家庭保健中手部卫生习惯的观察。
Observation of Hand Hygiene Practices in Home Health Care.
机构信息
Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA.
出版信息
J Am Med Dir Assoc. 2021 May;22(5):1029-1034. doi: 10.1016/j.jamda.2020.07.031. Epub 2020 Sep 15.
OBJECTIVE
To describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits.
DESIGN
Observational study of nurse hand hygiene practices.
SETTING
and Participants: Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency.
METHODS
Two researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's "5 Moments for Hand Hygiene" validated observation tool was used to record opportunities and actual practices of hand hygiene, with 3 additional opportunities specific to the HHC setting. Patient assessment data available in the agency electronic health record and a nurse demographic questionnaire were also collected to describe patients and nurse participants.
RESULTS
A total of 2014 opportunities were observed. On arrival in the home was the most frequent opportunity (n = 384), the least frequent was after touching a patient's surroundings (n = 43). The average hand hygiene adherence rate was 45.6% after adjusting for clustering at the nurse level. Adherence was highest after contact with body fluid (65.1%) and lowest after touching a patient (29.5%). The number of hand hygiene opportunities was higher when patients being served were at increased risk of an infection-related emergency department visit or hospitalization and when the home environment was observed to be "dirty." No nurse or patient demographic characteristics were associated with the rate of nurse hand hygiene adherence.
CONCLUSIONS AND IMPLICATIONS
Hand hygiene adherence in HHC is suboptimal, with rates mirroring those reported in hospital and outpatient settings. The connection between poor hand hygiene and infection transmission has been well studied, and it has received widespread attention with the outbreak of SARS-CoV-2. Agencies can use results found in this study to better inform quality improvement initiatives.
目的
描述家庭保健（HHC）环境中护士的手部卫生实践、护士对手部卫生指南的依从性，以及与家庭护理访问期间手部卫生机会相关的因素。
设计
护士手部卫生实践的观察性研究。
设置和参与者
观察了在一家大型非营利性 HHC 机构服务的患者家中执业/实习护士和注册护士。
方法
两名研究人员观察了 50 名护士进行的 400 次家庭护理访问。使用世界卫生组织（WHO）“5 个手部卫生时刻”验证的观察工具记录手部卫生机会和实际实践，另外还有 3 个特定于 HHC 环境的机会。还收集了可在机构电子健康记录中获得的患者评估数据和护士人口统计问卷，以描述患者和护士参与者。
结果
共观察到 2014 个机会。到达家庭是最常见的机会（n=384），最不常见的是触摸患者周围环境后（n=43）。调整护士水平聚类后，手部卫生依从率平均为 45.6%。接触体液后依从性最高（65.1%），接触患者后最低（29.5%）。当服务患者的风险增加感染相关急诊就诊或住院风险时，以及当家庭环境被观察到“肮脏”时，手部卫生机会的数量更高。没有护士或患者人口统计学特征与护士手部卫生依从率相关。
结论和意义
HHC 中的手部卫生依从性不理想，其比率与医院和门诊环境报告的比率相似。手部卫生不良与感染传播之间的联系已经得到了很好的研究，并且随着 SARS-CoV-2 的爆发，它受到了广泛的关注。机构可以使用本研究中的结果更好地为质量改进计划提供信息。
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