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重症监护病房医护人员手部卫生依从性的改善

Improvement of hand hygiene compliance among health care workers in intensive care units.

作者信息

Anwar M M, Elareed H R

机构信息

Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Egypt.

出版信息

J Prev Med Hyg. 2019 Mar 29;60(1):E31-E35. doi: 10.15167/2421-4248/jpmh2019.60.1.918. eCollection 2019 Mar.

Abstract

AIM

Hand hygiene (HH) is an essential component in preventing healthcare associated infections. The purpose of this study was to evaluate HH compliance among health care workers (HCWs) in intensive care units at Beni-Suef university hospital, Egypt before and after an intervention educational program.

METHODS

Data were collected by using the standardized WHO method for direct observation ''Five moments for HH'' approach. Observations were conducted in six ICUs before intervention (March to April 2017) and after the intervention (July to August 2017). The study included 608 opportunities (observations) among 177 HCWs collected before and 673 opportunities among 163 HCWs collected after the intervention.

RESULTS

Overall HH compliance increased significantly from 30.9 (95% CI: 27.2-34.6%) before intervention to 69.5 (95% CI: 65.2-72.6%) post intervention; with the highest HH compliance rate among nurses compared to physicians and workers (P = 0.001). Significantly higher HH compliance rates were observed after body fluid exposure, before aseptic procedures, and after patient contact compared to before patient contact and after patient surrounding contact (P = 0.001). In binary logistic regression analyses a statistically significant difference was shown (P = 0.047) for HH compliance among events before and after patient contact (OR = 1.399, 95% CI: 1.004-1.948).

CONCLUSIONS

The interventional educational program improved the HH compliance among ICUs-HCWs at Beni-Suef university hospital. The hospital should conduct monthly observational monitoring for the ICUs units sharing the findings to spread best practices. Provision of sustained training programs to help efficient and effective HH for care delivery is mandatory.

摘要

目的

手卫生是预防医疗相关感染的重要组成部分。本研究的目的是评估埃及贝尼苏韦夫大学医院重症监护病房医护人员在干预教育项目前后的手卫生依从性。

方法

采用世界卫生组织标准化的直接观察法“手卫生的五个时刻”收集数据。在干预前(2017年3月至4月)和干预后(2017年7月至8月)对六个重症监护病房进行观察。该研究包括干预前收集的177名医护人员中的608次观察机会,以及干预后收集的163名医护人员中的673次观察机会。

结果

总体手卫生依从性从干预前的30.9%(95%可信区间:27.2-34.6%)显著提高到干预后的69.5%(95%可信区间:65.2-72.6%);护士的手卫生依从率高于医生和其他工作人员(P = 0.001)。与接触患者前和接触患者周围环境后相比,在接触体液后、进行无菌操作前和接触患者后观察到显著更高的手卫生依从率(P = 0.001)。在二元逻辑回归分析中,接触患者前后事件的手卫生依从性显示出统计学显著差异(P = 0.047)(比值比=1.399,95%可信区间:1.004-1.948)。

结论

干预教育项目提高了贝尼苏韦夫大学医院重症监护病房医护人员的手卫生依从性。医院应每月对重症监护病房进行观察监测,并分享结果以推广最佳实践。必须提供持续培训项目,以帮助在护理过程中高效有效地进行手卫生。

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