Larson E L, Bryan J L, Adler L M, Blane C
Georgetown University School of Nursing, Washington DC 20005, USA.
Am J Infect Control. 1997 Feb;25(1):3-10. doi: 10.1016/s0196-6553(97)90046-8.
Few interventions to influence handwashing have had measurable effects. This prospective quasi-experimental study was designed to address predisposing, enabling, and reinforcing factors to improve frequency of handwashing.
Over a 12-month time period, a multifaceted intervention including focus group sessions, installation of automated sinks, and feedback to staff on handwashing frequency was implemented in one intensive care unit; a second unit served as a control. Dependent variables observed were handwashing frequency and self-reported practices and opinions about handwashing. Study phases included baseline, three phases of about 2 months each in duration in which sink automation was incrementally increased, and follow-up 2 months after intervention.
During 301 hours of observation, 2624 handwashings were recorded. Proportion of times hands were washed varied by indication, ranging from 38% before invasive procedures to 86% for dirty-to-clean procedures (p < 0.00001). Although there were some significant differences between experimental and control units in handwashing during the study, these differences had returned to baseline by the 2-month follow-up. There were no significant differences in self-reported practices and opinions from before to after intervention nor between units.
Intensive intervention, including feedback, education, and increased sink automation, had minimal long-term effect on handwashing frequency.
很少有影响洗手行为的干预措施能产生可衡量的效果。本前瞻性准实验研究旨在探讨易患因素、促成因素和强化因素，以提高洗手频率。
在12个月的时间里，在一个重症监护病房实施了多方面的干预措施，包括焦点小组会议、安装自动水槽以及向工作人员反馈洗手频率；另一个病房作为对照。观察的因变量包括洗手频率以及自我报告的洗手行为和看法。研究阶段包括基线期、三个持续约2个月的阶段（在此期间水槽自动化程度逐渐提高）以及干预后2个月的随访期。
在301小时的观察期间，记录到2624次洗手。洗手次数的比例因指征而异，从侵入性操作前的38%到从脏手到净手操作的86%（p < 0.00001）。尽管在研究期间实验组和对照组在洗手方面存在一些显著差异，但到2个月随访时，这些差异已恢复到基线水平。干预前后以及两组之间在自我报告的行为和看法方面均无显著差异。
包括反馈、教育和增加水槽自动化在内的强化干预对洗手频率的长期影响微乎其微。
