Lau Tiffany, Tang Grace, Mak Ka-lun, Leung Gilberto
Department of Community Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Clin Teach. 2014 Jun;11(3):159-64. doi: 10.1111/tct.12088.
Hand hygiene is an important component of patient-safety education. The World Health Organization recommends the use of hand hygiene measures at five clinical moments. While previous studies have treated hand hygiene as a single entity, we investigated whether and how the compliance of students may vary across the five clinical moments. We also studied their reasons for non-compliance with a view to inform teaching.
A voluntary self-administered questionnaire survey was conducted on a convenient sample of 339 medical and nursing students. The five clinical moments studied were: before touching a patient (moment 1); before a clean/aseptic procedure (moment 2); after body fluid exposure risk (moment 3); after touching a patient (moment 4); and after touching the patient's surroundings (moment 5).
The overall reported compliance rate was 83.0 per cent. The compliance rates were significantly lower at moments 1 and 5. Nursing students reported better overall compliance (p = 0.01), and at moments 2 (p = 0.0001) and 3 (p = 0.0001), than medical students. Medical students fared better at moment 4 (p = 0.009). The most common reason reported for non-compliance was 'forgetfulness'.
We identified differences in compliance rates across the five clinical moments of hand hygiene. Education programmes should not treat the hand hygiene process as a single entity, but should adopt a moment-specific approach to promote recall, with particular emphases on moments 1 and 5. Nursing and medical students may require different education strategies. Future studies on hand hygiene may also adopt a moment-specific approach.
手部卫生是患者安全教育的重要组成部分。世界卫生组织建议在五个临床时刻采取手部卫生措施。虽然先前的研究将手部卫生视为一个单一的整体，但我们调查了学生在这五个临床时刻的依从性是否以及如何存在差异。我们还研究了他们不依从的原因，以便为教学提供参考。
对339名医学和护理专业学生的便利样本进行了一项自愿的自我管理问卷调查。所研究的五个临床时刻分别是：接触患者前（时刻1）；进行清洁/无菌操作前（时刻2）；体液暴露风险后（时刻3）；接触患者后（时刻4）；以及接触患者周围环境后（时刻5）。
总体报告的依从率为83.0%。在时刻1和时刻5，依从率显著较低。护理专业学生报告的总体依从性更好（p = = 0.01），在时刻2（p = 0.0001）和时刻3（p = 0.0001），比医学专业学生更好。医学专业学生在时刻4表现更好（p = 0.009）。报告的最常见不依从原因是“遗忘”。
我们确定了手部卫生五个临床时刻的依从率存在差异。教育计划不应将手部卫生过程视为一个单一的整体，而应采用针对特定时刻的方法来促进记忆，特别强调时刻1和时刻5。护理和医学专业学生可能需要不同的教育策略。未来关于手部卫生的研究也可采用针对特定时刻的方法。
