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     

医务人员手卫生依从性调查

目的对某院医务人员手卫生采取综合干预措施,比较干预前后医务人员手卫生执行情况,评价干预效果。方法2013年4-6月为该院医务人员手卫生基线调查阶段,2013年7月开始实施干预,2013年10-12月为干预后效果评价阶段。调查人员利用调查表,隐蔽观察医务人员手卫生执行情况。 结果通过多种干预措施,医务人员手卫生依从率为53.86%,显著高于干预前的38.02%,差异有统计学意义（χ2=181.82,P＜0.05）;内科、外科、重症监护室手卫生依从率均高于干预前（均P＜0.05）。干预后,不同操作时机医务人员整体手卫生依从率为53.45%(2 044/3 824),显著高于干预前的41.87%(1 740/4 156)（χ2=107.2,P＜0.05）;除无菌操作,其余4个操作时机医务人员手卫生依从率均高于干预前（均P＜0.05）;不同岗位医务人员手卫生依从率均高于干预前（均P＜0.05）。结论采取积极的手卫生干预措施,可有效提高医务人员手卫生依从性。     

Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital.

OBJECTIVE: To evaluate educational level as a contributing factor in handwashing compliance. DESIGN: Observation of hand washing opportunities was performed for approximately 12 weeks before an announced Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit and for approximately 10 weeks after the visit. Trained observers recorded the date, time, and location of the observation; the type of healthcare worker or hospital employee observed; and the type of hand hygiene opportunity observed. SETTING: University of Toledo Medical Center, a 319-bed teaching hospital. RESULTS: A total of 2,373 observations were performed. The rate of hand washing compliance among nurses was 91.3% overall. Medical attending physicians had the lowest observed rate of compliance (72.4%; P<.001). Nurses showed statistically significant improvement in their rate of hand hygiene compliance after the JCAHO visit (P = .001), but no improvement was seen for attending physicians (P = .117). The compliance rate in the surgical intensive care unit was more than 90%, greater than that in other hospital units (P = .001). Statistically, the compliance rate was better during the first part of the week (Monday, Tuesday, and Wednesday) than during the latter part of the week (Thursday and Friday) (P = .002), and the compliance rate was better during the 3 PM-11 PM shift, compared with the 7 AM-3 PM shift (P<.001). When evaluated by logistic regression analysis, non-physician healthcare worker status and observation after the JCAHO accreditation visit were associated with an increased rate of hand hygiene compliance. CONCLUSION: An inverse correlation existed between the level of professional educational and the rate of compliance. Future research initiatives may need to address the different motivating factors for hand hygiene among nurses and physicians to increase compliance.     

医务人员手卫生依从性现状调查

目的了解西安市某三级甲等综合医院医务人员手卫生依从性现状。方法采取直接观察法,对该院73个临床科室医务人员手卫生现状进行现场观察。结果观察404名医务人员,手卫生时刻404次,实施手卫生255次,正确执行手卫生181次,依从率为63.12%,正确率为44.80%。ICU医务人员手卫生依从率（91.89%）和正确率（81.08%）均高于普通病房（分别为60.22%、41.14%）,差异具有统计学意义（χ2=14.485,P＜0.001;χ2=5.671,P=0.017）。不同人员类别中,护士手卫生依从率（73.76%）和正确率（60.18%）最高,辅助人员的手卫生依从率（40.90%）和正确率(10.20%)最低;5个手卫生时刻中,“接触患者血液体液后”的手卫生依从率最高(80.00%),“清洁或无菌操作前”的手卫生正确率最高(62.96%)。结论该医院医务人员手卫生依从率较高,但正确率较低。不同科室、职业类别和手卫生时刻的手卫生依从率和正确率不同,应重视全面提高医院工作人员的手卫生依从性。     

Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?

Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff-patient and staff-environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.     

