Department of Nurse Anesthesia, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0226, USA.
Am J Infect Control. 2012 Oct;40(8):756-9. doi: 10.1016/j.ajic.2011.10.008. Epub 2012 Feb 9.
Hand hygiene (HH) is poor in the health care environment representing a major public health concern. HH compliance is poorly studied in anesthesia providers who contribute extensively to nosocomial infection. The rate of HH opportunities and compliance by these providers was studied using embedded, clandestine observers. We aimed to quantify HH behaviors and taxonomize failures.
Following intensive training, 5 observers masquerading as nursing staff in an academic center, observed the HH of anesthesia providers over a 4-week period throughout the perioperative period using a World Health Organization tool. HH opportunities and HH failures were recorded and categorized using a qualitative content analysis.
Nearly 8,000 HH opportunities were observed. HH opportunities averaged 34 to 41/hour and peaked several times at 54/hour. Aggregate failure rate was 82% with a range of 64% to 93% by provider group.
HH was very poor among anesthesia providers. The task density of anesthesia care may conspire with an intrinsic HH failure rate to create great opportunity for horizontal and vertical vectors for nosocomial infection. Our observations have led to aggressive educational and ergonomic interventions at our facility. Given the task density of anesthesia care, and the observed failure rates, novel approaches to HH should be investigated.
医疗机构中的手部卫生（HH）较差，这是一个主要的公共卫生关注点。在对医院感染有重大贡献的麻醉提供者中，对 HH 依从性的研究甚少。我们使用嵌入式秘密观察员研究了这些提供者的 HH 机会和依从率。我们旨在量化 HH 行为并对失败进行分类。
经过强化培训，5 名观察员伪装成学术中心的护理人员，在整个围手术期内使用世界卫生组织工具观察麻醉提供者的 HH 情况，为期 4 周。使用定性内容分析记录 HH 机会和 HH 失败，并对其进行分类。
观察到近 8000 次 HH 机会。HH 机会平均每小时 34 到 41 次，有几次达到每小时 54 次。总失败率为 82%，按提供者群体划分的范围为 64%至 93%。
麻醉提供者的 HH 非常差。麻醉护理的任务密度可能与内在的 HH 失败率一起，为医院感染的水平和垂直传播创造了很大的机会。我们的观察结果导致我们机构采取了积极的教育和人体工程学干预措施。鉴于麻醉护理的任务密度和观察到的失败率，应研究 HH 的新方法。
