Boyce John M
Infectious Diseases Section, Hospital of Saint Raphael, New Haven, CT 06511, USA.
J Hosp Infect. 2008 Oct;70 Suppl 1:2-7. doi: 10.1016/S0195-6701(08)60003-1.
Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion program. Direct observation of care providers by trained personnel is currently considered the gold standard. Advantages include the ability to determine if hand hygiene is being performed at the correct times, establish compliance rates by healthcare worker type, and assess hand hygiene technique. However, observation surveys are time-consuming, permit observation of only a small fraction of all hand hygiene opportunities, and can be influenced by inter-rater reliability. Comparison of compliance rates obtained through observation surveys is problematic due to lack of standardization of criteria for compliance and observation techniques. Self-reporting of compliance is not sufficiently reliable to be useful. Monitoring the usage of hand hygiene products requires much less time and can be performed on an ongoing basis, and is less complicated. However, it does not provide information about the appropriateness and quality of hand hygiene practices or compliance rates by health-care worker type. Furthermore, it is not clear how product usage correlates with compliance established by observational surveys. Electronic methods for monitoring compliance require further evaluation before they can be routinely recommended. Clearly, further research is needed to develop efficient, reliable, and reproducible methods for monitoring hand hygiene compliance.
监测手部卫生依从性并为医护人员提供其表现的反馈被视为成功的手部卫生促进计划的组成部分。目前，由经过培训的人员直接观察护理人员被视为金标准。优点包括能够确定手部卫生是否在正确的时间进行、按医护人员类型确定依从率以及评估手部卫生技术。然而，观察调查耗时，只能观察到所有手部卫生机会中的一小部分，并且可能受到评分者间可靠性的影响。由于依从性标准和观察技术缺乏标准化，通过观察调查获得的依从率比较存在问题。自我报告的依从性不够可靠，无法发挥作用。监测手部卫生产品的使用所需时间少得多，可以持续进行，且不太复杂。然而，它无法提供关于手部卫生做法的适当性和质量或按医护人员类型划分的依从率的信息。此外，尚不清楚产品使用与观察调查确定的依从性之间的关联。在可以常规推荐之前，监测依从性的电子方法需要进一步评估。显然，需要进一步研究以开发高效、可靠和可重复的手部卫生依从性监测方法。