某医院医务人员手卫生KAP现状调查

目的 了解某医院医务人员手卫生KAP现状,为进一步推进手卫生工作提供科学依据。方法 现场单盲观察在班医务人员手卫生执行情况,通过科室分层抽样,对在岗医务人员进行手卫生问卷调查。结果 医务人员手卫生依从率为31.29%,正确率为41.27%;临床科室手卫生正确率高于医技科室,有统计学差异（χ2 = 4.121,P = 0.042）;各指征手卫生依从率有统计学差异（χ2 = 31.280,P＜0.001）;医务人员手卫生指征知晓率为95.32%,手卫生方法知晓率为83.75%;不同职业类别医务人员手卫生知识知晓率有统计学差异（χ2 = 12.248,P = 0.016）;影响医务人员手卫生依从性的因素有工作繁忙（63.60%）、手卫生设施不方便（48.16%）、主观不认同（16.54%）和经济因素（6.99%）。结论 医务人员手卫生依从性较低,不同科室、不同指征之间手卫生依从性差别较大;总体手卫生知识知晓情况良好,不同职业类别手卫生知识掌握情况有所不同;工作繁忙和设施不便是影响手卫生依从性的主要原因;医疗机构需要针对以上各方面,采取综合措施推进手卫生工作。     

手卫生宣传活动对ICU医护人员手卫生依从性的影响

目的评价手卫生活动对ICU医护人员手卫生依从性的干预效果。方法采用直接观察法观察ICU医护人员手卫生执行情况。结果 "接触患者前"的手卫生依从率,时段2明显高于时段1,且差异有统计学意义(χ2=6.950,P=0.008),见表1。时段3的手卫生依从率较时段2有显著下降,差异有统计学意义(χ2=6.615,P=0.013);"无菌操作前"手卫生依从率,时段1(χ2=11.636,P=0.001)及时段2(χ2=9.398,P=0.002)均明显高于时段3,时段1与时段2间,差异无统计学意义(χ2=0.132,P=0.717);"接触患者血液、体液后"手卫生依从率,时段2高于时段3(χ2=5.851,P=0.016),时段1与时段2,差异无统计学意义(χ2=0.320,P=0.572),时段2中使用ABHR的比例较时段1有明显的增加;"接触患者后"手卫生依从率,3个时段间,差异无统计学意义(χ2=4.889,P=0.087)。时段2及时段3中使用ABHR的比例较时段1有所升高;"接触患者周围环境后"手卫生依从率,时段1(χ2=20.636,P=0.000)及时段2(χ2=25.687,P=0.000)均明显高于时段3,时段3中,使用ABHR的比例有所下降。结论手卫生宣传活动普及了手卫生相关知识,提高了医务人员对手卫生的重视度及依从性。     

某综合医院手卫生依从性现状调查

目的了解某院医务人员手卫生依从性,探讨干预措施。方法设计调查表,由医院感染管理专职人员通过暗访、随机抽考等方式进行调查。 结果2013年7-9月调查医务人员1 188人次,手卫生依从率为61.87％,其中洗手正确率58.90％。护士的手卫生依从率（71.00%）高于医生（57.80%）及其他医务人员（32.14%）,洗手正确率（65.43%）高于其他医务人员（38.89%）,差异均有统计学意义（均P＜0.0125）。不同时机不同岗位医务人员手卫生依从性略有差异,“接触患者血液/体液/伤口敷料后”的手卫生依从率最高,为81.58％;“接触患者前”的手卫生依从率最低,为34.62％。调查中仅有297人次使用快速手消毒剂,占总人次数的25.00％。结论该院医务人员手卫生依从性有待进一步提高。     

Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance.

OBJECTIVE: To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities. DESIGN: Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses. SETTING: Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention. At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub. RESULTS: We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was found at a single intervention hospital, which had the greatest increase in the frequency of hand hygiene performance. CONCLUSIONS: During a 3-year period, a multimodal intervention program increased adherence to hand hygiene recommendations, especially to the use of alcohol-based hand rubs. In one hospital, a concomitant reduction was found in the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures.     

