Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany.
Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany.
J Hosp Infect. 2019 Nov;103(3):321-327. doi: 10.1016/j.jhin.2019.06.004. Epub 2019 Jun 18.
Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing.
To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy.
We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance.
Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected.
Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.
即使在易感染程序（根据世界卫生组织（WHO）的指示 2，“无菌操作前”）之前，手部卫生依从性仍然令人失望。
通过实施戴手套的手部消毒作为资源中性的流程优化策略来提高手部卫生依从性。
我们在干细胞移植病房进行了一项三阶段干预研究。在基线评估手部卫生依从性（第 1 阶段）后，允许（第 2 阶段）和限制（第 3 阶段）戴手套的手部消毒，以评估和区分学习和时间效果的干预。通过主动监测记录严重感染和医院获得性多药耐药菌的发生率。
当允许戴手套的手部消毒时，手部卫生依从性从 50%显著提高到 76%（P<0.001）。对于易感染程序（WHO 2），增幅最大，从 31%提高到 65%；P<0.001。严重感染呈下降趋势（从每 1000 个患者日 6.0 例降至 2.5 例），而多药耐药菌的传播并未受到影响。
戴手套的手部消毒显著提高了手部卫生的依从性，尤其是在与感染和感染预防相关的活动中。因此，这种流程优化可能是高度脆弱患者群体的另一种易于实施、资源中性的工具。
