interventions were replicated concurrently for 2 years in selected wards of an 800-bed university teaching hospital, with compliance assessed only within, not between, programs.
No significant improvement in HH compliance was observed after the introduction of AHR (incidence rate ratio [IRR] = 1.11; 95% confidence interval [CI] = 0.93 to 1.33; P = .238) or substitution of AHR for a similar product (IRR = 1.10; 95% CI = 0.91 to 1.32; P = .328) with concomitant education. The Washington program achieved a 48% (IRR = 1.48, 95% CI = 1.20 to 1.81; P < .001) improvement in compliance, sustained over 2 years. The Geneva program failed to induce a significant increase in HH compliance in 3 wards, but achieved a 56% (IRR = 1.56; 95% CI = 1.29 to 1.89; P < .001) improvement over the already high HH rate in 1 ward (infectious disease unit).
The Washington program demonstrated effectiveness in achieving sustained improved HH compliance, whereas the effect of the Geneva program was limited in those wards without strong medical leadership. Introduction of AHR without an associated behavioral modification program proved ineffective.
医护人员对手卫生（HH）的依从性普遍令人失望。两项主要计划（华盛顿计划和日内瓦计划）已展示出能带来持续改善的干预措施。据报道，引入含酒精洗手液（AHR）并结合教育也能提高依从性。
在一家拥有800张床位的大学教学医院的选定病房中，同时复制这些干预措施，为期2年，依从性仅在各计划内部而非各计划之间进行评估。
引入AHR（发病率比[IRR]=1.11；95%置信区间[CI]=0.93至1.33；P=0.238）或用类似产品替代AHR（IRR=1.10；95%CI=0.91至1.32；P=0.328）并同时进行教育后，未观察到HH依从性有显著改善。华盛顿计划使依从性提高了48%（IRR=1.48，95%CI=1.20至1.81；P<0.001），且在2年内持续保持。日内瓦计划在3个病房中未能显著提高HH依从性，但在1个病房（传染病科）中，在原本就较高的HH率基础上实现了56%（IRR=1.56；95%CI=1.29至1.89；P<0.001）的提高。
华盛顿计划在实现HH依从性持续改善方面证明是有效的，而日内瓦计划在那些缺乏强有力医疗领导的病房中效果有限。在没有相关行为改变计划的情况下引入AHR被证明是无效的。
