Saint S, Conti A, Bartoloni A, Virgili G, Mannelli F, Fumagalli S, di Martino P, Conti A A, Kaufman S R, Rogers M A M, Gensini G F
Division of General Medicine, University of Michigan Health System, Room 7E08, 300 N Ingalls, Ann Arbor, MI 48109-0429, USA.
Qual Saf Health Care. 2009 Dec;18(6):429-33. doi: 10.1136/qshc.2009.032771.
Despite the importance of hand hygiene in reducing infection, healthcare worker compliance with hand hygiene recommendations remains low. In a previous study, we found a generally low level of compliance at baseline, with substantial differences between doctors and nurses and between hospital units. We describe here the results of our multimodal intervention intended to improve levels of healthcare worker hand hygiene.
A 6-month, before-and-after, multimodal interventional study in five hospital units in Florence, Italy. We used direct observation to assess hand hygiene rates for doctors and nurses, focusing on hygiene before touching the patient. We explored reasons for unit variability via interviews of doctor and nurse leaders on the units.
Overall healthcare worker hand hygiene increased from 31.5% to 47.4% (p<0.001). Hand hygiene adherence among nurses increased from 33.7% to 47.9% (p<0.001); adherence among doctors increased from 27.5% to 46.6% (p<0.001). Improvement was statistically significant in three out of five units, and units differed in the magnitude of their improvement. Based on the interviews, variability appeared related to the "champion" on each unit, as well as the level of motivation each physician leader exhibited when the preintervention results were provided.
Although overall healthcare worker adherence with hand hygiene procedures before patient contact substantially increased after the multimodal intervention, considerable variability-for both nurses and doctors and across the 5 units-was seen. Although adherence substantially increased, overall hand hygiene in these units could still be greatly improved.
尽管手部卫生对于减少感染至关重要，但医护人员对手部卫生建议的依从性仍然很低。在之前的一项研究中，我们发现基线时依从性普遍较低，医生和护士之间以及医院各科室之间存在显著差异。我们在此描述旨在提高医护人员手部卫生水平的多模式干预的结果。
在意大利佛罗伦萨的五个医院科室进行了一项为期6个月的前后对照多模式干预研究。我们通过直接观察来评估医生和护士的手部卫生率，重点关注接触患者前的卫生情况。我们通过采访各科室的医生和护士领导来探究科室差异的原因。
医护人员的总体手部卫生率从31.5%提高到了47.4%（p<0.001）。护士的手部卫生依从性从33.7%提高到了47.9%（p<0.001）；医生的依从性从27.5%提高到了46.6%（p<0.001）。五个科室中有三个科室的改善具有统计学意义，且各科室改善的幅度有所不同。根据访谈，差异似乎与每个科室的“倡导者”以及在提供干预前结果时每位医生领导表现出的积极性水平有关。
尽管在多模式干预后，医护人员在接触患者前对手部卫生程序的总体依从性大幅提高，但无论是护士还是医生，以及在这五个科室中，都存在相当大的差异。尽管依从性大幅提高，但这些科室的总体手部卫生仍有很大的改善空间。
