Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan; Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
J Infect Chemother. 2021 Feb;27(2):329-335. doi: 10.1016/j.jiac.2020.12.002. Epub 2020 Dec 17.
Hand hygiene is crucial for infection control in long-term care facilities for elderly (LTCFEs), because it can be easily implemented in the low-resource settings of LTCFEs. This study investigated the actual status of hand hygiene adherence in LTCFEs, identified the factors inhibiting its appropriate implementation, and evaluated the effectiveness of a hand hygiene promotion program.
In this before-and-after study, participants were staff members (n = 142) at two LTCFEs in Gunma Prefecture, Japan. We modified the World Health Organization's "five moments for hand hygiene" and assessed participants' hand hygiene adherence rates in four situations: (1) Before touching around a resident's mucous membrane area; (2) Before medical practice or clean/aseptic procedures; (3) After body fluid exposure/risk or after touching around a resident's mucous membrane area; and (4) After touching a resident's contaminated environments. The study was divided into four phases. In Phase 1, participants self-assessed their hand hygiene adherence using a questionnaire. In Phase 2, we objectively assessed participants' pre-intervention adherence rates. In Phase 3, an intervention comprising various hand hygiene promotion measures, such as education and hands-on training on hand hygiene practices and timings, was implemented. In Phase 4, participants' post-intervention adherence rates were objectively measured.
Although most participants reported high hand hygiene adherence rate in the self-assessment (93.1%), the pre-intervention evaluation revealed otherwise (16.8%). Participants' post-intervention adherence rates increased for all four situations (77.3%).
The intervention program helped increase participants' hand hygiene adherence rates, indicating its effectiveness. Similar interventions in other LTCFEs may also improve adherence rates.
手部卫生对于老年人长期护理机构（LTCFEs）的感染控制至关重要，因为它可以在 LTCFE 的资源有限环境中轻松实施。本研究调查了 LTCFEs 中手部卫生依从性的实际状况，确定了抑制其适当实施的因素，并评估了手部卫生促进计划的效果。
在这项前后对照研究中，参与者为日本群马县两家 LTCFE 的工作人员（n=142）。我们修改了世界卫生组织的“五个手部卫生时刻”，并评估了参与者在四种情况下的手部卫生依从率：（1）在接触居民粘膜区域之前；（2）在进行医疗实践或清洁/无菌操作之前；（3）在接触体液或接触居民粘膜区域后；（4）在接触居民污染环境后。研究分为四个阶段。在第 1 阶段，参与者使用问卷自我评估其手部卫生依从率。在第 2 阶段，我们客观评估了参与者的干预前依从率。在第 3 阶段，实施了包括手部卫生实践和时机教育以及实践培训等各种手部卫生促进措施的干预措施。在第 4 阶段，客观测量了参与者的干预后依从率。
尽管大多数参与者在自我评估中报告了较高的手部卫生依从率（93.1%），但干预前评估结果却并非如此（16.8%）。所有四种情况下参与者的干预后依从率均有所提高（77.3%）。
干预计划有助于提高参与者的手部卫生依从率，表明其有效性。在其他 LTCFEs 中实施类似的干预措施也可能提高依从率。
