Asare Amgbo, Enweronu-Laryea Christabel C, Newman Mercy J
Department of Medicine, University of Ghana Medical School, Accra, Ghana.
J Infect Dev Ctries. 2009 Jun 1;3(5):352-6. doi: 10.3855/jidc.242.
Compliance with hand hygiene recommendations is the most important measure in preventing health care-associated infections. The objective of this study was to assess the nature of patient contact and the hand hygiene practices of nurses and physicians in the neonatal intensive care unit in a tertiary hospital in Ghana.
Unobtrusive observation of patient contact, hand hygiene practices, and hand washing technique among nurses and physicians attending randomly selected newborns for five hours daily for two weeks. Patient contact categorized as low-risk or high-risk. Hand hygiene practice before and after patient contact categorized as clean uncontaminated, clean recontaminated, new gloves, unchanged gloves. Compliance to alcohol rub use assessed.
The patient to nurse/physician ratio varied from 9:1 to 12:1. There were 97 patient contacts of which 49 were high-risk and 48 low-risk. Most (73%) patient contacts were from nurses. Compliance to hand hygiene recommendations before versus after patient contact was 15.4% versus 38.5% for physicians and 14.1% versus 9.9% for nurses. Gloves were used for 60.8% patient contacts (85.7% high-risk, 35.4% low-risk); however, compliance to recommended procedure occurred in only 12.2% of high-risk contacts and none of the low-risk contacts. Gloves were not changed between patients in 43.7% of high-risk contacts and 88.2% of low-risk contacts. Hand washing protocol was generally followed. Alcohol hand rub was always available but was not used for hand hygiene.
Hand hygiene compliance of physicians and nurses was low. Gloves and alcohol rub were not used according to recommended guidelines. Incorporating effective education programs that improve adherence to hand hygiene guidelines into the continuing education curriculum of health professionals is recommended.
遵守手部卫生建议是预防医疗保健相关感染的最重要措施。本研究的目的是评估加纳一家三级医院新生儿重症监护病房中患者接触的性质以及护士和医生的手部卫生习惯。
对随机选择的新生儿进行护理的护士和医生的患者接触情况、手部卫生习惯和洗手技术进行为期两周、每天5小时的非干扰性观察。将患者接触分为低风险或高风险。将患者接触前后的手部卫生习惯分为清洁未污染、清洁后再污染、新手套、未更换手套。评估酒精擦手液的使用依从性。
患者与护士/医生的比例在9:1至12:1之间。共有97次患者接触，其中49次为高风险，48次为低风险。大多数（73%）患者接触是由护士进行的。医生在患者接触前与接触后的手部卫生建议依从率分别为15.4%和38.5%，护士分别为14.1%和9.9%。60.8%的患者接触使用了手套（高风险接触中为85.7%，低风险接触中为35.4%）；然而，高风险接触中只有12.2%遵循了推荐程序，低风险接触中无一遵循。43.7%的高风险接触和88.2%的低风险接触在患者之间未更换手套。一般遵循洗手规程。酒精擦手液随时可用，但未用于手部卫生。
医生和护士的手部卫生依从性较低。手套和酒精擦手液未按照推荐指南使用。建议将提高手部卫生指南依从性的有效教育项目纳入卫生专业人员的继续教育课程。
