郑州市第一人民医院消毒供应中心工作人员手卫生现状调查结果分析

目的调查郑州市第一人民医院消毒供应中心(CSSD)工作人员手卫生情况,制定相应的改进措施。方法选取郑州市第一人民医院消毒供应中心的26名工作人员,其中护士10名、工人16名。对戴手套操作与未戴手套操作的人员进行分组手卫生监测。了解CSSD工作人员对手卫生知识知晓率、手卫生指征执行次数、工作人员手卫生依从性影响因素及手卫生效果。结果 CSSD护士对手卫生概念、手卫生指征、六步洗手法、戴手套擦免洗消毒液指征等知晓率均显著高于工人,差异均有统计学意义(P0.05)。护士进工作区前、处理污染物品后、清洁物品包装前、接触消毒物品前、接触无菌物品前、脱手套后、出工作区前、下班前等手卫生执行次数均显著高于工人,差异均有统计学意义(P0.05)。戴手套操作与未戴手套操作的工作人员手部清洁后立即检测手卫生合格率均为100%,随着工作时间越长,手卫生合格率越来越低;工作繁忙没有时间洗手、戴手套不用洗手、担心清洗不彻底和烫手、手卫生产品刺激皮肤均为CSSD工作人员手卫生依从性的影响因素。结论 CSSD工作人员手卫生依从性有待提高,应加强对工作人员的手卫生监测考核、健全规范洗手制度,从而提高工作人员手卫生意识与依从性。     

手卫生改进任重道远

目的探讨手卫生工作现状和改进策略。方法分析国内外手卫生发展现状,总结我国手卫生工作发展的基础与策略。结果手卫生法规逐步规范,手卫生设施不断完善,医务人员对手卫生的认知不断提升和依从性不断提高,手卫生工作的调查研究不断深入。结论我国手卫生工作发展迅速,取得了重要进展,为今后手卫生工作奠定了良好的基础;但与保障患者安全的要求有一定的距离,手卫生工作面临着巨大的挑战,任重道远。     

基层医院影响手卫生依从性的原因及对策

目的探讨基层医院医务人员手卫生依从性的影响原因及对策。方法加强领导及医务人员手卫生知识培训,改善手卫生设施。结果手卫生设施及医务人员的自觉性是影响手卫生工作依从性的主要原因。结论只有建立良好的手卫生设施及监督管理制度,才能提高护士手卫生工作的依从性。     

提高医务人员手卫生依从性管理

目的:加强医务人员的手卫生管理,提高落实卫生执行力度.方法:对医务人员在不同工作状态下的洗手状况进行监测,改进管理措施,提高洗手依从性结果:部分医务人员规范洗手行为差,实际洗手执行率低,习惯用手套代替洗手,存在手的再污染现象.结论:通过加强教育培训,制定并落实手卫生管理措施,改善洗手条件,优化手卫生方法,可提高洗手依从性.     

医务人员手卫生依从性现状及干预措施研究进展

综述国内外医务人员手卫生依从性的研究现状及影响原因,提出其干预措施包括建立失效模式与影响分析模式,改善医院手卫生设施、设置手卫生提醒,教育培训,合理排班、减轻工作强度,患者监督,手卫生的监测、管理、反馈及树立手卫生榜样,为寻找更加有效且效果持久的干预措施提供依据,提高医务人员手卫生依从性。     

手术室护士手卫生知信行现状调查分析

目的了解手术室护士对手卫生的认知、信念与行为,为改进手术室护士的手卫生状况提供依据。方法自行设计手术室护士手卫生认知、信念与行为问卷,对70名手术室护士进行相关调查。同时现场观察护士的手卫生行为。结果 65.71%的护士熟悉洗手指征,只有20.0%的护士认为能在手卫生方面做同事的表率;97.14%的护士有信心提高手卫生的依从性;31.43%的护士接触患者后能积极洗手或使用快速手消毒剂。在现场调查中高风险的行为手卫生依从性高(86.36%),不同操作风险护士洗手率比较,差异有统计学意义(P<0.01)。结论护士对手卫生信念较高,但认知与行为欠缺。应加强手卫生知识培训,督促指导护士的洗手行为,保障患者安全。     

