Compliance with hand hygiene and glove use in a university-affiliated hospital.

OBJECTIVE: The hands of healthcare workers often transmit pathogens causing nosocomial infections. This study examined compliance with handwashing and glove use. SETtING: A university-affiliated hospital. DESIGN: Compliance was observed covertly. Healthcare workers' demographics, hand hygiene facilities, indications for hand hygiene, compliance with handwashing and glove use in each procedure, and duration of handwashing were recorded. RESULTS: Nine nurses and 33 assistant physicians were monitored during the study. One researcher recorded 1400 potential opportunities for handwashing during 15-minute observation periods. The mean duration of handwashing was 10 +/- 2 seconds. Most healthcare workers (99.3%) used liquid soap during handwashing, but 79.8% did not dry their hands. For all indications, compliance with handwashing was 31.9% and compliance with glove use was 58.8%. Compliance with handwashing varied inversely with both the number of indications for hand hygiene and the number of patient beds in the hospital room. Compliance with handwashing was better in dirty high-risk situations. CONCLUSION: Compliance with handwashing was low, suggesting the need for new motivational strategies such as supplying feedback regarding compliance rates     

手卫生在遏制抗微生物药物耐药性中的作用

<正>Antimicrobial resistance(AMR)is increasing rapidly worldwide[1].The European Centre for Disease Prevention and Control(ECDC)estimates that 25 000deaths,2.5 million extra hospital days,and 1.5 billion extra Euros are associated with AMR infection in Europe each year[2].In the United States,according     

Evaluation of a program for updating recommendations about hand hygiene

BACKGROUND. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. METHODS. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. RESULTS. The frequency of inadequate answers for evaluating LK has fallen from 57.5% before to 18.9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31.0% to 55.6% (p <0.001). The IP and IPP have risen respectively from 11.4% and 9.6% in 2004 to 9.4% and 8.9% in 2006 (N.S.). CONCLUSION. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.     

加强医护人员手卫生干预对医院感染发生率的影响

目的 评估ICU医护人员手卫生依从性的改进对医院感染率的影响.方法 收集2010年8月-2011年4月527例入住成人ICU患者的医院感染相关数据,采用渐进式的手卫生干预措施,具体包括对医护人员手卫生行为存在的主要问题进行告知、提醒、督导,并将监测结果进行反馈.结果 干预期间医务人员手卫生依从率有明显的提高;干预期间的医院感染率为18.3％,低于干预前的22.0％及干预后的22.0％,但差异无统计学意义;干预前后,尿道插管相关性尿路感染发生率及动静脉插管相关性血流感染发生率变化均不显著,呼吸机相关性肺炎发生率下降明显(x2=9.267,P=0.010);干预期间鲍氏不动杆菌及铜绿假单胞菌引起的呼吸机相关性肺炎发生率下降明显,鲍氏不动杆菌引起呼吸机相关性肺炎发生时的插管天数较干预前后有所延长(t=-2.808,P=0.013).结论 医护人员手卫生依从性的改进可以降低医院感染发生率,但干预效果的持续性较差,在今后手卫生干预研究中,仍有待于探索长效的多模式手卫生干预措施.     

Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns.

OBJECTIVE: To quantify the different behavioral components of healthcare workers' motivation to comply with hand hygiene in a healthcare institution with a 10-year history of hand hygiene campaigning. DESIGN: Cross-sectional study, by use of an anonymous, self-administered questionnaire. SETTING: A 2,200-bed university teaching hospital. PARTICIPANTS: A stratified random sample of 2,961 medical and nursing staff. RESULTS: A total of 1,042 questionnaires (35.2%) were returned. Of the respondents, 271 (26.0%) were physicians, 629 (60.4%) were nurses, and 141 (13.5%) were nursing assistants. Overall, 1,008 respondents provided information about sex; 718 (71.2%) of these were women. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among behavioral beliefs, the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 (32.1%) of the respondents, and the perception that hand hygiene is effective at preventing these infections was ranked highly by 891 respondents (86.0%). Among normative beliefs, perceived social pressure from patients to perform hand hygiene was ranked highly by 760 respondents (73.7%), pressure from superiors was ranked highly by 687 (66.8%), pressure from colleagues was ranked highly by 596 (57.9%), and pressure from the person perceived to be most influential was ranked highly by 687 (68.8%). Among control beliefs, the perception that hand hygiene is relatively easy to perform was rated highly by 670 respondents (65.1%). High self-reported rates of adherence to hand hygiene (defined as performance of proper hand hygiene during 80% or more of hand hygiene opportunities) was independently associated with female sex, receipt of training in hand hygiene, participation in a previous hand hygiene campaign, peer pressure from colleagues, perceived good adherence by colleagues, and the perception that hand hygiene is relatively easy to perform. CONCLUSIONS: In a setting with a long tradition of hand hygiene campaigns, behavioral beliefs are strongly in favor of hand hygiene, but adherence is driven by peer pressure and the perception of high self-efficacy, rather than by reasoning about the impact of hand hygiene on patient safety. Female sex, training, and campaign exposure increased the likelihood of compliance with hand hygiene. This additional insight can help to shape future promotional activity.     

