Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Pediatrics. 2012 Apr;129(4):e1042-50. doi: 10.1542/peds.2011-1864. Epub 2012 Mar 5.
In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.
Strategies to improve hand hygiene were tested through multiple plan-do-study-act cycles, first by 1 general inpatient medical team and then spread to 4 additional teams. At the start of each rotation, residents completed an educational module and posttest about proper hand hygiene. Team compliance data were displayed daily in the resident conference room. Real-time identification and mitigation of failures by a hand-washing champion encouraged shared accountability. Organizational support ensured access to adequate hand hygiene supplies. The main outcome measure was percent compliance with acceptable hand hygiene, defined as use of an alcohol-based product or hand-washing with soap and turning off the faucet without using fingers or palm. Compliance was defined as acceptable hand hygiene before and after contact with the patient or care environment. Covert bedside observers recorded at least 8 observations of physicians' compliance per day.
Physician compliance with proper hand hygiene improved to >95% within 6 months and was sustained for 11 months.
Instituting a hand-washing champion for immediate identification and mitigation of failures was key in sustaining results. Improving physician compliance with proper hand hygiene is achievable and a first step in decreasing health care-associated infections.
2009 年，联合委员会（The Joint Commission）向各医院提出挑战，要求通过提高手卫生依从性来降低医源性感染的风险。在我们医院，医生的依从率低于其他医护人员，普通儿科病房的医生仅为 68%。我们采用改进方法和可靠性科学，使普通儿科住院医师团队的手卫生依从率提高到>95%。
通过多次计划-执行-研究-行动循环来测试提高手卫生的策略，首先在 1 个普通住院内科团队中进行，然后推广到另外 4 个团队。在每个轮次开始时，住院医师完成关于正确手卫生的教育模块和后测。团队的依从数据每天在住院医师会议室显示。洗手冠军实时识别和纠正失败行为，鼓励共同承担责任。组织支持确保获得足够的手卫生用品。主要观察指标是可接受手卫生的依从率，定义为使用酒精类产品或肥皂洗手并在不使用手指或手掌关闭水龙头。依从性定义为在接触患者或护理环境前后进行可接受的手卫生。隐蔽的床边观察员每天至少记录 8 次医生的依从情况。
医生正确手卫生的依从性在 6 个月内提高到>95%，并持续了 11 个月。
立即识别和纠正失败的洗手冠军是维持结果的关键。提高医生正确手卫生的依从率是可行的，也是降低医源性感染的第一步。