NICU环境卫生监测及医院感染的多中心现况调查

目的了解NICU环境卫生监测及医院感染的现况,为NICU医院感染管理和控制提供依据。方法选取7所综合性儿童医院NICU进行为期6个月的医院环境监测、医务人员手卫生依从性调查及医院感染病例监测。结果各医院NICU常规环境卫生监测合格率为98.87%,医院呼吸机相关性肺炎和中心静脉导管相关性血流感染的平均发生率分别为3.78‰和1.63‰,医院感染发生率与常规环境卫生监测合格率没有相关性。医务人员手卫生依从性为51.56%~67.19%。结论 NICU医院感染应更注重目标监测,医护人员的手卫生依从性有待加强,多中心调查可为全国范围内NICU医院感染管理和控制提供依据。     

浅谈洗手在消毒供应中心的重要性

目的:加强消毒供应中心工作人员对正确洗手重要性的认识,正确执行洗手和手卫生消毒的方法,以减少医源性感染.方法:采取六步洗手法,对消毒供应中心工作人员培训.结果:未经培训的工作人员洗手知识缺乏,洗手意识淡薄,洗手规范性和依从性低,而经过培训的工作人员明显提高(培训前后比较,P<0.05);同时手卫生监测结果亦有改善.结论:正确洗手能有效地改善手部卫生,从而减少医院感染机会.正确的洗手有效提高了洗手的合格率,而便捷的设施以及高效、迅速、使用方便的手卫生产品是保持有效洗手的必要条件.     

患者家属手卫生认知和现状调查分析

目的了解患者家属手卫生认知和行为现状。方法采用问卷调查法,对儿科、神经外科、重症监护病房210名患者家属进行手卫生认知和行为的调查。结果91.0%的住院患者家属都意识到手卫生对健康的重要性,但对接触患者及其物品前后、洗手可以保护自己和患者不被感染等认知率较低(18.6%~45.2%);在实际执行中14.8%~30.5%患者家属认为简单接触不需要洗手。结论患者家属手卫生认知低,实际执行较差,医院应加强对住院患者家属手卫生知识的宣教,改善洗手条件,督促手卫生的执行,以减少患者医院感染的发生。     

患者家属手卫生认知和现状调查分析

目的了解患者家属手卫生认知和行为现状。方法采用问卷调查法，对儿科、神经外科、重症监护病房210名患者家属进行手卫生认知和行为的调查。结果91．0％的住院患者家属都意识到手卫生对健康的重要性，但对接触患者及其物品前后、洗手可以保护自己和患者不被感染等认知率较低（18．6％～45．2％）；在实际执行中14．8％～30．5％患者家属认为简单接触不需要洗手。结论患者家属手卫生认知低，实际执行较差，医院应加强对住院患者家属手卫生知识的宣教，改善洗手条件，督促手卫生的执行，以减少患者医院感染的发生。     

医护一体院感防控模式在医院感染管理中的效果

目的 探讨医护一体院感防控模式在医院感染管理中的效果。方法 采用自身前后对照研究的方法 对传统院感防控模式和医护一体化院感防控模式进行效果比较,从手卫生、医疗废物、消毒隔离、多重耐 药菌、职业暴露和传染病6方面监测内容进行指标评价。结果 医护一体院感防控模式的实施在院感的医疗 废物处理正确率、消毒隔离知识掌握正确率、职业暴露知识掌握正确率、传染病监测正确率均高于传统院 感防控模式（P＜0.05）;在手卫生执行和多重耐药菌感染的正确率方面虽有波动,但医护一体院感防控模 式仍优于传统模式（P＜0.05）;医护一体化感控模式实施后,科室院感管控综合水平从全院第34名上升至 第3名。结论 医护一体院感防控模式的实施让医院感染的发生率得到了有效控制,极大程度上增加了医务 人员的手卫生依从率和医院感染诊断相关病原学送检率,是一种有效可行的院感防控模式。     

