Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany; Department of Anaesthesiology and Intensive Care, Hospital of Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany.
Am J Infect Control. 2023 Oct;51(10):1167-1171. doi: 10.1016/j.ajic.2023.04.007. Epub 2023 Apr 11.
Hand disinfection (HD) is known to be the single most effective prevention measure to avoid nosocomial infections, but the compliance rate (CR) remains low. The aim of this study was to determine the incidence of HD opportunities and the CR during the treatment of critically ill patients. One special focus was on glove usage to determine whether gloves were substituted for HD.
This is a single-blinded direct observation of employees of an.ßintensive care unit. One specially educated observer recorded all hand hygiene indications over a period of 21 8-hour shifts as well as performed HD and study of glove use behavior.
Over a period of 168.ßhours, 2,036 HDs should be performed during the care for 1 intensive care unit patient. In total, only 690 HDs occurred, resulting in a CR of 33.9%. With regard to the nurses, there was an HD opportunity around the clock every 6.ßminutes on average. About 17% of the total working time would have to be applied for 100% correct hand hygiene application. Donning or changing of gloves took place in 38.2% of all indications for HD.
Our results show that HD opportunities occur in high frequency during the treatment of critically ill patients. The compliance with HD remains too low, even when a 100% CR seems to be unachievable. Improvements should focus on aseptic procedures, combining the lowest CR with the highest procedural risk for the patient. The Healthcare Personal (HCP) uses gloves when an HD opportunity occurs. Implementing glove disinfection strategies in daily routine might help optimize patient care.
手部消毒（HD）是预防医院感染的最有效措施，但依从率（CR）仍然较低。本研究旨在确定治疗危重病患者时 HD 机会的发生率和 CR。特别关注的一点是手套的使用，以确定是否用手套代替了 HD。
这是对重症监护病房员工的单盲直接观察。一名受过专门培训的观察员在 21 个 8 小时轮班期间记录了所有手部卫生指征，并进行了 HD 和手套使用行为研究。
在 168 个小时的时间内，应为 1 名重症监护病房患者的护理进行 2036 次 HD。总共只发生了 690 次 HD，CR 为 33.9%。对于护士来说，平均每 6 分钟就有一次 HD 机会。大约 17%的总工作时间将用于 100%正确的手部卫生应用。在所有进行 HD 的指征中，戴手套或更换手套的情况占 38.2%。
我们的结果表明，在治疗危重病患者时，HD 机会频繁发生。即使 100%的 CR 似乎无法实现，HD 的依从率仍然过低。改进应侧重于无菌程序，将最低的 CR 与患者的最高程序风险结合起来。当发生 HD 机会时，医疗保健人员（HCP）会使用手套。在日常工作中实施手套消毒策略可能有助于优化患者护理。
