Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.
Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
J Clin Nurs. 2019 Mar;28(5-6):912-919. doi: 10.1111/jocn.14703. Epub 2018 Nov 14.
To explore whether an iterative process of information and training paired with a feedback system to observed healthcare professionals and the respective management improves hand hygiene (HH) compliance.
Healthcare-associated infections are a major risk for patient safety, and adherence to the "My five moments" (M5M) for HH varies significantly within organisations as well as within healthcare professional groups. Identified barriers in a baseline survey revealed the need of more information, training, repetitive compliance measurements and feedback to all healthcare professionals.
A quality improvement project using the method of direct observation of healthcare professionals in nonsurgical and surgical wards.
Between 2013 and 2017, 6,009 healthcare professionals were informed and trained, and HH compliance measurements were performed by hygiene experts. Compliance measurement results were documented in an online tool to give an immediate feedback to observed healthcare professionals. Additionally, a report was forwarded to the management of the respective department to raise awareness. Compliance rates per year were descriptively summarised. The research and reporting methodology followed SQUIRE 2.0.
In total, 84 compliance measurements with 19,295 "M5M for HH" were observed in 49 wards. Overall, mean HH compliance increased from 81.9 ± 5.2% in 2013 to 94.0 ± 3.6% in 2017. Physicians' HH compliance rate improved from 69.0 ± 16.6% to 89.3 ± 6.6%, that of nurses from 86.0 ± 6.9% to 96.4 ± 3.1%, and that of others from 60.5 ± 27.9% to 83.8 ± 20.2%. All M5M for HH (#1-#5) increased over the study period (#1: +16.9%; #2: +20.5%; #3: +7.6%; #4: +5.9%; #5: +12.7%).
Results demonstrated that an iterative process of information, training, observation and feedback over a period of 5 years can be successful in increasing HH compliance. Positive trends were observed for HH compliance rates across all healthcare professional groups as well as for all M5M for HH.
探索信息和培训的迭代过程，加上对医护人员和相应管理层的观察反馈系统，是否能提高手卫生（HH）依从性。
医疗保健相关感染是患者安全的主要风险，医疗机构内以及医护人员群体内部的 HH 依从性“五个时刻”（M5M）差异很大。基线调查中发现的障碍表明，所有医护人员都需要更多的信息、培训、反复的依从性测量和反馈。
使用直接观察非手术和手术病房医护人员的方法进行质量改进项目。
在 2013 年至 2017 年间，共有 6009 名医护人员接受了告知和培训，HH 依从性测量由卫生专家进行。依从性测量结果记录在在线工具中，以便立即向被观察的医护人员反馈。此外，还向相关部门管理层提交了一份报告，以提高他们的意识。每年的依从率进行描述性总结。研究和报告方法遵循 SQUIRE 2.0 标准。
共进行了 84 次依从性测量，观察了 49 个病房的 19295 次“HH 的五个时刻”。总体而言，HH 依从率从 2013 年的 81.9±5.2%提高到 2017 年的 94.0±3.6%。医生的 HH 依从率从 69.0±16.6%提高到 89.3±6.6%，护士的依从率从 86.0±6.9%提高到 96.4±3.1%，其他人员的依从率从 60.5±27.9%提高到 83.8±20.2%。所有 M5M（#1-#5）在研究期间均有所增加（#1：+16.9%；#2：+20.5%；#3：+7.6%；#4：+5.9%；#5：+12.7%）。
结果表明，在 5 年的时间里，通过信息、培训、观察和反馈的迭代过程，可以成功提高 HH 依从性。所有医护人员群体以及所有 M5M 的 HH 依从率都呈现出积极的趋势。
