Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Clin Infect Dis. 2021 Mar 1;72(5):814-820. doi: 10.1093/cid/ciaa130.
Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs' hand hygiene compliance.
We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs-2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities.
Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95-.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10-1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses' hand hygiene compliance was better than physicians' (aOR, 0.94 [95% CI, .91-.97]) and other HCWs' compliance (aOR, 0.87 [95% CI, .87-.94]).
Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.
大多数关于手卫生的文章要么报告总体依从性，要么报告特定手卫生时刻的依从性。如果医护人员（HCWs）不遵守这些时刻，那么这些时刻对患者的风险程度就会有所不同。我们评估了任务类型如何影响 HCWs 的手卫生依从性。
我们将 STAR*ICU 研究中连续的 HCWs 执行的任务链接到护理序列中，并识别出任务对-2 个连续的任务和干预的手卫生机会。我们将任务定义为关键任务和/或污染任务。我们使用带有随机效应的逻辑回归来确定关键任务和污染任务发生的几率，以及手卫生依从性的几率，调整了隔离预防措施、手套使用、HCW 类型和先前机会的依从性。
与其他任务相比，HCWs 在执行关键任务前进行手卫生的可能性较低（调整后的优势比 [aOR]，0.97 [95%置信区间 {CI}，0.95-0.98]），而在执行污染任务后进行手卫生的可能性较高（aOR，1.12 [95% CI，1.10-1.13]）。护士更有可能执行关键任务和污染任务，但护士的手卫生依从性优于医生（aOR，0.94 [95% CI，0.91-0.97]）和其他 HCWs 的依从性（aOR，0.87 [95% CI，0.87-0.94]）。
与执行关键任务前相比，HCWs 在执行污染任务后更有可能进行手卫生，这表明习惯和厌恶感可能会影响手卫生依从性。这些信息可以纳入干预措施，以改善手卫生实践，特别是在执行关键任务前和执行污染任务后。
