Santosaningsih Dewi, Erikawati Dewi, Santoso Sanarto, Noorhamdani Noorhamdani, Ratridewi Irene, Candradikusuma Didi, Chozin Iin N, Huwae Thomas E C J, van der Donk Gwen, van Boven Eva, Voor In 't Holt Anne F, Verbrugh Henri A, Severin Juliëtte A
Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia.
Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia.
Antimicrob Resist Infect Control. 2017 Feb 16;6:23. doi: 10.1186/s13756-017-0179-y. eCollection 2017.
Hand hygiene is recognized as an important measure to prevent healthcare-associated infections. Hand hygiene adherence among healthcare workers is associated with their knowledge and perception. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia.
The study was performed from May to October 2014 and divided into a pre-intervention, intervention, and post-intervention phase. This cluster randomized controlled trial allocated the implementation of three interventions to the departments, including role model training-pediatrics, active presentation-surgery, a combination of role model training and active presentation-internal medicine, and a control group-obstetrics-gynecology. Both direct observation and knowledge-perception survey of hand hygiene were performed using WHO tools.
Hand hygiene compliance was observed during 2,766 hand hygiene opportunities, and knowledge-perception was assessed among 196 participants in the pre-intervention and 88 in the post-intervention period. After intervention, the hand hygiene compliance rate improved significantly in pediatrics (24.1% to 43.7%; < 0.001), internal medicine (5.2% to 18.5%; < 0.001), and obstetrics-gynecology (10.1% to 20.5%; < 0.001). The nurses' incorrect use of hand rub while wearing gloves increased as well ( < 0.001). The average knowledge score improved from 5.6 (SD = 2.1) to 6.2 (SD = 1.9) ( < 0.05). In the perception survey, "strong smell of hand alcohol" as a reason for non-compliance increased significantly in the departments with intervention (10.1% to 22.9%; = 0.021).
The educational programs improved the hand hygiene compliance and knowledge among healthcare workers in two out of three intervention departments in a limited-resource hospital in Indonesia. Role model training had the most impact in this setting. However, adjustments to the strategy are necessary to further improve hand hygiene.
手部卫生被认为是预防医疗保健相关感染的一项重要措施。医护人员对手部卫生的依从性与其知识和认知有关。本研究旨在评估三种不同教育项目对提高印度尼西亚一家三级护理医院医护人员手部卫生依从性、知识和认知的效果。
该研究于2014年5月至10月进行，分为干预前、干预和干预后阶段。这项整群随机对照试验将三种干预措施的实施分配到各个科室，包括儿科榜样培训、外科主动演示、内科榜样培训与主动演示相结合，以及妇产科作为对照组。使用世界卫生组织的工具对手部卫生进行直接观察和知识认知调查。
在2766次手部卫生机会中观察了手部卫生依从情况，并在干预前对196名参与者以及干预后对88名参与者进行了知识认知评估。干预后，儿科（24.1%至43.7%；<0.001）、内科（5.2%至18.5%；<0.001）和妇产科（10.1%至20.5%；<0.001）的手部卫生依从率显著提高。护士戴手套时不正确使用擦手液的情况也有所增加（<0.001）。平均知识得分从5.6（标准差=2.1）提高到6.2（标准差=1.9）（<0.05）。在认知调查中，在有干预措施的科室，“手部酒精气味浓烈”作为不依从的一个原因显著增加（10.1%至22.9%；=0.021）。
在印度尼西亚一家资源有限的医院中，教育项目提高了三个干预科室中两个科室医护人员的手部卫生依从性和知识水平。在这种情况下，榜样培训的影响最大。然而，有必要对策略进行调整以进一步改善手部卫生。
