Schwadtke L, Graf K, Lutze B, von Lengerke T, Chaberny I F
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover.
Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische Hochschule Hannover.
Dtsch Med Wochenschr. 2014 Jun;139(25-26):1341-5. doi: 10.1055/s-0034-1370143. Epub 2014 Jun 10.
Hand hygiene practice is one of the most effective measures to prevent healthcare-associated infections. This study examines the trends of hand hygiene compliance among physicians and nurses on the intensive care units (ICU) and hematopoetic stem cell transplantation units (HSCTU) at Hannover Medical School. An observational study via repeated cross-sectional assessments was conducted during the first 6 years of the "AKTION Saubere Hände" (ASH), i.e. the German adaptation of WHO's "Clean Care is Safer Care" campaign.
Compliance rates were directly observed in accordance with WHO definitions on the 10 ICU and two HSCTU. Overall, 13,175 hand hygiene opportunities were observed between 2008 and 2013.
In 2008, compliance rates of physicians and nurses did not differ significantly in statistical terms (53% vs. 57%, p=0.085). Physicians' compliance improved to 64% in 2011, but declined again to 48.4% in 2013 (p < 0.001). In contrast, hand hygiene compliance among nurses had increased to 71.3% as soon as 2009 /10 (p < 0.001). Their compliance dropped to 55.8% in 2013 and thus to baseline level (p=0.444), while remaining higher than that of physicians (p=0.003). Similar trends pertained to the surgical ICU.
These results indicate that during the ASH-campaign hand hygiene compliance increased initially both among physicians and nurses, albeit so far not in a sustainable fashion. This implies an increased demand for interventions which not only promote motivation, but also its translation into stable and sustained behavior in accordance with guidelines.
手部卫生措施是预防医疗相关感染最有效的方法之一。本研究调查了汉诺威医学院重症监护病房（ICU）和造血干细胞移植病房（HSCTU）的医生和护士手部卫生依从性的变化趋势。在 “AKTION Saubere Hände”（ASH）（即世界卫生组织 “清洁护理更安全” 运动的德国版本）开展的头6年中，通过重复横断面评估进行了一项观察性研究。
根据世界卫生组织的定义，对10个ICU和2个HSCTU直接观察依从率。总体而言，在2008年至2013年期间观察到13175次手部卫生机会。
2008年，医生和护士的依从率在统计学上没有显著差异（53% 对57%，p = 0.085）。医生的依从率在2011年提高到64%，但在2013年又降至48.4%（p < 0.001）。相比之下，护士的手部卫生依从率在2009/10年度就提高到了71.3%（p < 0.001）。他们的依从率在2013年降至55.8%，回到了基线水平（p = 0.444），但仍高于医生的依从率（p = 0.003）。外科ICU也有类似趋势。
这些结果表明，在ASH运动期间，医生和护士的手部卫生依从率最初都有所提高，但目前还没有达到可持续的程度。这意味着需要增加干预措施，这些措施不仅要促进积极性，还要将其转化为符合指南的稳定和持续行为。