2014—2022年手卫生干预对医院感染例次发病率的影响

目的 观察多模式手卫生干预对手卫生依从性的影响,以及手卫生依从性与医院感染例次发病率之间的关系。方法 2014—2022年,某三甲医院感染控制团队对全院医务人员实施多模式手卫生干预,回顾性分析手卫生监测数据的变化趋势、手卫生依从率与医院感染例次发病率的相关性。结果 病房手卫生用品消耗量呈稳定上升趋势;手卫生依从率从2014年64.98%提高到2022年85.01%(P<0.001),医院感染例次发病率从1.21%下降至0.83%(P<0.05),手卫生依从率与医院感染例次发病率之间存在负相关(r=-0.369,P=0.027)。各季度不同区域及不同岗位的手卫生依从率均有所提高(P<0.001)。各季度5个时刻手卫生依从率中,无菌操作前与接触患者后的手卫生依从率小幅波动;接触患者周围环境后的手卫生依从率呈上升趋势;接触患者前与接触患者体液后的手卫生依从率在2020年之后有所下降(P<0.001)。结论 多模式手卫生干预能提高医务人员的手卫生依从性,提高医务人员手卫生意识有利于降低医院感染例次发病率。     

Hand hygiene and glove use behavior in an Italian hospital.

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2=0.014; P=.078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral patterns.     

手卫生综合干预对儿科医院感染发病率的影响

目的探索利用5M1E质量分析工具为基础的手卫生综合干预措施对儿科医院感染的影响。方法监测某院儿科29名医务人员手卫生情况,2015年4—6月为手卫生本底调查时间,采用5M1E质量分析工具,查找影响儿科手卫生依从率的各方面因素,2015年6月开始采取干预措施,与2015年7月—2016年3月手卫生情况进行比较。并分析比较2014年7月—2015年3月与2015年7月—2016年3月医院感染发病情况。结果医务人员手卫生依从率2015年4—6月为30.86%,2016年1—3月上升至81.94%;手卫生正确率则从68.14%上升至93.75%;医务人员手卫生依从率及正确率均呈逐渐上升趋势(χ~2值分别为2 608.626、630.798,均P0.001)。手卫生采样合格率由2015年4—6月的20.69%上升至2016年1—3月的89.66%(χ~2=31.957,P0.001)。医院感染发病率由2014年7月—2015年3月的7.74%下降至2015年7月—2016年3月的3.62%(χ~2=46.717,P0.001)。结论采用5M1E质量分析工具对儿科医务人员手卫生情况进行分析调查和综合干预,提升了医务人员手卫生依从率,降低了儿科患者医院感染发病率。     

感染控制与抗菌药物管理齐头并进有效遏制细菌耐药

细菌耐药(A MR)已经成为全球公共卫生安全危机,世界卫生组织要求全球各国积极行动,采取系统性措施遏制细菌耐药.此文从耐药细菌发生过程、危险因素和控制策略等方面进行阐述,表明A MR的发生和传播与抗菌药物使用、感染控制息息相关,提示控制A MR必须同时开展抗菌药物临床应用管理和感染控制,两者相互协同才能取得成功.     

医院员工手卫生行为教育干预的效果

目的探讨教育干预对医院员工手卫生的影响效果。方法选取医院医务人员、工勤人员为研究对象,施行教育干预的措施,对干预前、干预后情况进行调查、评价。结果干预后医院员工手卫生依从性显著提高。结论通过行为教育,干预提高医院员工手卫生依从性是有效、可行的。     

Development of a culturally sensitive educational intervention program to reduce the high incidence of tuberculosis among foreign-born Vietnamese

Objective. In Los Angeles County and Orange County 98% of Asians with tuberculosis (TB) were foreign born; newly arrived Vietnamese immigrants had the highest TB risk: i.e. > 100 times higher than that of the USA. The study objective was to find ways to reduce the high incidence of tuberculosis among the Vietnamese by: (1) identifying and understanding the cultural health beliefs and barriers among the Vietnamese population of Orange County California; and (2) developing a partnership between UCLA/VA/RAND MEDTEP key Vietnamese community-based organizations and community leaders in Orange County to develop and implement a comprehensive culturally sensitive educational intervention program. Design. Vietnamese residing in Orange County were recruited to obtain qualitative and quantitative data in 1998 and 1999 respectively. The study design included focus groups in-depth interviews and community surveys. Data were collected via qualitative reports computer-assisted random telephone interviews and self-administered questionnaires. Results. A conceptual schema was identified within the Vietnamese health belief system that recognized two different forms of tuberculosis: non-infectious psychological and infectious physical tuberculosis. It was possible to engage community organizations in developing programs to combat TB in the Vietnamese population. Conclusion. The Health beliefs of Vietnamese will be important considerations in developing a culturally sensitive educational intervention program to service this at-risk population.     