某医院医护人员手卫生依从性调查

目的了解医护人员手卫生状况,为进一步提高手卫生依从性提供依据。方法 2012—2014年某院采取多项手卫生干预措施,对每年8月1—31日医护人员手卫生依从性和各年度医院感染情况进行调查统计。结果 2012—2014年医护人员手卫生依从率分别为59.55%、62.13%和65.16%,呈增高趋势,(χ2=10.018,P=0.002);医院感染率分别为2.13%、1.48%和1.06%,呈降低趋势(χ2=82.377,P0.001);医生手卫生依从率(57.97%)低于护士(65.97%);不同手卫生时刻中接触患者前的手卫生依从率最低(41.32%),而接触患者体液后依从率最高(76.47%)。结论该院手卫生综合干预措施已初见成效,完善并提高医护人员手卫生依从性有利于预防医院感染。     

ATP生物荧光检测法提高ICU轮科医生手卫生依从性的效果

目的了解ATP生物荧光检测法在短时间内提高内科重症监护室（ICU）轮科医生手卫生依从性和合格率的效果。方法首先对内科ICU轮科医生手卫生的现状进行基线摸底调查,根据结果制定监测频率和方法。然后采用ATP生物荧光检测法随机对医生的手卫生进行现场检测和结果反馈。对干预后的医生手卫生情况进行调查。结果基线摸底调查阶段共采样120人次,医生手卫生总体合格率为73.33%,手卫生依从率只有14.17%。采用ATP现场检测和反馈的干预方法后,医生手卫生合格率提高至82.24%（χ2=13.68,P=0.008）;干预中洗手依从率最高,达到69.44%。结论ATP生物荧光检测法现场监测医生手卫生情况并及时反馈,可以提高医生手卫生的依从性和合格率。     

医疗综合目标评估对医务人员手卫生依从率的影响

目的评价医疗综合目标评估管理体系对医务人员手卫生依从率的影响。方法采用医疗综合目标评估管理体系对某三级甲等综合医院医务人员手卫生依从率进行干预,比较干预前(2012年12月)和干预后(2013年1月—2014年6月)医务人员手卫生依从率和每床日速干手消毒剂使用量。结果干预后医务人员手卫生依从率为85.17%(18 208/21 379),高于干预前的39.92%(853/2 137),干预后较干预前提升了113.35%(χ2=2 590.81,P0.001)。干预后,不同科室、岗位、手卫生时刻医务人员手卫生依从率均高于干预前,差异有统计学意义(均P0.001);干预后,全院医务人员手卫生依从率呈逐月上升的趋势,且自2013年10月起,一直稳定在较高水平(90%)。速干手消毒剂使用量干预后为10.54 mL/床日(9 323.5L/884 489床日),较干预前增加了3.30 mL/床日[干预前为7.24 mL/床日(4 200 L/579 841床日)],提升了45.58%。结论医疗综合目标评估能有效提升手卫生依从率,并持续保持在较高水平;该项措施也可能通过霍桑效应影响医务人员手卫生行为,是一项长期有效提升手卫生依从率的管理举措。     

Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit.

An observational study was performed at a level III neonatal intensive care unit to assess the impact of a hand hygiene promotion educational program on rates of compliance with hand hygiene on entrance into the unit. There was an initial improvement in the rate of compliance at 1 month after the intervention (from 89% [168 of 189 opportunities] to 100% [212 of 212 opportunities]; P<.001], but the rate decreased to the baseline rate at 3 months (89% [85 of 96 opportunities]).     

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。     

院长查房提高医务人员手卫生依从性

目的探讨医院感染管理科（院感科）参与业务院长查房对某基层医院医务人员手卫生执行情况的影响。方法调查该院2012年1-6月（对照组：院感科未参与业务院长查房）和2013年1-6月（实验组：院感科参与业务院长查房）手卫生执行情况,比较两组医务人员手卫生依从率及各科室手卫生用品消耗量。结果实验组医院感染例次率（1.49%）显著低于对照组（2.01%）（χ2=4.31,P＜0.05）;医务人员手卫生依从率为71.56%（3 249/4 540）,显著高于对照组的44.00%（1 914/4 350）。实验组和对照组护士手卫生依从性均高于医生（χ2分别为151.30、179.92,均P＜0.001）;实验组各科室手卫生依从性由高至低依次为儿科、妇产科、外科、内科。实验组和对照组快速手消毒剂消耗量分别为5.38 mL/床日、1.88 mL/床日,洗手液消耗量分别为11.51 mL/床日、7.03 mL/床日。结论将手卫生纳入业务院长查房内容,取得院领导的重视,可明显提高医务人员手卫生依从性,降低医院感染发生率,确保医疗安全。     

