Doronina Olena, Jones Denise, Martello Marianna, Biron Alain, Lavoie-Tremblay Mélanie
Masters Candidate, Ingram School of Nursing, McGill University, McGill University Health Centre, Montreal, QC, Canada.
Assistant to the Director, Quality, Patient Safety, and Performance McGill University Health Centre, Montreal, QC, Canada.
J Nurs Scholarsh. 2017 Mar;49(2):143-152. doi: 10.1111/jnu.12274. Epub 2017 Jan 23.
The purpose of the present systematic review is to identify the interventions that improve hand hygiene compliance (HHC) specifically among nurses.
A systematic review was performed guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to evaluate the short and long-term effects of interventions to promote hand hygiene practices among nurses in the hospital setting. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline Global Health, and Embase was conducted in addition to studies identified by the most recent systematic review. Six studies met inclusion criteria: three randomized controlled trials (RCTs), one controlled before and after studies (CBAs), and two interrupted times series (ITS).
One RCT reported effectiveness and 6-month sustainability of the effect related to multimodal-directed and multimodal with team leadership-directed strategies. The other two RCTs found positive effect of education and feedback on compliance; however, compliance rates declined after 1 month. Education was also found to improve HHC up to 3 months postintervention. An electronic reminder and feedback system evaluated by an ITS improved HHC and detected variation in HHC through the day.
This review showed that single and combined interventions do improve hand hygiene practices among nurses; however, there is a need for more methodologically robust studies to define the most effective and sustainable interventions.
Although hand hygiene is the most effective measure to prevent healthcare-associated infections, compliance with hand hygiene remains low. Nurses are among the healthcare providers who spend the most time in direct patient contact. Therefore, there is a need for research to identify the interventions that improve HHC in this group.
本系统评价的目的是确定专门针对护士提高手卫生依从性（HHC）的干预措施。
按照系统评价和Meta分析的首选报告项目进行系统评价，以评估促进医院环境中护士手卫生行为的干预措施的短期和长期效果。除了通过最新系统评价确定的研究外，还检索了护理及相关健康文献累积索引、Medline全球健康数据库和Embase。六项研究符合纳入标准：三项随机对照试验（RCT）、一项前后对照研究（CBA）和两项中断时间序列（ITS）研究。
一项RCT报告了与多模式指导和团队领导指导策略相关的有效性及效果的6个月持续性。另外两项RCT发现教育和反馈对依从性有积极影响；然而，1个月后依从率下降。还发现教育在干预后长达3个月可提高HHC。通过一项ITS评估的电子提醒和反馈系统改善了HHC，并检测出全天HHC的变化。
本评价表明，单一和联合干预措施确实能改善护士的手卫生行为；然而，需要更多方法学严谨的研究来确定最有效和可持续的干预措施。
尽管手卫生是预防医疗相关感染最有效的措施，但手卫生依从性仍然很低。护士是与患者直接接触时间最长的医疗服务提供者之一。因此，需要开展研究来确定能提高该群体HHC的干预措施。
