Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway.
BMC Infect Dis. 2022 Feb 14;22(1):156. doi: 10.1186/s12879-022-07143-6.
Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not.
This observational study used the World Health Organization's observation tool for studying hand hygiene indication and adherence: "My five moments for hand hygiene." For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway.
The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them.
Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers' knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.
医疗机构相关感染是患者安全的主要威胁，尤其是居住在养老院中的弱势老年人群体，他们感染和死亡的风险更高。尽管良好的手部卫生是预防感染的最有效措施，但针对养老院中手部卫生依从性的研究很少。本研究旨在使用经过验证的观察工具，调查养老院中护生观察员的手部卫生依从性。此外，还研究医护人员何时进行手部卫生以及何时不进行手部卫生。
本观察性研究使用世界卫生组织的手部卫生指示和依从性观察工具：“我的五个手部卫生时刻”。2021 年 2 月和 3 月的每周 1 天，105 名护理专业一年级学生在挪威一个大城市的 20 个养老院病房中进行了 7316 次手部卫生观察。
本研究的总体依从率为 58.3%。手部卫生依从率从 2 月的 65.8%下降到 3 月的 51.4%。不同病房之间的依从率差异很大，从 26.4%到 83.1%不等，且与职业状态、手部卫生指征和手套使用有关。护理学生的依从率最高，其次是护士。戴手套会降低依从率。医护人员在接触患者后比在接近患者前更倾向于进行手部卫生。
手部卫生依从率太低，无法保护所有居民免受医疗机构相关感染，本研究结果表明，有许多因素会影响手部卫生依从率，例如教育、职业状态和手套使用。需要提高医护人员对手部卫生的知识和技能，以减少医疗机构相关感染，必须持续开展对手部卫生依从性重要性的提醒活动。需要采取干预措施提高医护人员的手部卫生依从性，以减少养老院中的感染和抗生素使用。
