Infection Prevention and Control, Boston Children's Hospital, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Infection Prevention and Control, Boston Children's Hospital, Boston, MA.
Am J Infect Control. 2023 May;51(5):514-519. doi: 10.1016/j.ajic.2023.01.013. Epub 2023 Mar 16.
Hand hygiene (HH) is critical to prevent health care-associated infections (HAIs). Clinician perspectives on maintaining high reliability are poorly defined.
We surveyed physicians, nurse practitioners, and physician assistants to understand perceptions of and barriers to high reliability in HH. The Systems Engineering Initiative for Patient Safety 2.0 model was used to develop an electronic survey exploring 6 human factors engineering (HFE) domains.
Among 61 respondents, 70% perceived HH as "essential" to patient safety. While 87% reported alcohol-based hand rub (ABHR) availability as very effective in improving HH reliability, 77% reported dispensers to be "sometimes" or "often" empty. Clinicians in surgery/anesthesia were more likely than those in medical specialties to note skin irritation from ABHR (OR 4.94; 95% CI 1.37-17.81) and less likely to believe feedback was effective in improving HH (OR 0.26; 95% CI 0.08-0.88). One quarter of respondents indicated the layout of patient care areas was not conducive to performing HH. Staffing shortages and the pace and demands of work precluded HH for 15% and 11% of respondents, respectively.
Aspects of organizational culture, environment, tasks, and tools were identified as barriers to high reliability in HH. HFE principles can be applied to more effectively promote HH.
手部卫生（HH）对于预防医疗保健相关感染（HAI）至关重要。临床医生对保持高可靠性的看法尚未得到明确界定。
我们调查了医生、护士从业者和医师助理，以了解他们对 HH 高可靠性的看法和障碍。使用患者安全系统工程倡议 2.0 模型开发了一项电子调查，探索了 6 个人因工程（HFE）领域。
在 61 名受访者中，70%认为 HH“对患者安全至关重要”。虽然 87%的人报告说，酒精基洗手液（ABHR）的可用性非常有效地提高了 HH 的可靠性，但 77%的人报告说分配器“有时”或“经常”空着。与医学专业的临床医生相比，手术/麻醉科的临床医生更有可能注意到 ABHR 引起的皮肤刺激（OR 4.94；95%CI 1.37-17.81），并且不太相信反馈能有效改善 HH（OR 0.26；95%CI 0.08-0.88）。四分之一的受访者表示，患者护理区域的布局不利于进行 HH。分别有 15%和 11%的受访者表示人员短缺和工作节奏和需求妨碍了 HH。
组织文化、环境、任务和工具等方面被确定为 HH 高可靠性的障碍。可以应用 HFE 原则来更有效地促进 HH。
