Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein 627/701, São Paulo, Brazil.
Am J Infect Control. 2011 Feb;39(1):1-5. doi: 10.1016/j.ajic.2010.05.024.
There is a paucity of data evaluating whether positive deviance (PD) can sustain improvement in hand hygiene compliance.
An observational study comparing the effect of PD on compliance with hand hygiene was conducted in two 20-bed step-down units (SDUs) at a private tertiary care hospital. In a 3-month baseline period (April-June 2008), hand hygiene counts were performed by electronic handwashing counters. Between July 1, 2008, and November 30, 2009, (East SDU) and between September 30, 2008, and December 2009 (West SDU), PD was applied in both units.
There was more than a 2-fold difference in the number of alcohol gel aliquots dispensed per month from April 2008 (before PD) to November 2009 (last month in PD) in the East SDU. There was also a 2-fold difference in the number of alcohol gel aliquots dispensed per month from September 2008 (before PD) to December 2009 (last month in PD) in the West SDU. The difference in the rate of health care‒associated infections (HAIs) between the baseline period and 2009 was statistically significant in the East SDU (5.8 vs 2.8 per 1,000 device-days; P = .008) and in the West SDU (3.7 vs 1.7 per 1,000 device-days; P = .023).
PD was responsible for a sustained improvement in hand hygiene in the inpatient setting and was associated with a decrease in the incidence of device-associated HAIs.
目前评估积极偏差（PD）是否能持续提高手卫生依从性的数据很少。
在一家私立三甲医院的两个 20 床的重症监护病房（SDU）中进行了一项观察性研究，比较 PD 对遵守手卫生的影响。在 3 个月的基线期（2008 年 4 月至 6 月）中，使用电子洗手计数器进行手卫生计数。在 2008 年 7 月 1 日至 2009 年 11 月 30 日（东 SDU）和 2008 年 9 月 30 日至 2009 年 12 月（西 SDU）期间，两个单位都实施了 PD。
在东 SDU 中，从 2008 年 4 月（PD 前）到 2009 年 11 月（PD 最后一个月），每月分配的酒精凝胶剂量相差两倍多。在西 SDU 中，从 2008 年 9 月（PD 前）到 2009 年 12 月（PD 最后一个月），每月分配的酒精凝胶剂量相差两倍多。东 SDU 中，与基线期相比，2009 年的医疗保健相关感染（HAI）发生率差异具有统计学意义（每千个设备日 5.8 例与 2.8 例；P =.008），西 SDU 中，差异也有统计学意义（每千个设备日 3.7 例与 1.7 例；P =.023）。
PD 可使住院环境中的手卫生持续改善，并与设备相关 HAI 发生率的降低有关。
