School of Public Health, University College Cork, Ireland.
Pathology Department, Bon Secours Hospital, Cork, Ireland.
Epidemiol Infect. 2020 Apr 2;148:e83. doi: 10.1017/S095026882000076X.
Participation in European surveillance for bloodstream infection (BSI) commenced in Ireland in 1999 with all laboratories (n = 39) participating by 2014. Observational hand hygiene auditing (OHHA) was implemented in 2011. The aim of this study was to evaluate the impact of OHHA on hand hygiene compliance, alcohol hand rub (AHR) procurement and the incidence of sensitive and resistant Staphylococcus aureus and Enterococcus faecium and faecalis BSI. A prospective segmented regression analysis was performed to determine the temporal association between OHHA and outcomes. Observed hand hygiene improved from 74.7% (73.7-75.6) in 2011 to 90.8% (90.1-91.3) in 2016. AHR procurement increased from 20.1 l/1000 bed days used (BDU) in 2009 to 33.2 l/1000 BDU in 2016. A pre-intervention reduction of 2% per quarter in the ratio of methicillin sensitive Staphylococcus aureus BSI/BDU stabilized in the time period after the intervention (P < 0.01). The ratio of Methicillin resistant Staphylococcus aureus (MRSA) BSI/BDU was decreasing by 5% per quarter pre-intervention, this slowed to 2% per quarter post intervention, (P < 0.01). There was no significant change in the ratio of vancomycin sensitive (P = 0.49) or vancomycin resistant (P = 0.90) Enterococcus sp. BSI/BDU post intervention. This study shows national OHHA increased observed hand hygiene compliance and AHR procurement, however there was no associated reduction in BSI.
参与欧洲血流感染（BSI）监测始于 1999 年，当时爱尔兰所有实验室（n=39）均参与其中，2014 年全部实验室参与监测。2011 年实施了观察性手卫生审核（OHHA）。本研究旨在评估 OHHA 对手卫生依从性、酒精擦手液（AHR）采购以及敏感和耐药金黄色葡萄球菌和粪肠球菌和屎肠球菌 BSI 的发生率的影响。采用前瞻性分段回归分析来确定 OHHA 与结果之间的时间关联。观察到手卫生从 2011 年的 74.7%（73.7-75.6）提高到 2016 年的 90.8%（90.1-91.3）。AHR 采购从 2009 年的 20.1 升/千床日（BDU）增加到 2016 年的 33.2 升/千床日。干预前每季度敏感型甲氧西林金黄色葡萄球菌 BSI/BDU 比值减少 2%，在干预后稳定下来（P<0.01）。干预前每季度耐甲氧西林金黄色葡萄球菌（MRSA）BSI/BDU 比值减少 5%，干预后减少 2%，（P<0.01）。万古霉素敏感（P=0.49）或万古霉素耐药（P=0.90）肠球菌 BSI/BDU 比值在干预后没有显著变化。本研究表明，全国性 OHHA 提高了观察到手卫生依从性和 AHR 采购，但 BSI 没有减少。
