新型冠状病毒肺炎对医院手卫生执行情况的影响：使用群组电子监测的多中心观察性研究。
Impact of COVID-19 on hospital hand hygiene performance: a multicentre observational study using group electronic monitoring.
机构信息
Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont.
出版信息
CMAJ Open. 2021 Dec 14;9(4):E1175-E1180. doi: 10.9778/cmajo.20210072. Print 2021 Oct-Dec.
BACKGROUND
Reliable reports on hand hygiene performance throughout the COVID-19 pandemic are lacking as most hospitals continue to rely on direct observation to measure this quality indicator. Using group electronic hand hygiene monitoring, we sought to assess the impact of COVID-19 on adherence to hand hygiene.
METHODS
Across 12 Ontario hospitals (5 university and 7 community teaching hospitals), a group electronic hand hygiene monitoring system was installed before the pandemic to provide continuous measurement of hand hygiene adherence across 978 ward and 367 critical care beds. We performed an interrupted time-series study of institutional hand hygiene adherence in association with a COVID-19 inpatient census and the Ontario daily count of COVID-19 cases during a baseline period (Nov. 1, 2019, to Feb. 29, 2020), the pre-peak period of the first wave of the pandemic (Mar. 1 to Apr. 24, 2020), and the post-peak period of the first wave (Apr. 25 to July 5, 2020). We used a Poisson regression model to assess the association between the hospital COVID-19 census and institutional hand hygiene adherence while adjusting for the correlation within inpatient units.
RESULTS
At baseline, the rate of hand hygiene adherence was 46.0% (6 325 401 of 13 750 968 opportunities) and this improved beginning in March 2020 to a daily peak of 79.3% (66 640 of 84 026 opportunities) on Mar. 30, 2020. Each patient admitted with COVID-19 was associated with improved hand hygiene adherence (incidence rate ratio [IRR] 1.0621, 95% confidence interval [CI] 1.0619-1.0623). Increasing Ontario daily case count was similarly associated with improved hand hygiene (IRR 1.0026, 95% CI 1.0021-1.0032). After peak COVID-19 community and inpatient numbers, hand hygiene adherence declined and returned to baseline.
INTERPRETATION
The first wave of the COVID-19 pandemic was associated with significant improvement in hand hygiene adherence, measured using a group electronic monitoring system. Future research should seek to determine whether strategies that focus on health care worker perception of personal risk can achieve sustainable improvements in hand hygiene performance.
背景
由于大多数医院继续依赖直接观察来衡量手部卫生质量指标，因此缺乏有关整个 COVID-19 大流行期间手部卫生执行情况的可靠报告。我们使用群组电子手部卫生监测，旨在评估 COVID-19 对遵守手部卫生的影响。
方法
在安大略省的 12 家医院（5 家大学医院和 7 家社区教学医院）中，在大流行之前安装了群组电子手部卫生监测系统，以便对 978 张病房和 367 张重症监护病床的手部卫生依从率进行连续测量。我们对机构手部卫生依从性进行了一项中断时间序列研究，该研究与 COVID-19 住院患者普查以及安大略省 COVID-19 病例每日计数相关联，时间范围是基线期（2019 年 11 月 1 日至 2 月 29 日）、大流行第一波的前期（2020 年 3 月 1 日至 4 月 24 日）和第一波的后期（2020 年 4 月 25 日至 7 月 5 日）。我们使用泊松回归模型来评估医院 COVID-19 普查与机构手部卫生依从性之间的关联，同时在住院患者单元内进行相关性调整。
结果
在基线期，手部卫生依从率为 46.0%（13 750 968 次机会中的 6 325 401 次），从 2020 年 3 月开始改善，于 2020 年 3 月 30 日达到每日峰值 79.3%（84 026 次机会中的 66 640 次）。每例确诊 COVID-19 的患者均与手部卫生依从性的提高相关（发病率比 [IRR] 1.0621，95%置信区间 [CI] 1.0619-1.0623）。安大略省每日病例数的增加也与手部卫生的改善有关（IRR 1.0026，95%CI 1.0021-1.0032）。在 COVID-19 社区和住院患者数量达到高峰后，手部卫生依从性下降并恢复到基线水平。
解释
使用群组电子监测系统测量，第一波 COVID-19 大流行与手部卫生依从性的显著改善有关。未来的研究应寻求确定是否可以通过关注卫生保健工作者对个人风险的认知的策略来实现手部卫生执行情况的可持续改善。
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