Han Ke, Dou Feng-man, Zhang Li-jie, Zhu Bao-ping
Immunization Institution, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2011 Nov;32(11):1139-42.
To evaluate the compliance on hand-hygiene and related factors among healthcare providers working at secondary and tertiary hospitals in Chengdu.
On-site observations regarding hand-hygiene compliance and facilities were conducted in 6 hospitals in Chengdu. Doctors and nurses were asked and recorded about their knowledge regarding hand-hygiene.
Of 1535 activities where hand-hygiene was deemed necessary, under observating healthcare providers would perform hand-hygiene procedures 17.8% of the time (12.8% of the time before touching a patient, 21.0% of the time before touching objects around a patient, 27.3% of the time after touching a patient, and 31.5% of the time after removing gloves). Only 2.2% of the treating rooms were equipped with foot-operated or automatic faucets;of these only 24.5% had soap or alcohol-based hand-sanitizer, and 6.3% had paper towel or other hand-drying equipment. 92.8% of the healthcare providers knew of the six-step method on hand-washing. More than 90.0% of the healthcare providers knew that both palm and back of the hands as well as the front and back of the fingers should be washed. However, only 22.8% knew that the hand-washing procedure should last ≥ 15 seconds. Rates on hand hygiene among chief or more senior physicians (14.6%), attending physicians (9.2%) and junior doctors (15.6%), nurses in chief (25.0%), senior nurses (26.3%) and junior nurses (20.5%) showed no significant differences (P > 0.05). Similarly, scores on related knowledge between chief or senior physicians (12.4 ± 3.2), attending physicians (13.6 ± 3.3) and junior doctors (13.4 ± 2.9), nurses in charge (15.2 ± 2.0), senior nurses (14.8 ± 2.1) and junior nurses (14.3 ± 2.6) also showed no significant differences (P > 0.05). Rate on hand hygiene among nurses (22.7%) was significantly higher than that of the doctors (13.6%). Rate of hand hygiene among 50 - 59 years old healthcare providers (7.4%) was significantly lower than those of all the other age groups (17.1% - 25.0%); rate of female health care providers (19.5%) was significantly higher than that of males (13.8%). Similarly, the nurse's knowledge score (14.7 ± 2.3) was significantly higher than that of the doctors (13.2 ± 3.1). Among 50 - 59 years old healthcare providers, the rate was (12.2 ± 3.8) significantly lower than that of 20 - 29 (14.0 ± 2.6), 30 - 39 (14.3 ± 2.9) and 40 - 49 year olds (13.8 ± 2.7). Again, the knowledge score of females (14.5 ± 2.5) was significantly higher than that of males (12.7 ± 3.2) (P < 0.05).
The high-level knowledge on hand-hygiene among healthcare providers in this area did not translate into good practices. Also, most of the hospitals had poor hand-hygiene equipment. We recommend that training and periodic monitoring be conducted, and hand-hygiene equipment be improved to facilitate hand-hygiene practices among healthcare providers.
评估成都二级和三级医院医护人员手卫生依从性及相关因素。
对成都6家医院进行手卫生依从性及设施的现场观察。询问并记录医生和护士关于手卫生的知识。
在1535项认为有必要进行手卫生的活动中，观察到医护人员实际执行手卫生程序的时间占比为17.8%（接触患者前为12.8%，接触患者周围物体前为21.0%，接触患者后为27.3%，脱手套后为31.5%）。仅2.2%的治疗室配备了脚踏式或自动水龙头；其中只有24.5%有肥皂或含酒精洗手液，6.3%有纸巾或其他干手设备。92.8%的医护人员知晓六步洗手法。超过90.0%的医护人员知道双手掌心、手背以及手指前后都应清洗。然而，只有22.8%的人知道洗手程序应持续≥15秒。主任医师（14.6%）、主治医师（9.2%）和住院医师（15.6%），护士长（25.0%）、主管护师（26.3%）和护师（20.5%）的手卫生执行率无显著差异（P>0.05）。同样，主任医师（12.4±3.2）、主治医师（13.6±3.3）和住院医师（13.4±2.9），护士长（15.2±2.0）、主管护师（14.8±2.1）和护师（14.3±2.6）的相关知识得分也无显著差异（P>0.05）。护士的手卫生执行率（22.7%）显著高于医生（13.6%）。50 - 59岁医护人员的手卫生执行率（7.4%）显著低于其他所有年龄组（17.1% - 25.0%）；女性医护人员的执行率（19.5%）显著高于男性（13.8%）。同样，护士的知识得分（14.7±2.3）显著高于医生（13.2±3.1）。在50 - 59岁医护人员中，得分（12.2±3.8）显著低于20 - 29岁（14.0±2.6）、30 - 39岁（14.3±2.9）和40 - 49岁（13.8±2.7）的人员。同样，女性的知识得分（14.5±2.5）显著高于男性（12.7±3.2）（P<0.05）。
该地区医护人员对手卫生知识掌握程度较高，但并未转化为良好的实践行为。此外，大多数医院的手卫生设施较差。我们建议开展培训和定期监测，并改善手卫生设施，以促进医护人员的手卫生实践。