洗手前后细菌监测提高护士手卫生依从性研究

目的探讨手细菌监测对护士手卫生依从性的影响。方法对全院每个科室培训1名兼职感染管理控制护士,由其每月随机抽取2名护士分别于操作后洗手前、洗手后进行手细菌监测;采用隐蔽性观察法于实施手细菌监测前后观察护士洗手及手消毒方法合格率。结果实施手细菌监测后,护士洗手及手消毒方法合格率显著优于实施前(均P<0.01)。结论手细菌监测管理措施可有效提高手卫生执行力度和效果。     

Creating a Manual for Proper Hand Hygiene and Its Clinical Effects

Purpose To prevent cross-infections, we created a manual for the treatment of infectious wounds that clarifies when to wash one's hands and when to wear gloves. Methods Six patients with widespread infectious wounds caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated. The bacterial count on the hands of the staff was calculated. We then compared the number of patients with MRSA isolated, and typed the MRSA isolates using pulsed-field gel electrophoresis (PFGE). Results The pathogenic bacterial count among hospital staff before treatment/before hand hygiene was 8.2 × 10 colony-forming units (cfu)/hand, which were not detected before treatment/after hand hygiene. The pathogenic bacterial count on the hands before hand hygiene/after treatment climbed to 9.1 × 10⁵ cfu/hand, and after treatment/after hand hygiene decreased to 0.38 cfu/hand. The number of patients with MRSA isolates before this protocol was 15/402 (3.7%), but that level significantly decreased to 5/411 (1.2%) after implementation of the manual. There were 13 strains of type F by PFGE before the manual was adopted, but five strains of MRSA isolated after the present manual was enforced were all observed to have different migration patterns. Conclusion A hand hygiene manual is effective for decreasing the rate of cross-infection.     

Local survey of practice patterns for barrier precautions during anesthesia practice

BACKGROUND: Performing appropriate infection control procedures including barrier precautions with aseptic technique during anesthesia practice is extremely important in order to prevent nosocomial infection in surgical patients, as well as to avoid occupational exposure for anesthesiologists. METHODS: We conducted a survey to investigate current practice patterns of anesthesiologists with special emphasis on the application of barrier precautions during invasive procedure; intravascular catheter insertion or endotracheal intubation. RESULTS: In general, the compliance of hand hygiene practice was poor specifically immediately before or after performing invasive procedures; approximately two-thirds of the anesthesiologists were not performing hand washing. Despite most anesthesiologists have knowledge regarding the importance of maximal barrir precautions (MBP) during central venous catheter insertion, only a half of them did perform the MPB. Concerns for additional costs or time for anesthesia preparation, as well as poor arrangement for alcohol-based antiseptics handrubs in the operation room could be the factors affecting the poor compliance. CONCLUSIONS: Anesthesiologists should change their practice to adequately apply appropriate aseptic barrier precautions including hand hygiene. Improvement of the medical payment system to cover the costs for infection control in the operating room should also be considered.     

Hand hygiene in intensive care

Hand hygiene represents the main way to prevent and/or at least reduce nosocomial infection incidence. In this paper we discuss this "hot topic" through both the analysis of CDC guide lines and the data resulting from a questionnaire survey sent to health care workers, eventually corroborated by their direct observation. From literature data and our survey result analyses, we are more than convinced that the winning strategies for a slow but progressive improvement of hand washing practice and compliance are (i). using a product able to decontaminate hands very quickly and without needing water; (ii). the health care worker awareness of hand hygiene and compliance feed-back importance. From our questionnaire survey as well as from our direct observation, we found a very low (5.6%) compliance of our hospital health care workers to CDC guidelines for hand washing. This may be justified above all by ward logistical and structural problems, as only 55% of sinks are located inside patient rooms, but also because there is a lacking of knowledge of new CDC suggested practices and decontaminating products. Health care worker specific training and the choice of an alcoholic antiseptic disinfectant, allowed us to significantly increase their compliance to proper practices in hand washing and hygiene, showing their interest in such an important and delicate matter.     

