医护人员手卫生研究进展

回顾医院感染与医护人员手卫生的关系、医护人员手卫生现状、影响医护人员手卫生依从性的因素等方面研究进展。提出应采取各种措施提高医护人员手卫生依从性,从而降低医院感染发病率,提高医护质量。     

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。     

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.     

普通外科医务人员手卫生认知和依从性调查与分析

目的：调查《医务人员手卫生规范》实施后,普外病区医务人员手卫生认知与依从性执行情况,为改进手卫生工作提供依据。方法通过问卷调查和现场观察的方法,对普通外科156名工作人员其手卫生认知与依从性执行情况进行调查。结果在不同岗位和工作区域的工作人员中,监护室护士手卫生认知和依从性最高,保洁人员最差,接触患者前手卫生依从性最差。结论手卫生认知与依从性和相关理论知识的培训、执行力度的监督及医护人员自身的重视度、责任心相关。     

加强手卫生管理在控制ICU医院感染中的作用

目的:调查重症监护病房医务人员手卫生现状及其对医院感染的影响.方法:采用加强手卫生干预措施,改善手卫生设施、建立有效的监督管理机制.结果:经过1年手卫生干预措施,本医院ICU医院感染率由2008年的42.70%下降到2009年的27.36%.采取干预措施之后,ICU 医护人员手卫生依从性明显加强,各种手卫生指征执行率明显提高.干预后医护人员手卫生依从率由59.0%提高到80.8%,所有手卫生指征执行率都有明显提高.结论:有效手卫生控制,可明降低医院ICU感染率.     

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。     

我院实习医生手卫生依从性调查分析

目的:了解我院实习医生手卫生依从率,强化实习医生手卫生意识.方法:采用自行设计问卷调查表对我院168名实习医生进行手卫生知识、洗手依从性的调查.结果:实习医生对各种操作后洗手知识的掌握较好,基本的洗手知识掌握不理想;影响手卫生的因素有很多.结论:提高实习医生手卫生依从性,除提供足量洗手设施、加强基础知识培训外,个人责任心的培养及带教老师的楷模作用也非常重.     

两种不同培训方式对医护人员手卫生依从性的影响

目的 探讨两种不同培训方式对医护人员手卫生依从性的影响.方法 抽取医护人员共80名,随机划分为甲组和乙组,各40例.甲组使用常规培训方式,乙组使用手卫生污染培训方式,评估医务人员手卫生总依从度、消毒效果.结果 甲组医务人员手卫生总依从度低于乙组(P<0.05).洗手前,医务人员手带菌量≥50cfu/cm3、<50cfu...     

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。     

公共场所手卫生现状调查分析

目的 调查不同公共场所人群进出盥洗间洗手前后手卫生效果及手卫生依从性的评价.方法 2020年1月-2021年2月,选择五星级酒店公共盥洗间、客轮渡候船室盥洗间、高中学校公共盥洗间、图书馆盥洗间4类具有代表性的公共场所随机选择各120例作为观察组,医务工作人员120例作为对照组检测洗手前后手细菌菌落计数.对以上五处采样点...     

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.     

外科重症监护室医务人员手部接触行为观察与分析

目的了解ICU医务人员手部与患者及其周围物表接触行为,为加强院感防控工作提供参考。方法将IPad分布于外科ICU不同方位,通过视频拍摄采集医务人员手部与患者及其周围物表接触行为的发生及目的等信息。结果拍摄视频15份,共计19.02 h,每份(1.27±0.18)h。采集接触行为292人次,平均15.35人次/h。接触总频次463次,其中物表接触286次,发生率61.77%,平均15.03次/h;患者接触177次,发生率38.23%,平均9.31次/h。在各类人员中,护士接触人次最多(150人次),其他依次为助理护士(92人次)、医生(42人次)及其他人员(8人次);非必要接触行为共发生144人次,医生、护士、助理护士及其他人员分别为15人次、85人次、41人次和3人次,各类人群之间必要与非必要接触比例比较,差异有统计学意义(P0.05)。结论应加强医务人员对接触行为的重视,尽量降低与患者的接触频率,减少医院感染的发生。     

不同手卫生方式对术后肺部感染的影响研究

目的 探讨全身麻醉过程中使用手消毒液及佩戴一次性薄膜手套对患者术后肺部感染发生率的影响.方法 选择气管插管全身麻醉手术(预计手术时间＞2 h)患者180例,按随机数字表法分为3组(每组60例):常规组(A组)、手消毒液组(B组)及薄膜手套组(C组).分别于麻醉前、麻醉2h及麻醉结束时对麻醉机吸气端、呼气端、储气囊口进行细菌采样,随后进行培养及鉴定.术后对患者进行5d随访,统计肺部感染发生率.结果 ①麻醉全程麻醉机通气系统中,A组污染标本共94份(52.22％),B组31份(17.22％),C组34份(18.89％).B组、C组麻醉全程麻醉机通气系统污染率低于A组(P＜0.05),B组、C组比较,差异无统计学意义(P＞0.05).②术后随访,A组患者中12例出现肺部感染,发生率为20.0％,B组、C组患者各出现2例肺部感染,发生率均为3.33％,B组、C组患者术后肺部感染发病率低于A组,差异有统计学意义(P＜0.05).结论 麻醉过程中使用手消毒液及佩戴一次性薄膜手套均可降低术中麻醉机通气系统污染率及患者术后肺部感染发生率.     

Improving hand hygiene in a low‐resource setting: A nurse‐led quality improvement project

Hand hygiene is a simple but often ignored practice in health care systems worldwide, but it is integral for nosocomial infection prevention, with many hospital‐acquired infections being linked to inadequate hand hygiene practice. At the burns unit in Kamuzu Central Hospital, 50% of patients were found to have acquired pseudomonas infections: one of the contributing factors being inadequate hand hygiene. This quality improvement project was part of a course for nurses to introduce change for patient benefit, with the aim of increasing the baseline figures for hand hygiene practices and hand hygiene facilities from 37% and 22%, respectively (baseline collected in November 2019). Using robust, standard quality improvement processes, measures were put in place such as checklists to observe hand hygiene compliance and facilities, appointment of a hand hygiene committee who monitored and sustained activities of the project, procurement and distribution of handrub and placement of hand‐washing buckets and soap at strategic points. The project saw an increase in availability of hand‐washing facilities to 95.6% and hand hygiene practices increase to >80% within 6 months. The project demonstrates that low cost interventions, led by nurses, can make a real difference to practice in resource poor countries.     

Infection prevention and surgery in the pandemic era

The COVID-19 pandemic has had a significant impact on surgical specialties. COVID-19 carries a significant risk to the surgical patient and the healthcare workers looking after them, with an increased incidence of pulmonary complications and mortality in patients who test positive perioperatively. Appropriate infection prevention and control measures are critical to ensure appropriate care is given and to reduce the risk of onward transmission. This article will discuss the measures that have been instigated and contributed to infection control in surgery, such as testing, patient isolation, personal protective equipment and ventilation. The COVID-19 pandemic has led to healthcare workers across many specialities working together to provide essential clinical care. This collaborative approach is critical to maintain excellent infection prevention and control practices required during this pandemic, which protect patients and preserve surgical services.     

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。     

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。