Qushmaq Ismael A, Heels-Ansdell Diane, Cook Deborah J, Loeb Mark B, Meade Maureen O
Department of Medicine, Section of Critical Care Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.
Pol Arch Med Wewn. 2008 Oct;118(10):543-7.
Adherence to hand hygiene recommendations in the intensive care unit (ICU) is variable and moderate, at best.
To measure adherence to hand hygiene recommendations among ICU clinicians in a prospective observational study in 6 multidisciplinary ICUs among 4 hospitals.
We observed 115 clinicians (64 nurses, 21 respiratory therapists, 18 residents and 12 physicians) during 1 patient encounter, each. Clinicians were unaware that they were under observation. We documented use of gloves, soap, and alcohol solution before and after patient encounters for purposes of physical examination or patient care.
The rate of adherence to current recommendations was 20% (95% CI 13.7-28.2). All 23 clinicians adhering to recommendations used gloves followed by washing with soap or alcohol solution. 57.4% (95% CI 48.3-66.0) of clinicians used some form of hand hygiene without fully adhering to recommendations, whereas 42.6% did not appear to attend to hand hygiene at all during observation. By univariate analysis, with nurses as the reference group, we found trends suggesting lowest adherence rates among residents (odds ratio [OR] 0.32, 95% CI 0.11-0.96) and intensivists (OR 0.46, 95% CI, 0.13-1.60), and highest adherence among respiratory therapists (OR 2.05, 95% CI 0.67-6.30). We also observed a center effect (p = 0.04). However, multivariate analysis showed no relationship of hand hygiene to clinician group (p = 0.06) nor ICU (p = 0.05).
Multidisciplinary, multimethod approaches to improving hand hygiene are likely necessary to improve the modest adherence to hand hygiene that we observed.
重症监护病房（ICU）中对手卫生建议的遵守情况充其量只是参差不齐且处于中等水平。
在4家医院的6个多学科ICU中进行一项前瞻性观察研究，以衡量ICU临床医生对手卫生建议的遵守情况。
我们观察了115名临床医生（64名护士、21名呼吸治疗师、18名住院医师和12名医生），每人观察1次患者接触过程。临床医生并不知道自己正处于观察之中。我们记录了临床医生在进行体格检查或患者护理前后使用手套、肥皂和酒精溶液的情况。
当前建议的遵守率为20%（95%置信区间13.7 - 28.2）。所有23名遵守建议的临床医生都使用了手套，随后用肥皂或酒精溶液洗手。57.4%（95%置信区间48.3 - 66.0）的临床医生采用了某种形式的手卫生措施，但未完全遵守建议，而42.6%的临床医生在观察期间似乎根本没有注意手卫生。通过单因素分析，以护士为参照组，我们发现有趋势表明住院医师（比值比[OR] 0.32，95%置信区间0.11 - 0.96）和重症监护医生（OR 0.46，95%置信区间0.13 - 1.60）的遵守率最低，呼吸治疗师的遵守率最高（OR 2.05，95%置信区间0.67 - 6.30）。我们还观察到了中心效应（p = 0.04）。然而，多因素分析显示手卫生与临床医生组（p = 0.06）以及ICU（p = 0.05）均无关联。
可能需要采用多学科、多方法的途径来改善手卫生状况，以提高我们所观察到的对手卫生的适度遵守情况。
