Kolola Tufa, Gezahegn Takele
Department of public health, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia.
Antimicrob Resist Infect Control. 2017 Oct 30;6:109. doi: 10.1186/s13756-017-0268-y. eCollection 2017.
Hand hygiene (HH) is recognized as the single most effective strategy for preventing health care-associated infections. In developing countries, data on hand hygiene compliance is available only for few health-care facilities. This study aimed to assess hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia.
This study employed the WHO hand hygiene observation method. Direct observation of the health care workers (HCWs) was conducted using an observation record form in five different wards. Trained and validated observers watched HCWs while they had direct contact with patients or their surroundings, and the observers then recorded all possible hand hygiene opportunities and hand hygiene actions. Observation was conducted over a 24 h period to minimize selection bias. More than 200 opportunities per ward were observed according to WHO recommendation, except in neonatal intensive care unit. HH compliance was calculated by dividing the number of times hand hygiene was performed by the total number of opportunities for hand hygiene. A 95% confidence interval (CI) was computed for compliance with the exact binomial method.
A total of 917 hand hygiene opportunities were observed during the study. Overall HH compliance was 22.0% (95% CI: 19.4-24.9). HH compliance was similar across all professional categories and did not vary by shift. Levels of compliance were lower before patient contact (2.4%; 95% CI: 0.9-5.3), before an aseptic procedure (3.6%; 95% CI: 1.6-7.6) and after contact with patient surroundings (3.3%; 95% CI: 1.2-7.9), whereas better levels of compliance were found after body fluid exposure (75.8%; 95% CI: 68.0-82.3) and after patient contact (42.8%; 95% CI: 35.2-50.7).
HH compliance of HCWs was found to be low in Debre Berhan referral hospital. Compliance with indications that protect patients from infection was lower than that protect the HCWs. The findings of this study indicate that HH compliance needs further improvement.
手部卫生（HH）被认为是预防医疗保健相关感染的最有效单一策略。在发展中国家，仅少数医疗保健机构有手部卫生依从性的数据。本研究旨在评估埃塞俄比亚德布雷伯哈恩转诊医院医护人员的手部卫生依从性。
本研究采用世界卫生组织手部卫生观察方法。使用观察记录表在五个不同病房对医护人员（HCWs）进行直接观察。经过培训且经验证的观察员在医护人员与患者或其周围环境直接接触时进行观察，然后记录所有可能的手部卫生时机和手部卫生行为。观察持续24小时以尽量减少选择偏倚。除新生儿重症监护病房外，根据世界卫生组织的建议，每个病房观察了200多个时机。手部卫生依从性通过将手部卫生执行次数除以手部卫生总时机数来计算。使用精确二项式方法计算95%置信区间（CI）。
研究期间共观察到917个手部卫生时机。总体手部卫生依从性为22.0%（95%CI：19.4 - 24.9）。所有专业类别中的手部卫生依从性相似，且不因班次而异。在接触患者前（2.4%；95%CI：0.9 - 5.3）、进行无菌操作前（3.6%；95%CI：1.6 - 7.6）以及接触患者周围环境后（3.3%；95%CI：1.2 - 7.9）的依从性水平较低，而在体液暴露后（75.8%；95%CI：68.0 - 82.3）和接触患者后（42.8%；95%CI：35.2 - 50.7）的依从性水平较高。
在德布雷伯哈恩转诊医院发现医护人员的手部卫生依从性较低。对保护患者免受感染指征的依从性低于保护医护人员的指征。本研究结果表明手部卫生依从性需要进一步提高。
