Stewardson Andrew J, Iten Anne, Camus Véronique, Gayet-Ageron Angèle, Caulfield Darren, Lacey Gerard, Pittet Didier
Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Clinical Epidemiology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
PLoS One. 2014 Sep 2;9(9):e105866. doi: 10.1371/journal.pone.0105866. eCollection 2014.
Hand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. We assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device's diagnostic capacity.
A controlled before-after study: subjects in Group A were exposed to the SureWash for four weeks followed by Group B for 12 weeks. Each subject's hand hygiene technique was assessed by blinded observers at baseline (T0) and following intervention periods (T1 and T2). Primary outcome was performance of a complete hand hygiene action, requiring all six poses during an action lasting ≥20 seconds. The number of poses per hand hygiene action (maximum 6) was assessed in a post-hoc analysis. SureWash's diagnostic capacity compared to human observers was assessed using ROC curve analysis.
Thirty-four and 29 healthcare workers were recruited to groups A and B, respectively. No participants performed a complete action at baseline. At T1, one Group A participant and no Group B participants performed a complete action. At baseline, the median number of poses performed per action was 2.0 and 1.0 in Groups A and B, respectively (p = 0.12). At T1, the number of poses per action was greater in Group A (post-intervention) than Group B (control): median 3.8 and 2.0, respectively (p<0.001). In Group A, the number of poses performed twelve weeks post-intervention (median 3.0) remained higher than baseline (p<0.001). The area under the ROC curves for the 6 poses ranged from 0.59 to 0.88.
While no impact on complete actions was demonstrated, SureWash significantly increased the number of poses per hand hygiene action and demonstrated good diagnostic capacity.
手部卫生是医疗保健中感染控制的关键组成部分。世界卫生组织建议医护人员在每次手部卫生操作时执行六个特定姿势。SureWash（爱尔兰都柏林的Glanta有限公司）是一种新型设备，它使用视频测量技术和即时反馈来教授这种技术。我们评估了自主使用SureWash对医护人员手部卫生技术的影响，并评估了该设备的诊断能力。
一项前后对照研究：A组受试者使用SureWash四周，随后B组使用12周。在基线期（T0）以及干预期之后（T1和T2），由不知情的观察者对每位受试者的手部卫生技术进行评估。主要结局是完成一次完整的手部卫生操作，即在持续≥20秒的一次操作中执行所有六个姿势。在事后分析中评估每次手部卫生操作的姿势数量（最多6个）。使用ROC曲线分析评估SureWash与人类观察者相比的诊断能力。
分别招募了34名和29名医护人员进入A组和B组。在基线时，没有参与者完成一次完整的操作。在T1时，A组有一名参与者完成了一次完整的操作，B组没有参与者完成。在基线时，A组和B组每次操作执行的姿势中位数分别为2.0和1.0（p = 0.12）。在T1时，A组（干预后）每次操作的姿势数量多于B组（对照组）：中位数分别为3.8和2.0（p<0.001）。在A组中，干预后十二周执行的姿势数量（中位数3.0）仍高于基线（p<0.001）。六个姿势的ROC曲线下面积范围为0.59至0.88。
虽然未证明对完整操作有影响，但SureWash显著增加了每次手部卫生操作的姿势数量，并显示出良好的诊断能力。
