Jansson Miia M, Syrjälä Hannu P, Ohtonen Pasi P, Meriläinen Merja H, Kyngäs Helvi A, Ala-Kokko Tero I
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Unit of Nursing Science and Health Management, University of Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu, Finland.
Am J Infect Control. 2016 Jun 1;44(6):625-30. doi: 10.1016/j.ajic.2015.12.030. Epub 2016 Feb 18.
To evaluate how critical nurses' knowledge of and adherence to current care hand hygiene (HH) guidelines differ between randomly allocated intervention and control groups before and after simulation education in both a simulation setting and clinical practice during a 2-year follow-up period. It was hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase compared with a control group after simulation education.
A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized critical care nurses participated in the baseline measurements; of these, 17 completed all the study procedures. Participants' HH adherence was observed only in high-risk contact situations prior to and postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants' HH knowledge was evaluated at the end of each observational session.
The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final postintervention measurement at 24 months (P = .002). However, the linear mixed model did not identify any significant group (P = .77) or time-group interactions (P = .17) between the study groups after 2 years of simulation education. In addition, simulation education had no impact on participants' HH knowledge.
After a single simulation education session, critical care nurses' knowledge of and adherence to current HH guidelines remained below targeted behavior rates.
评估在为期2年的随访期内，在模拟环境和临床实践中，随机分配的干预组和对照组在模拟教育前后，护士对当前护理手卫生（HH）指南的知识掌握情况和依从性有何差异。假设模拟教育后，干预组对当前HH指南的知识掌握情况和依从性可能会高于对照组。
在芬兰奥卢一家拥有22张床位的成人内科-外科混合重症监护病房进行了一项前瞻性、平行、随机对照试验，并进行重复测量。最初随机分配的40名重症监护护士中有30名参与了基线测量；其中，17名完成了所有研究程序。仅在气管内吸痰事件前后的高风险接触情况下，采用直接、非参与性观察方法观察参与者的HH依从性。在每次观察期结束时评估参与者的HH知识。
在24个月的最终干预后测量中，总体HH依从性从基线值40.8%提高到50.8%（P = 0.002）。然而，经过2年的模拟教育后，线性混合模型未发现研究组之间存在任何显著的组间差异（P = 0.77）或时间-组间交互作用（P = 0.17）。此外，模拟教育对参与者的HH知识没有影响。
经过一次模拟教育后，重症监护护士对当前HH指南的知识掌握情况和依从性仍低于目标行为率。
