多模式干预以提高三级保健中心的手卫生依从性。
A multimodal intervention to improve hand hygiene compliance in a tertiary care center.
机构信息
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
出版信息
Am J Infect Control. 2018 Jul;46(7):775-780. doi: 10.1016/j.ajic.2017.12.017. Epub 2018 May 9.
BACKGROUND
Healthcare-associated infections (HAIs) are a major threat to patient safety worldwide. HAIs are mainly transmitted via the hands of healthcare workers (HCWs), and HCW compliance with hand hygiene (HH) practices is reportedly low. Therefore, multimodal interventions are needed to develop effective HH improvement strategies. In this study, we assessed the effect of multimodal interventions on improvement of HH compliance.
METHODS
This study was conducted in 2 intensive care units from August 2016 to October 2016. It encompassed 3 phases: pre-intervention (20 days), intervention (1 month), and post-intervention (20 days). A total of 53 HCWs, including physicians, nurses, and housekeeping staff, were included in the HH audit. The audit was analyzed by direct observation and by a completed knowledge, attitude, and practice (KAP) questionnaire.
RESULTS
A total of 6350 HH opportunities were recorded; the results were 34.7%, 35%, and 69.7% for hand hygiene complete adherence rate (HHCAR), hand hygiene partial adherence rate (HHPAR), and hand hygiene adherence rate (HHAR), respectively. The HHCAR in the pre-intervention and post-intervention phases were 3% and 70.1%, respectively. HHCAR was highest among nurses (3.6% in the pre-intervention phase and 80.7% in the post-intervention phase). Other findings were that senior physicians had better HH compliance than junior physicians; in the pre-intervention phase, the HHCAR was better in the evening (4.8%); in the post-intervention phase, the HHCAR was better in the morning (72.1%); women had a higher HHCAR than men; and in the pre-intervention phase, good compliance was seen with Moments 2 and 3 of the World Health Organization's (WHO) Five Moments for Hand Hygiene, whereas in the post-intervention phase, good compliance was seen with Moments 3, 4, and 5. Questionnaire-based data were also analyzed to assess KAP of HH. We found that only 55%-82% of HCWs were aware of the WHO's Five Moments for Hand Hygiene. In the post-intervention phase, we observed a significant improvement in KAP of the study group.
CONCLUSION
Significant improvement in HH compliance can be achieved through a systematic, multidimensional intervention involving all types of HCWs.
背景
医疗保健相关感染（HAI）是全球范围内患者安全的主要威胁。HAI 主要通过医护人员（HCW）的手传播，据报道，HCW 对手卫生（HH）实践的依从性较低。因此，需要采取多模式干预措施来制定有效的 HH 改善策略。在这项研究中，我们评估了多模式干预对 HH 依从性改善的效果。
方法
这项研究于 2016 年 8 月至 10 月在 2 个重症监护病房进行，包括 3 个阶段：干预前（20 天）、干预（1 个月）和干预后（20 天）。共有 53 名 HCW，包括医生、护士和保洁人员，参与了 HH 审核。审核通过直接观察和完成的知识、态度和实践（KAP）问卷进行分析。
结果
共记录了 6350 次 HH 机会，HH 完全依从率（HHCAR）、HH 部分依从率（HHPAR）和 HH 依从率（HHAR）分别为 34.7%、35%和 69.7%。干预前和干预后的 HHCAR 分别为 3%和 70.1%。护士的 HHCAR 最高（干预前阶段为 3.6%，干预后阶段为 80.7%）。其他发现包括：资深医生的 HH 依从性优于初级医生；干预前阶段，晚上 HH 依从性较好（4.8%）；干预后阶段，早上 HH 依从性较好（72.1%）；女性的 HH 依从性高于男性；干预前阶段，符合世界卫生组织（WHO）的五个手卫生时刻中的时刻 2 和时刻 3 的 HH 依从性较好，而干预后阶段，时刻 3、4 和 5 的 HH 依从性较好。还分析了基于问卷的数据，以评估 HH 的 KAP。我们发现只有 55%-82%的 HCW 知道 WHO 的五个手卫生时刻。在干预后阶段，研究组的 KAP 观察到显著改善。
结论
通过涉及所有类型 HCW 的系统、多维干预措施，可以显著提高 HH 依从性。
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