Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department Antimcrobial Resistance and Healthcare related Infections of the unit Epidemiology and Surveillance of the Centre for Infectious Disease Control of the National Institute, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
Antimicrob Resist Infect Control. 2022 Mar 18;11(1):50. doi: 10.1186/s13756-022-01088-w.
Hand hygiene is an important measure to prevent healthcare-associated infections in long-term care facilities.
To evaluate compliance with hand hygiene recommendations by different nursing professionals in long-term care facilities and to investigate determinants potentially influencing hand hygiene and whether these differed between the different cadres of staff.
We conducted two sub-studies: we measured hand hygiene compliance of 496 professionals in 14 long-term care facilities (23 wards) through direct observation using World Health Organisation's 'five moments of hand hygiene' observation tool. In addition, we performed a survey to examine determinants that may influence hand hygiene and to determine differences between different cadres of staff. We used a principal component analysis approach with varimax rotation to explore the underlying factor structure of the determinants.
We found an overall mean hand hygiene compliance of 17%. There was considerable variation between wards (5-38%) and between specific World Health Organization hand hygiene moments. In addition, hand hygiene compliance varied widely within and between different cadres of staff. The determinant analysis was conducted on 177 questionnaires. For all nursing professionals, we found multiple determinants in four domains: 'social context and leadership', 'resources', 'individual healthcare professional factors' and 'risk perception'. In two domains, several barriers were perceived differently by nursing assistants and nurses. In the domain 'social context and leadership', this included (1) how the manager addresses barriers to enable hand hygiene as recommended and (2) how the manager pays attention to correct adherence to the hand hygiene guidelines. In the 'risk perception' domain, this included a resident's risk of acquiring an infection as a result of the nursing professional's failure to comply with the hand hygiene guidelines.
Hand hygiene compliance was low and influenced by multiple factors, several of which varied among different cadres of staff. When designing interventions to improve hand hygiene performance in long-term care facilities, strategies should take into account these determinants and how they vary between different cadres of staff. We recommend exploring hand hygiene determinants at ward level and among different cadres of staff, for example by using our exploratory questionnaire.
Registration number 50-53000-98-113, 'Compliance with hand hygiene in nursing homes: go for a sustainable effect' on ClinicalTrials.gov. Date of registration 28-6-2016.
手部卫生是预防长期护理机构中发生医源性感染的重要措施。
评估不同护理专业人员在长期护理机构中遵守手部卫生建议的情况，并调查可能影响手部卫生的决定因素，以及这些因素在不同员工群体之间是否存在差异。
我们进行了两项子研究：通过使用世界卫生组织的“五个手部卫生时刻”观察工具对 14 家长期护理机构（23 个病房）的 496 名专业人员进行直接观察，测量手部卫生依从率。此外，我们进行了一项调查，以检查可能影响手部卫生的决定因素，并确定不同员工群体之间的差异。我们使用主成分分析方法和方差极大旋转来探索决定因素的潜在结构。
我们发现总体手部卫生依从率为 17%。病房之间（5%-38%）和特定的世界卫生组织手部卫生时刻之间存在相当大的差异。此外，不同员工群体之间和内部的手部卫生依从率差异很大。决定因素分析是在 177 份问卷上进行的。对于所有护理专业人员，我们在四个领域发现了多个决定因素：“社会背景和领导力”、“资源”、“个体医护人员因素”和“风险感知”。在两个领域，护理助理和护士对多个障碍的感知存在差异。在“社会背景和领导力”领域，这包括（1）经理如何解决障碍以按照建议促进手部卫生，以及（2）经理如何关注正确遵守手部卫生指南。在“风险感知”领域，这包括由于护理专业人员不遵守手部卫生指南而导致居民感染的风险。
手部卫生依从率较低，受多种因素影响，其中一些因素在不同员工群体之间存在差异。在设计提高长期护理机构手部卫生绩效的干预措施时，策略应考虑这些决定因素以及它们在不同员工群体之间的差异。我们建议在病房层面和不同员工群体中探索手部卫生决定因素，例如使用我们的探索性问卷。
注册号 50-53000-98-113，“养老院的手部卫生依从性：追求可持续效果”，在 ClinicalTrials.gov 上。注册日期 2016 年 6 月 28 日。
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