Ministry of Health, Assir, Abha, Saudi Arabia.
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
J Hosp Infect. 2018 Oct;100(2):152-158. doi: 10.1016/j.jhin.2018.03.013. Epub 2018 Mar 17.
Hand hygiene compliance among healthcare workers (HCWs) in intensive care units (ICUs) is disconcertingly low.
To identify the effective intervention(s) for increasing HH compliance among HCWs in adult ICUs.
Two major electronic databases, OVID Medline and CINAHL, were searched by using a combination of MeSH terms and text words (e.g. hand hygiene, hand washing, compliance, adher*, improve*, develop* and intensive care unit) for relevant articles. This was supplemented by Google Scholar and hand searching of included bibliographies. Data from identified articles were then abstracted, quality-assessed, and combined into a summary effect.
Of 89 titles and abstracts that were identified, 14 articles were finally included. Overall study quality was good. However, variations in design, setting, sample size, and intervention(s) tested precluded a meta-analysis; hence a narrative synthesis was conducted. The interventions included education, observation, provision of supplies, improving access and directive support; tested singly or in combination; resulted in positive outcomes in all but one study. A combination of administrative support, 'supplies', education and training, reminders, surveillance, and performance feedback raised the compliance from a baseline of 51.5% to a record 80.1%; but no set of intervention(s) could improve the compliance to the desired near-100% level.
Available data suggest that multi-modal interventions are effective in raising the compliance to a 'plateau' level but not up to the desired standard. Methodologically appropriate trials of combined interventions could enhance the evidence about interventions to improve hand hygiene compliance among ICU staff.
重症监护病房（ICU）医护人员的手卫生依从性令人不安地低。
确定提高成人 ICU 医护人员手卫生依从性的有效干预措施。
使用医学主题词和文本词（例如手卫生、洗手、依从性、坚持、提高、开发和重症监护病房）的组合，在 OVID Medline 和 CINAHL 两个主要电子数据库中进行搜索，以查找相关文章。此外，还使用了 Google Scholar 和纳入文献的手工搜索。然后，从确定的文章中提取数据，进行质量评估，并将其合并为综合效果。
在 89 个标题和摘要中，最终有 14 篇文章被纳入。总体研究质量良好。然而，设计、设置、样本量和测试的干预措施存在差异，因此无法进行荟萃分析；因此，进行了叙述性综合。干预措施包括教育、观察、提供用品、改善获取途径和指导支持；单独或组合使用；除一项研究外，所有研究均产生了积极结果。行政支持、“用品”、教育和培训、提醒、监测和绩效反馈的组合将依从性从基线的 51.5%提高到了创纪录的 80.1%；但是，没有一组干预措施可以将依从性提高到理想的接近 100%的水平。
现有数据表明，多模式干预措施可有效提高依从性达到“高原”水平，但无法达到理想标准。对联合干预措施进行适当方法学的试验可以增强关于提高 ICU 工作人员手卫生依从性的干预措施的证据。
