Clack Lauren, Scotoni Manuela, Wolfensberger Aline, Sax Hugo
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Antimicrob Resist Infect Control. 2017 Oct 30;6:108. doi: 10.1186/s13756-017-0267-z. eCollection 2017.
Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings.
A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland.
Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone ( = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone ( = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s.
The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.
医护人员的手是医疗保健中病原体传播的首要途径，但迄今为止，手部详细轨迹的研究还不够充分。我们开发并应用了一种新方法，系统记录手部与表面的接触情况（HSE），以描绘现实医疗环境中真正的手部传播途径。
使用头戴式摄像头和商业编码软件，记录8名护士和2名医生的10次主动护理过程，并使用分层编码方案对HSE类型和持续时间进行编码。我们根据世界卫生组织的“手卫生五个时刻”，确定了与患者感染风险特别相关的HSE序列。该研究在瑞士一家拥有900张床位的大学医院的创伤重症监护病房进行。
总体而言，这10段视频总计296.5分钟，涉及8名护士和2名医生。共识别出4222次HSE（每4.2秒1次），涉及裸手（79%）和戴手套的手（21%）。患者区域内的HSE（=1775；42%）包括移动物体（33%）、固定表面（5%）和患者完整皮肤（4%），而患者区域外的HSE（=1953；46%）包括医护人员自身身体（10%）、移动物体（28%）和固定表面（8%）。另有494次（12%）事件涉及患者关键部位。序列分析显示，有291次HSE从患者区域外转移到区域内，即“定植事件”，有217次从任何表面转移到关键部位，即“感染事件”。手部卫生共发生97次，在定植事件中发生14次（依从率5%），在感染事件中发生3次（依从率1%）。平均而言，手部揉搓持续13±9秒。
大量的HSE突出了手在潜在病原体传播中的核心作用，而定植和感染事件中手部卫生的发生频率很低。我们的方法产生了一种有效的视频和编码工具，用于深入分析主动患者护理期间的手部轨迹，这可能有助于设计更有效的预防方案。