多模式干预措施提高手卫生依从率的效果评价

目的探讨切实可行的手卫生干预方法,提高医务人员手卫生依从性,降低医院感染率。方法选择某院外科作为干预科室,2013年1—2月对干预科室进行基线调查,2013年3月—2014年4月对干预科室采取多模式干预措施,2014年5—6月采用与基线调查相同的方法进行干预后调查,比较干预前后医务人员手卫生依从性和医院感染情况。结果经过干预,直接接触患者前后医务人员手卫生依从性均明显升高;医务人员手卫生依从率由干预前的53.32%上升至干预后的69.27%,差异有统计学意义(χ2=26.19,P0.001)。直接接触患者前医务人员的手卫生方式:干预前以皂液+流动水为主(67.02%),干预后以速干手消毒剂为主(61.08%);直接接触患者后医务人员的手卫生方式:干预前后均以皂液+流动水为主(分别为86.40%和70.41%)。干预前,医务人员直接接触患者前后的手卫生干手方式均以工作服擦干为主,干预后,均以干手纸巾干手为主。干预科室的医院感染率由干预前的3.08%下降至干预后的2.00%,差异有统计学意义(χ2=7.76,P=0.005)。结论对干预科室采取多模式干预措施可有效提高医务人员手卫生依从率。     

Subungual bacteria of the hand: contribution to the glove juice test; efficacy of antimicrobial detergents

Methodologies for evaluating the efficacy of antimicrobial agents in the bacterial flora of the hand involve variations of the "glove juice" or "sterile bag" procedures. In this study we demonstrate that the subungual flora contribute significantly to the recovery of bacteria in these procedures. Culturing hands that had the subungual spaces sealed with acrylic polish demonstrated a decay type of curve for the number of bacteria recovered in successive samplings with 10(6) colony forming units (CFU) bacteria recovered in the first sampling and 10(3) in the sixth while the opposite hand on which the subungual spaces were not sealed demonstrated a continuous recovery of 10(6) CFU. Serial scrubbings of three minutes with plain detergent, 10% povidone-iodine or 4% chlorhexidine demonstrated a three logarithm reduction for povidone-iodine and four logarithm reduction compared to plain detergent alone for chlorhexidine in hands that had subungual spaces sealed, while the opposite hand showed only a 0.5 to 1.0 logarithm reduction. Povidone-iodine produced a 0.6 logarithm reduction and 4% chlorhexidine or 1.4 logarithm reduction in the density of subungual bacteria.     

Patient decision making: use of and adherence to telephone-based nurse triage recommendations.

OBJECTIVE: Health plans, employer groups, and medical providers offer telephone-based nurse triage services to provide ready access to medical advice and information to assist patients in making decisions about their medical needs. The purpose of this study is to assess patient adherence to nurse triage recommendations. PATIENTS AND METHODS: The study includes data for members of an HMO located in a large metropolitan area who used the triage service during 1997 (n = 22,998). The nurse triage call data are linked with medical claims and encounter data to assess patient medical service utilization following a call to the triage service to assess triage adherence. The authors consider no use of medical services following a triage call with the recommendation to use self-care advice at home an indicator of adherence to this recommendation. RESULTS: The percentage of callers who adhered to triage recommendations to use hospital emergency services, physician office services, or self-care advice was 79.2%, 57.4%, and 65.8%, respectively. Adherence varies somewhat by age. CONCLUSION: The reported adherence levels are lower than those obtained from self-reported data reported elsewhere. Given the inherent limitations of both types of data, actual telephone-based nurse triage adherence may lie between the 2 levels.     

手卫生成本与医院感染发病率的研究

目的总结分析手卫生成本对医院感染发病率的影响,探讨持续改进的方法,为医院管理提供数据支持。方法调查2013年1月-2014年6月某院手卫生推进项目所消耗费用、医院感染发病率,以及2014年上半年手卫生的依从性。结果按照半年度进行统计,2013年上半年、2013年下半年、2014年上半年手卫生推进项目的费用分别为283 490、414 232、522 345元,2014年上半年较2013年上半年同比增长84.26%;医院感染发病率分别为3.13%、3.33%、3.03%,差异有统计学意义（χ2=10.37,P＜0.001）。2014年上半年手卫生依从率由1月份的35.00%升至6月份的59.49%。影响手卫生执行居前3位的原因为：工作忙,没有时间做手卫生;手卫生设施或用品不足;手卫生相关知识不足。结论加大手卫生相关物品的投入,可以提高手卫生依从性,降低医院感染发病率。     

医院工勤人员执行手卫生与干预措施

目的了解工勤人员手卫生执行情况,建立切实可行的手卫生干预措施,提高其手卫生执行率。方法通过对全院各类工勤人员采取手卫生干预措施,调查比较干预前后工勤人员手卫生执行率及洗手方法正确率的变化。结果全院各类工勤人员接触患者及进出特殊病房前后、接触污染物品后洗手执行率从干预前分别为19.8%、26.7%、30.2%提高到干预后的48.8%、60.0%、61.6%;脱手套后洗手执行率从干预前30.2%提高至干预后的51.2%,洗手方法正确率从干预前的24.4%提高至干预后的60.0%。结论重视对医院工勤人员手卫生执行情况的监督并采取相应的干预措施,有助于提高手卫生执行率,降低医院感染率,减轻患者痛苦和经济损失。