McInnes Elizabeth, Phillips Rosemary, Middleton Sandy, Gould Dinah
BMC Infect Dis. 2014 Nov 18;14:611. doi: 10.1186/s12879-014-0611-3.
Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers' compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers' views on current and innovative strategies to improve hand hygiene compliance.
Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically.
Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer.
To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness.
尽管人们普遍认识到手部卫生对于降低医疗相关感染发生率的重要性，但医护人员对最佳实践的依从性一直不尽人意。医院高级管理人员有责任实施患者安全举措，因此处于理想位置，能够为改进提高手部卫生依从性的策略提供建议。这是一个研究不足的领域，因此本研究的目的是确定医院高级管理人员对当前及创新策略以提高手部卫生依从性的看法。
采用定性设计，对澳大利亚悉尼一家大型教学和转诊医院的13名经过有目的抽样的高级管理人员进行面对面访谈。对数据进行主题分析。
出现了七个主题：文化变革始于领导者，更新并强化信息，将五个手卫生时刻与患者全程就医过程相联系，可采取行动的审核结果，赋予患者权力，重新认识不依从行为，以及开始使用强制手段。
为加强手部卫生计划，基于五个手卫生时刻的策略应根据特定角色和环境进行调整，并考虑患者的全程就医过程，包括患者与临床及非临床工作人员的互动。高级临床和非临床领导者应明显支持并强制推行最佳实践举措，并明确表示手部卫生不依从在文化和专业层面上是组织所不能接受的。包括纪律处分成分且将手部卫生不依从视为患者安全错误的策略，在工作人员的可接受性和有效性方面可能值得评估。
