Sunnybrook Health Sciences Centre, Toronto, Canada.
Sunnybrook Research Institute, Toronto, Canada.
Clin Infect Dis. 2020 Dec 17;71(10):e680-e685. doi: 10.1093/cid/ciaa412.
The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking.
A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections.
After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47-1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months (P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53-1.04]; P = .08).
The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH.
目前衡量手卫生（HH）的方法依赖于人工审核员，他们只能捕捉到<1%的 HH 机会，并且很快被员工识别出来，导致绩效膨胀。群体电子监测是一种经过验证的测量 HH 依从性的方法，但缺乏证明该技术临床效果的数据。
在加拿大安大略省的 5 家急性护理医院的 26 个住院内科和外科病房进行了一项逐步楔形集群随机质量改进研究。该干预措施包括通过群体电子监测进行日常 HH 报告，以指导以单位为基础的改进策略。主要结果是基线和干预之间每月 HH 依从率（百分比）。次要结果包括耐抗生素的生物体（如耐甲氧西林金黄色葡萄球菌（MRSA））和其他医疗保健相关感染的传播。
在调整了住院病房内和医院内的相关性后，与干预相关的 HH 依从率有显著提高（发生率比[IRR]，1.73 [95%置信区间{CI}，1.47-1.99]；P<0.0001）。与干预相关的每月 HH 依从率从干预前的 29%（1 395 450/4 544 144）增加到干预后的 37%（598 035/1 536 643），1 个月内持续增加，直到 10 个月后增加到 53%（804 108/1 515 537）（P<0.0001）。MRSA 的医疗保健相关传播有减少的趋势（IRR，0.74 [95% CI，.53-1.04]；P=0.08）。
引入群体电子监测系统在两年内迅速显著提高了 HH 性能。与直接观察相比，这种方法在测量和改善 HH 方面具有显著优势。
