Department of Control Engineering and Information Technology (BME-IIT), Budapest University of Technology and Economics, Magyar tudósok krt, 2, Budapest H-1117, Hungary.
BMC Infect Dis. 2013 May 30;13:249. doi: 10.1186/1471-2334-13-249.
Hand hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO's 6 Step technique.
A hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.
Despite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation.
Ongoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.
手部卫生依从性通常通过观察遵守“世界卫生组织五个时刻”的情况，以机会数量作为分母来评估。由于没有用于常规评估手部卫生技术的既定方法，因此通常不会监测活动的质量。本研究的目的是使用新型成像技术客观评估手部消毒剂的覆盖范围，并寻找在使用世界卫生组织六步洗手法后错过区域的模式和趋势。
在新加坡国立大学医院，一项针对 5200 名临床工作人员的手部卫生教育和评估计划在 7 天内进行。参与者以小组形式由专业培训师引导，通过 5 个教育站，包括技术培训和紫外线灯评估，并通过手部数字摄影提供支持。事先定义了令人满意的手部卫生质量的客观标准。随后分析了在评估计划期间创建的图像数据库。确定了不良手部卫生质量的模式，并将其与员工的人口统计学特征联系起来。
尽管评估是在培训后立即进行的，但只有 72%的员工达到了令人满意的覆盖率。分别有 24%和 18%的情况下，未能充分清洁手部的掌背和掌面。3.5%的受试者指尖未被覆盖。基于 4642 份记录的分析表明，护士的表现最好（77%通过），女性的表现优于男性（75%比 62%，p<0.001）。还确定了与年龄和职业有关的其他风险指标。
持续的教育和培训对于提高临床工作人员的手部卫生依从性和技术至关重要。确定典型的失败部位可以帮助开发改进的培训。
