First Global Patient Safety Challenge, WHO Patient Safety Programme, WHO, Geneva, Switzerland.
Lancet Infect Dis. 2013 Oct;13(10):843-51. doi: 10.1016/S1473-3099(13)70163-4. Epub 2013 Aug 23.
Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries.
We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010.
We noted 21,884 hand-hygiene opportunities during 1423 sessions before the intervention and 23,746 opportunities during 1784 sessions after. Overall compliance increased from 51.0% before the intervention (95% CI 45.1-56.9) to 67.2% after (61.8-72.2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4.67, 95% CI 3.16-6.89; p<0.0001) than in high-income countries (2.19, 2.03-2.37; p<0.0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2.15, 1.99-2.32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18.7 (95% CI 17.8-19.7) to 24.7 (23.7-25.6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up.
Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide.
WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.
与医疗保健相关的感染是全球范围内对患者安全的主要威胁。传播主要通过医护人员的手进行，但对建议的遵守率通常较低，需要有效的改进策略。我们评估了世界卫生组织（WHO）改善手卫生策略在五个国家的效果。
我们在 2006 年 12 月至 2008 年 12 月期间在哥斯达黎加、意大利、马里、巴基斯坦和沙特阿拉伯的六个试点地点（43 家医院的 55 个科室）进行了一项准实验研究。使用逐步方法分四个 3-6 个月阶段实施 WHO 的策略，并通过问卷调查评估医护人员的手部卫生依从性及其对微生物传播和手部卫生原则的了解。我们将依从性表示为预定义机会中手部卫生措施（即洗手或手部揉搓）的比例。我们在 2010 年 4 月评估了核心策略活动的长期可持续性。
在干预前的 1423 次和干预后的 1784 次中，我们注意到 21884 次手部卫生机会。整体依从率从干预前的 51.0%（95%CI 45.1-56.9）增加到干预后的 67.2%（61.8-72.2）。依从性与人均国民总收入独立相关，在低收入和中等收入国家（比值比[OR] 4.67，95%CI 3.16-6.89；p<0.0001）的干预效果大于高收入国家（2.19，2.03-2.37；p<0.0001）。在调整主要混杂因素后，所有地点的卫生保健工作者的依从性都因实施而有了重大影响（OR 2.15，1.99-2.32）。所有地点在接受教育课程后，医护人员的知识都有所提高，平均分数从 18.7（95%CI 17.8-19.7）增加到 24.7（23.7-25.6）。干预后 2 年，所有地点均报告持续开展手部卫生活动，依从性和知识水平持续或进一步提高，包括国家层面的扩大。
在不同国家的各种环境中实施世卫组织手部卫生策略是可行和可持续的，可显著提高医护人员的依从性和知识水平，支持在全球范围内的推荐使用。
世卫组织、日内瓦大学附属医院、瑞士国家科学基金会、瑞士公共卫生管理与医院药剂师学会。
