综合重症监护病房医护人员手卫生干预效果分析

目的对某院重症监护病房(ICU)医护人员手卫生进行干预,评估医护人员手卫生依从性及其影响因素。方法选取某三级甲等教学医院ICU37名医护人员作为调查对象,采用直接与间接法对其干预前后的手卫生情况进行观察、分析。结果手卫生监测第一阶段中,基线调查期手卫生依从率(46.96%)和干预后观察期(63.30%)比较,差异有统计学意义(χ~2=7.344,P=0.007);手卫生监测第二阶段中ICU手卫生依从率从57.85%上升至88.58%。手卫生依从率与平均每床日手卫生用品消耗量呈正相关(r=0.725,P0.001),与医院感染发病率、例次发病率均呈负相关关系(r值分别为-0.983、-0.990,均P0.001),使用含乙醇免洗手消毒剂手卫生依从率与平均每床日手卫生用品消耗量呈正相关(r=0.391,P0.001)。结论手卫生依从性监测和干预需要长期连续性进行,直接观察法与间接手卫生产品消耗评估法相结合,可以对医护人员手卫生依从性进行有效的监测和干预。

Intervention effect on hand hygiene of health care workers in a general intensive care unit

ObjectiveTo intervene hand hygiene(HH) of health care workers (HCWs) in an intensive care unit(ICU) of a hospital, and evaluate HH compliance of HCWs and influencing factors.Methods37 HCWs from an ICU of a teaching hospital were chosen as studied subjects, HH status before and after intervention was observed and analyzed by direct and indirect methods.ResultsIn the first monitoring stage, HH rate in baseline and post intervention survey stage was significantly different （46.96% vs 63.30%, χ2=7.344，P=0.007); in the second monitoring stage, HH compliance rate increased from 57.85% to 88.58%. HH compliance rate was positively correlated with consumption of HH product per bed day（r=0.725,P＜0.001）, but negatively correlated with incidence of healthcare associated infection(HAI) and case rate of HAI（r=-0.983, -0.990, respectively, both P＜0.001）, HH rate to alcohol based hand sanitizers was positively correlated with consumption of HH product per bed day （r=0.391, P＜0.001）.ConclusionLong term monitoring and intervention of HH compliance is necessary, combination of direct observation and indirect assessment of HH product consumption is helpful for effective monitoring and intervention of HH compliance among HCWs.