儿科重症监护病房手卫生依从性及行为决定因素：一项观察性研究。
Hand hygiene compliance and behavioural determinants in a paediatric intensive care unit: An observational study.
机构信息
Pediatric Nursing Department, Paulista Nursing School, Federal University of São Paulo, Napoleão de Barros Street, 754. Vila Clementino, São Paulo, 04024-002, Office 113, Brazil.
出版信息
Aust Crit Care. 2019 Jan;32(1):21-27. doi: 10.1016/j.aucc.2018.02.010. Epub 2018 Mar 23.
BACKGROUND
Hand hygiene is considered the single most effective means of reducing healthcare-associated infections, but improving and sustaining hand hygiene compliance remains a great challenge.
OBJECTIVES
To compare hand hygiene compliance before and after interventions to promote adherence in a paediatric intensive care unit (PICU) and to identify predictors of intention to perform the behaviour "hand hygiene during patient care in the PICU".
METHODS
A before and after study was conducted in three phases. Based on the World Health Organization guideline for hand hygiene compliance monitoring, 1261 hand hygiene opportunities were directly observed during routine patient care by two observers simultaneously, in a nine-bed PICU in Brazil, before and after infrastructure and educational interventions. To identify predictors of healthcare professionals' intention to perform the behaviour hand hygiene during patient care, a data collection instrument was designed based on the Theory of Planned Behaviour. Statistical analyses were undertaken using Chi-square test or the Fisher's exact test and regression analysis. A significance level of 5% (p < 0.05) was applied to all analyses.
RESULTS
The hand hygiene compliance rate increased significantly from 27.3% in the "pre-intervention phase" to 33.1% in "phase 1-post-intervention," to 37.0% in "phase 2-post-intervention" (p = .010). Perceived social pressure (p = .026) was a determinant factor of intention to perform the behaviour.
CONCLUSIONS
Hand hygiene compliance raised significantly after infrastructure, educational, and performance feedback interventions. However, despite the significant effect of the implemented interventions, the overall hand hygiene compliance rate was low. Perceived social pressure characterised a determinant factor of intention to perform the behaviour "hand hygiene during patient care in the PICU", reinforcing the need for behaviour determinants analysis when designing promotional interventions.
背景
手卫生被认为是降低医疗机构相关性感染的最有效手段，但提高和维持手卫生依从性仍然是一个巨大的挑战。
目的
比较干预措施前后促进儿科重症监护病房（PICU）手卫生依从性的效果，并确定“在 PICU 进行患者护理时进行手卫生”行为意向的预测因素。
方法
在三个阶段进行了一项前后对照研究。根据世界卫生组织手卫生依从性监测指南，在巴西的一个 9 床 PICU 中，在基础设施和教育干预前后，由两名观察者同时在常规患者护理期间直接观察 1261 次手卫生机会。为了确定医疗保健专业人员执行“在 PICU 进行患者护理时进行手卫生”行为意向的预测因素，根据计划行为理论设计了一个数据收集工具。使用卡方检验或 Fisher 精确检验和回归分析进行统计分析。所有分析均应用 5%的显著性水平（p<0.05）。
结果
手卫生依从率从“干预前阶段”的 27.3%显著提高到“第 1 阶段-干预后”的 33.1%，再到“第 2 阶段-干预后”的 37.0%（p=0.010）。感知社会压力（p=0.026）是行为意向的决定因素。
结论
在基础设施、教育和绩效反馈干预后，手卫生依从率显著提高。然而，尽管实施的干预措施具有显著效果，但总体手卫生依从率仍然较低。感知社会压力是“在 PICU 进行患者护理时进行手卫生”行为意向的决定因素，在设计促进性干预措施时需要对手卫生行为决定因素进行分析。
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