Marra Alexandre R, D'Arco Cláudia, Bravim Bruno de Arruda, Martino Marinês Dalla Valle, Correa Luci, Silva Cláudia Vallone, Lamblet Luiz Carlos R, Silva Moacyr, de Lima Gisele, Guastelli Luciana Reis, Barbosa Luciana, dos Santos Oscar Fernando Pavão, Edmond Michael B
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Infect Control Hosp Epidemiol. 2008 Aug;29(8):730-5. doi: 10.1086/590122.
To evaluate hand hygiene compliance in 2 adult step-down units (SDUs).
A 6-month (from March to September 2007), controlled trial comparing 2 SDUs, one with a feedback intervention program (ie, the intervention unit) and one without (ie, the control unit).
Two 20-bed SDUs at a tertiary care private hospital.
Hand hygiene episodes were measured by electronic recording devices and periodic observational surveys. In the intervention unit, feedback was provided by the SDU nurse manager, who explained twice a week to the healthcare workers the goals and targets for the process measures.
A total of 117,579 hand hygiene episodes were recorded in the intervention unit, and a total of 110,718 were recorded in the control unit (P = .63). There was no significant difference in the amount of chlorhexidine used in the intervention and control units (34.0 vs 26.7 L per 1,000 patient-days; P = .36) or the amount of alcohol gel used (72.5 vs 70.7 L per 1,000 patient-days; P = .93). However, in both units, healthcare workers used alcohol gel more frequently than chlorhexidine (143.2 vs 60.7 L per 1,000 patient-days; P < .001). Nosocomial infection rates in the intervention and control units, respectively, were as follows: for bloodstream infection, 3.5 and 0.79 infections per 1,000 catheter-days (P = .18); for urinary tract infection, 15.8 and 15.7 infections per 1,000 catheter-days (P = .99); and for tracheostomy-associated pneumonia, 10.7 and 5.1 infections per 1,000 device-days (P = .13). There were no cases of infection with vancomycin-resistant enterococci and only a single case of infection with methicillin-resistant Staphylococcus aureus (in the control unit).
The feedback intervention regarding hand hygiene had no significant effect on the rate of compliance. Other measures must be used to increase and sustain the rate of hand hygiene compliance.
评估2个成人降级护理病房（SDU）的手卫生依从性。
一项为期6个月（2007年3月至9月）的对照试验，比较2个SDU，一个实施反馈干预项目（即干预病房），另一个不实施（即对照病房）。
一家三级私立医院的两个拥有20张床位的SDU。
通过电子记录设备和定期观察性调查来测量手卫生事件。在干预病房，由SDU护士长提供反馈，她每周两次向医护人员解释过程指标的目标。
干预病房共记录了117,579次手卫生事件，对照病房共记录了110,718次（P = 0.63）。干预病房和对照病房使用洗必泰的量无显著差异（每1000患者日分别为34.0升和26.7升；P = 0.36），使用酒精凝胶的量也无显著差异（每1000患者日分别为72.5升和70.7升；P = 0.93）。然而，在两个病房中，医护人员使用酒精凝胶的频率均高于洗必泰（每1000患者日分别为143.2升和60.7升；P < 0.001）。干预病房和对照病房的医院感染率分别如下：血流感染，每1000导管日分别为3.5例和0.79例感染（P = 0.18）；尿路感染，每1000导管日分别为15.8例和15.7例感染（P = 0.99）；气管切开相关肺炎，每1000器械日分别为10.7例和5.1例感染（P = 0.13）。未发生耐万古霉素肠球菌感染病例，仅在对照病房发生1例耐甲氧西林金黄色葡萄球菌感染病例。
关于手卫生的反馈干预对依从率无显著影响。必须采用其他措施来提高并维持手卫生依从率。
