涉及便携式酒精擦手液的手卫生干预措施的集群随机对照试验，以控制长期护理设施中的感染。
Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities.
机构信息
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong.
出版信息
Infect Control Hosp Epidemiol. 2011 Jan;32(1):67-76. doi: 10.1086/657636. Epub 2010 Nov 18.
OBJECTIVE
To investigate the effectiveness of a multifaceted hand hygiene program involving the use of pocket-sized containers of antiseptic gel in long-term care facilities (LTCFs) with elderly residents.
METHODS
In this clustered randomized controlled trial, Hong Kong LTCFs for elderly persons were recruited via snowball sampling. Staff hand hygiene adherence was directly observed, and residents' infections necessitating hospitalization were recorded. After a 3-month preintervention period, LTCFs were randomized to receive pocket-sized containers of alcohol-based gel, reminder materials, and education for all HCWs (treatment group) or to receive basic life support education and workshops for all healthcare workers (HCWs) (control group). A 2-week intervention period (April 1-15, 2007) was followed by 7 months of postintervention observations.
RESULTS
In the 3 treatment LTCFs, adherence to hand rubbing increased from 5 (1.5%) of 333 to 233 (15.9%) of 1,465 hand hygiene opportunities (P = .001)and total hand hygiene adherence increased from 86 (25.8%) of 333 to 488 (33.3%) of 1,465 opportunities (P = .01)after intervention; the 3 control LTCFs showed no significant change. In the treatment group, the incidence of serious infections decreased from 31 cases in 21,862 resident-days (1.42 cases per 1,000 resident-days) to 33 cases in 50,441 resident-days (0.65 cases per 1,000 resident-days) (P = .002), whereas in the control group, it increased from 16 cases in 32,726 resident-days (0.49 cases per 1,000 resident-days) to 85 cases in 81,177 resident-days (1.05 cases per 1,000 resident-days) (P = .004]). In the treatment group, the incidence of pneumonia decreased from 0.91 to 0.28 cases per 1,000 resident-days (P = .001) and the death rate due to infection decreased from 0.37 to 0.10 deaths per 1,000 resident-days (P = .01); the control group revealed no significant change.
CONCLUSIONS
A hand hygiene program involving the use of pocket-sized containers of antiseptic gel and education could effectively increase adherence to hand rubbing and reduce the incidence of serious infections in LTCFs with elderly residents.
目的
调查一项涉及在有老年居民的长期护理机构（LTCF）中使用袖珍装酒精凝胶的多方面手部卫生计划的效果。
方法
在这项聚类随机对照试验中，通过滚雪球抽样的方式招募香港老年人的 LTCF。直接观察工作人员的手部卫生依从性，并记录需要住院治疗的居民感染情况。在 3 个月的干预前阶段后，LTCF 被随机分配接受袖珍装酒精凝胶、提醒材料和所有卫生保健工作者（HCWs）的教育（治疗组）或接受基本生命支持教育和所有卫生保健工作者（HCWs）的研讨会（对照组）。干预期为 2 周（2007 年 4 月 1 日至 15 日），随后进行 7 个月的干预后观察。
结果
在 3 家接受治疗的 LTCF 中，手部揉搓依从率从 333 次机会中的 5 次（1.5%）增加到 1,465 次机会中的 233 次（15.9%）（P =.001），总手部卫生依从率从 333 次机会中的 86 次（25.8%）增加到 1,465 次机会中的 488 次（33.3%）（P =.01）干预后；3 家对照 LTCF 没有明显变化。在治疗组中，严重感染的发生率从 21,862 名居民天的 31 例（每 1,000 名居民天 1.42 例）降至 50,441 名居民天的 33 例（每 1,000 名居民天 0.65 例）（P =.002），而在对照组中，它从 32,726 名居民天的 16 例（每 1,000 名居民天 0.49 例）增加到 81,177 名居民天的 85 例（每 1,000 名居民天 1.05 例）（P =.004）。在治疗组中，肺炎的发生率从每 1,000 名居民天 0.91 例降至 0.28 例（P =.001），感染死亡率从每 1,000 名居民天 0.37 例降至 0.10 例（P =.01）；对照组没有明显变化。
结论
一项涉及使用袖珍装酒精凝胶和教育的手部卫生计划可以有效提高手部揉搓的依从性，并降低有老年居民的长期护理机构严重感染的发生率。
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