组合式干预在提高手卫生依从性中的应用

目的探讨提高医务人员手卫生依从性的有效方法。方法2012年,采用一系列组合式管理措施,对某院医务人员手卫生依从性进行干预。结果2012年该院手卫生依从性检查共计72次,改造全院非手触式水龙头86个,补充张贴宣传图、洗手流程图420张。2012年手卫生依从率为60.48%,显著高于2011年的34.50%（χ2=458.70,P＜0.05）;手卫生合格为82.13%,显著高于2011年的60.04%（χ2=188.41,P＜0.05）。2012年全院及重症监护室快速手消毒剂每床日使用量分别为3.15 mL、21.82 mL,显著高于2011年的0.39 mL、17.81 mL（t值分别为2.59、2.76,均P＜0.05）。结论采取组合式干预措施,能有效提高医务人员手卫生的依从性。     

2011年宜昌市37所医院执行手卫生现状调查

目的了解宜昌市城区各级医院医务人员手卫生执行情况,探讨提高手卫生执行率的途径。方法现场调查该市城区37所医院医务人员手卫生执行情况,发放问卷调查影响手卫生执行的因素。结果37所医院共调查医务人员238名,总体手卫生执行率为32.38%（125/386）,其中三级医院为46.81%,二级医院为53.19%,民营医院为23.53%,乡镇卫生院为7.69%,其他一级医院为17.95%,各医院间医务人员手卫生执行率差异有统计学意义（P＜0.05）。接触患者前、进行无菌操作前、体液暴露后、接触患者后、接触患者周围环境后和脱手套后6项手卫生指征执行率中,进行无菌操作前(89.58%,43/48)和脱手套后(80.49%,33/41)手卫生执行率最高。护士的手卫生执行率为54.82%（74/135）,显著高于其他组（P＜0.01）;妇产科医务人员手卫生执行率为83.78%（31/37）,显著高于其他科室（P＜0.01）。37所医院中,18.92%配备有非手触式水龙头,43.24%配备有干手设施。洗手后, 39.76%(33/83)的医务人员用一次性纸巾擦手或风干机吹干手,13.25%(11/83)自然晾干双手,46.99%(39/83)用工作服擦手。影响医务人员手卫生执行的前3位因素是：工作太忙（42.86%）、未引起足够重视（38.24%）、手卫生设施不足（36.56%）。结论宜昌市城区医院总体手卫生执行率低,手卫生执行状况亟待改进。     

口腔专科医院医务人员手卫生依从性干预效果

目的提高口腔专科医院医务人员的手卫生依从性,有效降低医院感染率。方法依照世界卫生组织推荐的《手卫生指南》及《手卫生实施方案》,制订系统、循序渐进的口腔专科医院手卫生促进方案,分5个步骤进行:全院戒备、基线调查、实施改进、跟踪调查和回顾分析。对比手卫生促进活动前后医务人员的手卫生依从性。结果通过手卫生促进活动,医务人员手卫生知识问卷调查平均得分由之前的58.33分提高至77.40分,提升了32.69%;平均手卫生依从率由24.28%(59/243)上升至49.81%(133/267),差异有统计学意义(χ2=35.331,P=0.000);5个手卫生时刻的手卫生状况也有较大改善。结论手卫生促进活动对口腔专科医院医务人员的手卫生依从性有显著影响。     

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。     

Predictors of hand hygiene in the emergency department

We conducted an observational study to identify predictors of hand hygiene (HH) in the emergency department. Compliance with HH was 89.7% over 5,865 opportunities. Observation unit, hallway or high-visibility location, glove use, and worker type predicted worse HH. Hallway location was the strongest predictor (relative risk, 88.9% [95% confidence interval, 85.9%-92.1%]).