保洁员手卫生依从性培训对高原肺心病住院患者肺部感染的影响分析

目的探讨保洁员手卫生依从性培训对高原肺心病住院患者肺部感染的影响,为降低肺部感染发生率提供参考依据。方法对2015年12月-2016年5月医院上岗11名保洁员进行手卫生依从性培训,比较培训前后共37例患者肺部感染发生率、保洁员手部细菌总数及手卫生依从性。结果培训前,受检患者的肺部感染率为20.00%,培训后,受检患者的肺部感染率为5.88%;培训前,11名保洁员手部细菌总数均超过10CFU/cm~2,其中11~100CFU/cm~2 3例,101~500CFU/cm~2 6例,>500CFU/cm~2 2例;培训后,11名保洁员的手部细菌总数均不超过500CFU/cm~2,其中≤10CFU/cm~2 7例,11~100CFU/cm~2 2例,101~500CFU/cm~2 2例。培训前,保洁员操作前、操作后、接触患者前、接触患者后的手卫生依从性分别为54.55%、36.36%、63.64%、63.64%,培训后分别为81.82%、72.73%、72.73%、90.91%。结论开展保洁员手卫生依从性培训能够降低高原肺心病住院患者肺部感染的发生风险,提高保洁员手卫生依从性,值得临床推广。     

静脉药物调配中心手卫生集束化管理探讨

为了分析静脉药物调配中心开展手卫生集束化管理对预防感染的作用,2018年1—12月解放军总医院第七医学中心静脉药物调配中心开展常规管理措施,将其作为对照组;2019年1—12月开展集束化管理,将其作为观察组。对比两组医务人员手卫生合格率、依从性、清洗前后手部平均细菌数量、手卫生知识知晓情况。结果显示,观察组与对照组医务人员手卫生合格率分别是95.24%、83.33%,差异有统计学意义(χ~2=6.222,P0.05)。观察组与对照组医务人员手卫生依从性分别是95.00%、60.00%,差异有统计学意义(χ~2=73.399,P0.05)。清洗前观察组与对照组医务人员手部平均细菌数量分别是(27.18±6.27)CFU/cm~2、(27.27±6.32)CFU/cm~2,差异无统计学意义(t=0.093,P0.05);清洗后观察组医务人员手部平均细菌数量是(6.57±1.80)CFU/cm~2,低于常规组(10.20±2.11)CFU/cm~2,差异有统计学意义(t=11.996,P0.05)。观察组医务人员自我防护知识、洗手指征以及手卫生概念知晓率分别是97.62%、96.43%、100.00%,高于常规组的72.62%、75.00%、79.76%,差异有统计学意义(χ~2=20.724、19.461、18.914,P0.05)。静脉药物调配中心开展手卫生集束化管理能够提升医护人员手卫生合格率以及依从性,减少其手部平均细菌数量,提高对自我防护知识、洗手指征以及手卫生概念知晓程度,发挥一定干预作用。     

医务人员手卫生与洗手依从性现状及管理对策

目的了解医务人员手卫生的现状,研究手卫生与医院感染的关系,从而制定手卫生管理对策。方法随机抽查8个临床科室部分医务人员手污染现状,研究医务人员手携带病原菌的种类及性质,分析其污染因素。结果医务人员工作过程中手细菌携带率为100.0%,洗手后细菌携带率为30.4%;携带的主要细菌为:大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、产碱假单胞菌、变形菌属、金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌属等。结论医务人员手部污染是医院交叉感染的重要危险因素,必须强化医务人员医院感染理念教育,重视手卫生的监督管理,提高对洗手的认知性和依从性,才能有效预防与控制由手传播的医院内交叉感染。     

医护人员洗手情况调查

目的 认识手卫生制度对医院感染控制的影响,探讨有效的手卫生执行措施.方法 随机抽取258名医务人员,调查其洗手情况,同时对医院执行手卫生制度前(2004-2005年)、后(2006-2007年)的医院感染率作比较.结果 医务人员洗手率低,进行一般操作前及进出Ⅱ类病区时洗手率仅为35.02%～49.42%,洗手合格率仪为54.17%;而执行手卫生制度后本院医院感染率下降达30.00%.结论 手卫生制度是防止医院感染最重要的措施之一,而医务人员手卫生意识普遍不强,应从制定规范、加强监督及完善相应配套设施去保障医务人员的依从性.     

