School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India.
Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India.
J Pediatric Infect Dis Soc. 2019 Nov 6;8(5):408-413. doi: 10.1093/jpids/piy076.
Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit.
We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively.
A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9-5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36-16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities.
Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.
本研究旨在量化医疗保健提供者遵守手卫生协议的情况，并为资源匮乏的新生儿重症监护病房提高手卫生依从性制定一个概念框架。
我们制定了一个分三个阶段的干预措施，包括部门讨论、审核和后续行动。在夜间和日间班次进行了为期四个月的非介入式审核。审核结果进行了呈现，并共同制定了一个提高手卫生依从性的障碍和解决方案的概念框架。
共观察到 1308 次手卫生机会。在 1227 次计划的患者接触中，观察到手洗事件（707 次[58.6%]）、手搓事件（442 次[36%]）和未进行手卫生事件（78 次[6.4%]）。在复苏过程中，未进行手卫生的发生率为 20%。在复苏过程中，未进行手卫生的机会比计划接触时多发生 3.2 倍（95%置信区间，1.9-5.3 倍），当医护人员在患者之间移动时，未进行手卫生的机会多发生 6.14 倍（95%置信区间，2.36-16.01 倍）。通过全体新生儿重症监护病房团队成员参与的根本原因分析，确定了手卫生不合规的结构和过程决定因素。手洗平均持续时间为 40 秒。在 83%的情况下，洗手后忽略了擦干手。在 77%的情况下，手洗后出现了手部再污染。在 27%的手洗事件中，只洗到了肘部水平。在科室审查研究结果后，在每个婴儿床旁放置了手搓消毒剂，以解决这些遗漏的机会。
在复苏过程中和患者接触之间，手卫生情况并不理想。我们通过根本原因分析制定了一个改进手卫生的概念框架。