A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance.

BACKGROUND: This study intended to investigate the degree of compliance with hand hygiene and use of gloves by health workers in haemodialysis (HD) units, and the factors that influenced adherence to hand hygiene protocols. METHODS: During the month of November 2003, one person observed the health care staff in each of nine different dialysis units, during 495 randomly distributed 30 min observation periods that covered all steps of a haemodialysis session (connection, dialysis and disconnection). The observers noted the number of potential opportunities to implement standard precautions and the number of occasions on which the precautions were actually taken. Adherence to standard precautions was evaluated, analysing the influence of the following variables: the patient-to-nurse ratio, the number of HD shifts scheduled per day, acute HD units vs chronic, whether or not infectious patients were isolated and in-house vs contract cleaning personnel. RESULTS: There were a total of 977 opportunities to wear gloves for, and to wash the hands following, a patient-oriented activity, and 1902 opportunities to wash hands before such an activity. Gloves were actually used on 92.9% of these occasions. Hands were washed only 35.6% of the time after patient contact, and only 13.8% of the time before patient contact. Poor adherence to hand washing was associated with the number of shifts per HD unit per day and with higher patient-to-nurse ratios. In the acute HD units, there was greater adherence to standard precautions than in the chronic units, although there too it was substandard. The personnel's knowledge of patients' infectious status did not modify their adherence to hand hygiene practices. A higher patient-to-nurse ratio independently influenced hand washing both before and after patient contact. CONCLUSIONS: The overall adherence of health care workers to recommended hand washing practices is low. Whether or not programmes promoting higher hand hygiene standards and the potential use of alcohol-based hand cleansers will improve hand hygiene practices in HD units requires further investigation.     

Hand washing and hand disinfection: more than your mother taught you

Hand washing is considered the single most important intervention for prevention of nosocomial infections in patients and health care workers. Unfortunately, compliance with standard protocols for hand hygiene in the health care environment, and especially within intensive care areas such as operating rooms and post-anesthesia care units, has been generally poor. In this article, we consider the current standards for hand hygiene as they pertain to the practice of anesthesiology. We discuss the consequences of poor compliance with hand washing practices for patient and health care provider safety. And we describe modern innovations in hand washing procedures and products that improve the opportunities for anesthesiologists to employ safe hand hygiene.     

护士对ICU转出患者在普通病房交接班现状调查分析

目的调查ICU护士和普通病房护士对ICU转出患者交接班认知现状,为有效实施ICU转出患者延续护理服务及相关知识培训提供依据。方法采用自行设计的问卷对广州市三甲医院107名ICU护士和373名普通病房护士在转出患者在认知、态度、执行过程中现状进行调查。结果本研究发现护士ICU护士和普通病房在交接班时对于患者的一般信息、生命体征、专科病情交接、心理情况、药物交接、医院感染交接、患者物品交接等方面,认知有不同;普通病房护士和ICU护士对ICU转出患者交接时的药物、管道和皮肤的交接方面均认为非常重要。结论针对ICU护士和普通病房护士的不同培训需求,应提供不同的系统、规范化的培训。     

短肠综合征患者饮食行为特征及管理的质性研究

目的 深入了解短肠综合征患者饮食行为特征及自我饮食管理方面的体验,以进一步指导和干预患者饮食管理,提高饮食管理依从性.方法 运用质性研究中的现象学方法 ,对15例短肠综合征患者进行面对面、半结构式访谈,采用Colaizzi现象学资料分析法分析访谈资料.结果 短肠综合征患者的饮食行为特征及管理中主要存在4个方面的体验:日...