手部卫生与患者安全

目的 为加强手部卫生的管理.降低医源性感染,保障患者安全.方法 通过复习相关文献和感染控制指南,了解医院手部卫生现状,并提出相应措施.结果 医务人员手短暂沾染病原菌足医院感染最常见的传播方式,护理人员的手病原菌检出率＞80.0%,其中铜绿假单胞菌、大肠埃希菌和金黄色葡萄球菌的检出率分别为25.9%、22.2%和14.8%.结论 提高对手部卫生的认识,掌握手部卫生的有效预防与控制病原菌传播手段,对降低医院感染具有非常重要的意义.     

重庆市级医院医务人员手卫生状况及影响因素

目的了解重庆市市级医院医务人员手卫生状况,为制定有效的手卫生管理策略提供依据。方法 2016年4—6月通过调查问卷、现场观察及手表面采样的方法,对24所市级医院的111名医务人员手卫生状况进行调查研究。结果所有被调查科室均设置有专门的洗手设施,且被调查者均采用流水洗手的方式进行手卫生。医务人员洗手使用消毒剂的比例(82名,73.87%)高于采用六步洗手(42名,37.84%);接触患者前手卫生执行率为99.10%(110名),高于接触患者后的89.19%(99名),差异有统计学意义(χ~2值分别为29.23、9.88,均P0.01)。诊疗活动中手卫生前手最大菌落总数为475 CFU/cm~2,手卫生后手最大菌落总数为85 CFU/cm~2,洗手后手菌落计数低于洗手前(P0.01)。年龄、性别、科室和职业是影响手卫生的重要因素。洗手前,护士手卫生合格率高于非护士,女性、护士以及Ⅰ类环境中医务人员手表面菌落总数分别低于男性、非护士以及其他类型环境,各组比较差异均有统计学意义(均P0.05)。洗手后各组手卫生合格率均有提高,医务人员手表面菌落总数均有减少。结论重庆市市级医院洗手设施配置和手卫生效果均较好,但≥35岁年龄组、男性、Ⅲ和Ⅳ类环境科室的医务人员,以及非护士的手卫生依从性有待进一步提高。     

医务人员手卫生执行现状调查分析

目的 了解临床医务人员手卫生执行现状,探讨提高医务人员手卫生依从性的措施,从而减少医院感染的发生.方法 采用自行设计的调查问卷并结合现场观察手卫生过程的方法 ,对医院30个临床科室的120名医务人员进行手卫生知识和执行率的调查.结果 81.7%的医务人员接受过手卫生知识的培训;89.2%的医务人员认为洗手可减少医院感染,2.5%的医务人员认为手卫生对临床治疗结果 无影响;接触患者前手卫生执行率为30.8%,接触患者后手卫生执行率为49.2%,两者比较,差异有统计学意义(P<0.01).结论 医务人员手卫生意识薄弱,手卫生相关知识缺乏,执行率低;应加强宣传教育,提高医务人员手卫生知识,推广使用快速手消毒剂,提高医务人员手卫生依从性,降低医院感染.     

手术室医务人员感染知识及手卫生执行现状调查

目的了解医院手术室医务人员感染知识及执行现状,以期降低手术室医务人员因素引起的交叉感染发生。方法选取25名手术室医务人员进行感染知识及手卫生执行状况调查,采取SPSS17.0软件进行统计分析。结果感染知识知晓率>90.0%的为医务人员是否可以指甲过长及佩戴首饰、控制医院感染最简便有效的方法、戴手套是否能完全避免手被病原菌感染;知晓率<50.0%的为国际洗手日、手卫生含义、最新医院感染标准执行时间、医务人员手卫生规范实施时间;25名医务人员感染知识的平均知晓率为69.8%;对手卫生执行状况调查结果显示,平均执行率为46.0%。结论手术室医务人员感染知识知晓情况尚可,但手卫生执行率相对较低,手术室医务人员在手卫生执行方面尚需加强。     

手卫生规范化管理

据报道医务人员手革兰阴性杆菌携带率为20%~30%,而烧伤病房或监护病房工作人员可高达80%或更多。25%普通医院护士手分离到金黄色葡萄球菌,因此,规范手部的清洗与消毒管理是医院感染管理艰巨的任务之一。1加强全院医护培训由医院感染管理科、医务科、护理部负责,对全体医护人员分批分类进行培训,其内容含规范手卫生的必要性和重要性、手卫生知识、洗手指征、正确洗手方法、手卫生监测方法、标准预防的概念等,使医务人员掌握洗手在保护患者、预防外源性医院感染中的重要作用,从而提高规范洗手行为的自觉性。2强制性干预措施2.1洗手法操作考核…     

