医务人员手卫生依从性评价方法的探讨

目的探索手卫生依从性的评价方法。方法采用直接观察法调查2011—2018年某院临床医技科室医务人员手卫生依从率,调取同期全院各科室手卫生用品,包括清洁剂和速干手消毒剂使用量,计算每床日手卫生次数。利用隐蔽式调查的方法结合手卫生用品使用量计算每床日手卫生次数,对直接观察获得的手卫生依从率进行校正,分析霍桑效应。结果采用直接观察法调查2011—2018年手卫生依从率,呈逐年上升趋势(χ2=11 712.41,P0.01),由最初的38.17%提升至94.46%。根据速干手消毒剂和清洁剂每次使用量估算每床日手卫生次数,2011年为12.41次,2018年为22.37次;每床日速干手消毒剂使用量和每床日清洁剂使用量与手卫生依从率均有较好相关性(r值分别为0.82、0.79,均P0.05)。校正后的手卫生依从率为36.87%～69.10%,与直接观察法相差1%～43%。结论采取手卫生用品使用量和手卫生依从率双重指标,对正确评估手卫生具有很好的指导意义,能避免过高评估手卫生依从率。

Evaluation methods of hand hygiene compliance of health care workers

Objective To explore the evaluation methods of hand hygiene(HH) compliance. Methods HH compliance rate of health care workers(HCWs) in clinical technical departments of a hospital from 2011 to 2018 was investigated by direct observation method, consumption of HH supplies, including detergent and alcohol-based hand rub in all departments of hospital during the same period were investigated, HH opportunities per bed-day were calculated. Concealed survey combined with consumption of HH supplies was adopted to calculate HH opportunities per bed-day. Directly observed HH compliance rate was adjusted and Hawthorne effect was analyzed. Results HH compliance rate surveyed through direct observation method in 2011-2018 increased year by year (χ²=11 712.41,P<0.01), from 38.17% to 94.46%. According to the amount of consumption of alcohol-based hand rub and detergent each time, opportunities of HH per bed-day were estimated to be 12.41 in 2011 and 22.37 in 2018; consumption of alcohol-based hand rub and detergent per bed-day had good correlation with HH compliance rate (r values were 0.82 and 0.79, respectively, P<0.05). The adjusted HH compliance rates were 36.87%-69.10%, which were 1%-43% different from that of direct observation. Conclusion Consumption of HH supplies and HH compliance rate have good guiding significance for the correct evaluation on HH, and can avoid over-evaluation of HH compliance rate.