Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Infect Control Hosp Epidemiol. 2010 Nov;31(11):1170-6. doi: 10.1086/656592.
Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Cluster-randomized controlled trial.
Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada.
After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008.
We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P < .001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group.
Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.
医护人员（HCWs）对手卫生的依从性被广泛认为是减少医源性感染传播的关键因素。本研究的目的是评估一项多方面干预措施对提高 HCWs 手卫生依从率的影响，并评估其对医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）定植发生率的影响。
整群随机对照试验。
加拿大安大略省汉密尔顿的 3 家三级保健医院的 30 个医院病房。
在收集数据的 3 个月基线期之后，将 15 个病房随机分配到干预组（采用绩效反馈、小组教学研讨会和海报），15 个病房分到常规组。在每个病房的随机 15 分钟时间段内观察手卫生情况，并使用 2007 年 6 月至 2008 年 5 月的每周监测标本测量 MRSA 定植的发生率。
我们发现，在干预组中，7901 次手卫生机会中有 3812 次（48.2%）符合要求，而在对照组中，7526 次机会中有 3205 次（42.6%）符合要求（P <.001；独立 t 检验）。干预组医院获得性 MRSA 定植的发生率没有降低。
在安大略省三级保健医院的 HCWs 中，多方面干预措施使手卫生依从率提高了 6%，这一提高具有统计学意义，但 MRSA 定植的发生率并未降低。
