Nottingham University Hospitals NHS Trust, The Queen's Medical Centre, Nottingham, UK.
J Hosp Infect. 2010 Nov;76(3):252-5. doi: 10.1016/j.jhin.2010.06.027. Epub 2010 Sep 20.
This observational study measured healthcare workers' (HCWs'), patients' and visitors' hand hygiene compliance over a 24h period in two hospital wards using the 'five moments of hand hygiene' observation tool. Hand hygiene is considered to be the most effective measure in reducing healthcare-associated infections but studies have reported suboptimal levels of compliance. Most studies have used random observational time-periods for data collection and this has been criticised. We monitored a total of 823 hand hygiene opportunities (HCWs, N=659; patients and visitors, N=164). Among HCWs, compliance was 47% for doctors, 75% for nurses, 78% for allied health professionals, and 59% for ancillary and other staff (P<0.001). There was no difference in compliance between patients and visitors (56% vs 57%, P=0.87). Hand hygiene compliance varied depending on which of the five moments of hygiene HCWs had undertaken (P<0.001), with compliance before an aseptic task being 100% (3/3); after body fluid exposure 93% (86/93); after patient contact 80% (114/142); before patient contact 68% (196/290); and after contact with surroundings 50% (65/129). Lower levels of compliance were found for HCWs working during the early shift (P<0.001). For patients and visitors there was no evidence of an association between moments of hygiene and compliance. Levels of compliance were higher compared with previous reported estimates. Medical staff had the lowest level of compliance and this continues to be a concern which warrants specific future interventions.
本观察性研究使用“五个手卫生时刻”观察工具，在两个医院病房内，对医护人员（HCWs）、患者和访客在 24 小时内的手卫生依从率进行了测量。手卫生被认为是降低医源性感染最有效的措施，但研究报告的依从率并不理想。大多数研究都使用随机观察时间来收集数据，这一点受到了批评。我们共监测了 823 次手卫生机会（HCWs：659 例；患者和访客：164 例）。在 HCWs 中，医生的依从率为 47%，护士为 75%，辅助卫生专业人员为 78%，辅助和其他工作人员为 59%（P<0.001）。患者和访客的依从率没有差异（56%比 57%，P=0.87）。手卫生依从率取决于 HCWs 进行的五个卫生时刻之一（P<0.001），无菌操作前的依从率为 100%（3/3）；体液暴露后为 93%（86/93）；接触患者后为 80%（114/142）；接触患者前为 68%（196/290）；接触周围环境后为 50%（65/129）。早班 HCWs 的依从率较低（P<0.001）。对于患者和访客，没有证据表明卫生时刻与依从率之间存在关联。与之前报告的估计相比，依从率更高。医务人员的依从率最低，这仍然是一个令人关注的问题，需要特别关注。
