Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea.
College of Nursing, The Catholic University of Korea, Seoul, South Korea.
J Hosp Infect. 2019 Aug;102(4):394-406. doi: 10.1016/j.jhin.2019.03.013. Epub 2019 Mar 30.
The emergency department (ED) is where hand hygiene problems are significant as the procedures in the ED are often high risk and invasive. To date, there have been no comprehensive reviews on hand hygiene in EDs. The aim of this study was to investigate hand hygiene compliance (HHC) rate, factors affecting the HHC rate, and intervention strategies to improve HHC in EDs. Electronic databases were used to search for research published from 1948 to January 2018. The databases included ovidMEDLINE, ovidEMBASE, the Cochrane Library, CINAHL, Koreamed, and Kmbase. All study designs were included. Two reviewers independently extracted the data and assessed the bias risk using reliable and validated tools. A narrative synthesis was performed. Twenty-four studies, including 12 cross-sectional surveys and 12 interventional studies, were included. Of the 12 interventional studies reviewed, only 33% (N = 4) reported HHC rates of more than 50%. Factors that influenced HHC included types of healthcare worker, hand hygiene indication, ED crowding, positive attitudes towards HHC, patient location, auditing hand hygiene, and type of shift. Almost all of the studies (83.3%) applied multimodal or dual interventions to improve HHC. A range of strategies, including education, monitoring and providing feedback, campaigns, and cues, effectively improved HHC. The review findings indicate that there is a room for improvement in HHC in EDs. Future randomized controlled trials are necessary to determine which intervention modalities are most effective and sustainable for HHC improvement.
急诊科（ED）是手部卫生问题显著的地方，因为 ED 中的程序通常具有高风险和侵入性。迄今为止，尚无关于 ED 手部卫生的综合审查。本研究的目的是调查 ED 中的手部卫生依从性（HHC）率、影响 HHC 率的因素以及改善 ED 中 HHC 的干预策略。使用电子数据库搜索了 1948 年至 2018 年 1 月发表的研究。这些数据库包括 ovidMEDLINE、ovidEMBASE、Cochrane 图书馆、CINAHL、Koreamed 和 Kmbase。纳入了所有研究设计。两名审查员独立提取数据，并使用可靠和经过验证的工具评估偏倚风险。进行了叙述性综合。共纳入 24 项研究，包括 12 项横断面调查和 12 项干预研究。在审查的 12 项干预研究中，只有 33%（N=4）报告的 HHC 率超过 50%。影响 HHC 的因素包括医护人员类型、手部卫生指征、ED 拥挤程度、对 HHC 的积极态度、患者位置、手部卫生审核以及轮班类型。几乎所有研究（83.3%）都应用了多种模式或双重干预措施来改善 HHC。一系列策略，包括教育、监测和提供反馈、运动和提示，有效地提高了 HHC。审查结果表明，ED 中的 HHC 还有改进的空间。需要未来的随机对照试验来确定哪些干预模式对改善 HHC 最有效和可持续。