医务人员洗手依从性管理与医院感染

目的调查医院医务人员手卫生和洗手依从性的现状,探讨手卫生与医院感染的关系,制定手卫生的管理对策。方法了解医务人员手污染现状和携带病原菌的种类。结果医务人员工作中细菌携带率为100.0%,洗手后细菌携带率为20.8%;携带的病原菌包括:金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌、产气肠杆菌、变形菌属等。结论医务人员手污染是病原菌传播的重要途径,必须重视手卫生的监督管理,提高对洗手的认知性和依从性,才能有效的预防经手传播的医院感染。     

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。     

血液透析室院感管理现状及对策探讨

[目的]调查医疗机构血透室院感管理现状及问题并提出对策建议。[方法]采用问卷调查对血透室医院感染管理进行现况调查。[结果]被调查的39家血透室中,30%布局流程不合理,手卫生设施不全的占27.8%,手卫生执行不到位的占20.5%;感染和非感染隔离措施不到位的占20%～40%,医护人员对相关感染防控知识知晓率为87.1%。[结论]医疗机构血透室在房屋布局、手卫生设施、关键防控措施执行、人员培训等方面还有待改进,以消除感染隐患。     

儿科病房4例麻疹医院感染暴发流行病学调查

目的调查某院儿科病房麻疹医院感染暴发的原因,为有效控制医院感染提供科学依据。方法对该院儿科病房2008年12月6-30日发生的4例麻疹感染患儿病历资料进行回顾性调查分析。结果4例麻疹患儿麻疹病毒IgM抗体检测均呈阳性。第1例为首发病例,后3例均与第1例有流行病学接触史,发病时间不超过麻疹的平均潜伏期（2周左右）。结论此次事件是一起由麻疹病毒引起的医院感染暴发事件。建议建立早期预警机制,实施严格的消毒隔离措施,加强医务人员手卫生和无菌操作,重视环境、物体表面消毒,减少陪护和探视人员,有效控制和预防医院感染暴发。     

集束化干预急性出血性结膜炎聚集性事件的效果

目的调查某院眼科病房急性出血性结膜炎聚集性事件发生的原因,为医院感染综合防控提供依据。方法回顾性调查2016年1—11月该院眼科病区发生的急性出血性结膜炎病例,对病区开展现场流行病学及环境卫生学调查。调查2016年1—8月(督导前)和2016年9—11月(督导后)该病区医务人员的手卫生依从性。并通过ATP快速荧光检测仪对该病区医务人员手、常规诊疗仪器及高频接触环境物体表面进行采样,制定集束化干预策略进行医院感染防控。结果 2016年8月4日—9月17日共11例急性出血性结膜炎患者,其中住院患者9例,门诊复诊患者2例;医务人员3例。仅采集到I病区2例患者眼部分泌物,经病毒学检测证实为腺病毒感染所导致。ATP检测医务人员手卫生合格率为28.57%,环境物体表面合格率为34.38%。督导前病区医务人员手卫生依从率为50.00%,督导后为78.52%,差异有统计学意义(χ~2=4.89,P=0.03)。督导期间裂隙灯、眼压计等公用检查设备消毒措施执行率76.64%。集束化干预策略实施后,眼科病房自10月中旬后几个月未再发现出血性结膜炎感染病例。结论做好手卫生和环境清洁消毒仍是重要的感染防控手段,采取及时、可行的集束化干预策略能够有效的控制感染的暴发或流行。     

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.     

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。     

Introduction of a waterless alcohol-based hand rub in a long-term-care facility.

OBJECTIVE: To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF). METHODS: Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub. RESULTS: Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change. CONCLUSION: The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.     

Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units .

BACKGROUND: There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN: A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. SETTING: The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS: An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS: During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P< .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P= .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS: The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.     

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     

加强陪护人员管理对重型颅脑损伤患者下呼吸道感染的影响分析

目的：探讨加强陪护人员管理对改善重型颅脑损伤患者发生呼吸道感染的影响,为临床护理工作提供参考。方法：选取2012年收治的30例重型颅脑损伤患者为对照组,给予常规护理措施;选取2013年收治的30例重型颅脑损伤患者为观察组,在常规护理基础上,加强陪护人员对预防医院感染知识培训及考核,并在病房增添手卫生设备,指导陪护人员手卫生,通过加强对陪护人员的管理,观察两组患者发生下呼吸道感染的情况。结果：对照组有11例发生下呼吸道感染,发生率为36.7%,观察组有3例发生下呼吸道感染,发生率为10.0%,两组比较差异有统计学意义（P〈0.05）。结论：加强陪护人员管理,让陪护人员参与医院感染控制,是降低重型颅脑损伤患者下呼吸道感染的有效措施之一。