Pettinger A, Nettleman M D
Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City 52242.
Infect Control Hosp Epidemiol. 1991 May;12(5):303-7. doi: 10.1086/646343.
To investigate compliance with isolation precautions.
A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study.
The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility.
Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals.
We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p less than .01). Visitors were more compliant than healthcare workers (88% versus 41%; p less than .01). Spending more time in the room was associated with improved compliance (p less than .01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p less than .05). The compliance rate for nurses improved as the nurse/patient ratio improved (p = .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance.
Noncompliance was widespread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.
调查隔离预防措施的依从性。
1989年为期十周的前瞻性观察性研究。参与者并不知晓该研究。
一所拥有900张床位的大学三级护理机构中，设有24张床位的外科重症监护病房的隔离区。
研究参与者包括在指定的15分钟时间段内进入病房的任何医护人员或访客。
我们观察到467名受试者进入病房。严格隔离的依从性（65%）优于伤口/皮肤隔离（40%）或排泄物/分泌物隔离（36%）（p<0.01）。访客的依从性高于医护人员（88%对41%；p<0.01）。在病房停留时间越长，依从性越高（p<0.01）。与单独进入病房的受试者相比，成群进入病房的受试者依从性更高（51%对41%；p<0.05）。随着护士与患者比例的提高，护士的依从率也有所提高（p = 0.14）。依从性与疾病严重程度无关。多变量分析显示，在病房停留的时间、是否为访客以及采用严格隔离是依从性的独立预测因素。
不依从现象普遍存在。当以成本控制的名义对医生和护士的时间提出更高要求时，必须考虑到一些未被察觉的后果，比如依从性降低所带来的后果。
