医务人员干手设施的选择与探讨

医院感染通常是直接或间接通过手来传播，因此洗手是预防医院感染最重要的措施之一。笔者通过对使用一次性擦手纸巾、专人专用消毒毛巾两种干燥手方法的于手洁净度、成本、使用方便程度、环保等进行比较，为临床选择清洁、便捷的于手设施提供依据。     

两种干手纸对外科手消毒效果的影响

目的：通过对一次性无菌干手纸与一次性消毒干手纸干手后的外科手消毒效果检测,了解2种干手纸对外科手消毒效果的影响,为选择符合外科手消毒规范要求的干手方式提供参考数据。方法：2016年3月至2017年10月,对医务人员术前外科洗手分2组各使用不同干手纸干手再进行外科手消毒后对双手进行采样,共采集159份样本。所有样本按规范要求接种于营养琼脂平皿,经37℃温箱培养48小时,计数菌落数。结果：一次性无菌干手纸与一次性消毒干手纸在医务人员外科洗手的干手环节使用,外科手消毒合格率均为100.00%,P＞0.05。结论：一次性无菌干手纸与一次性消毒干手纸对外科手消毒效果的影响没有差别。     

医务人员不同干手方法成本对比

目前常用的干手方法有一次性擦手纸、消毒小毛巾和感应式手烘干机,其价格高低众说纷纭.在此笔者对不同干手方法进行了成本对比分析. 1 成本计算方法 1.1 擦手纸心相印牌擦手纸:每次使用两张,每次干手成本0.06元.     

免洗手泡沫消毒液在外科手消毒中应用的效果观察

目的 探讨免洗手泡沫消毒液在外科手消毒中的应用效果.方法 对手术人员外科洗手随机应用葡泰免洗手泡沫消毒液洗手法与刷手、聚维酮碘消毒洗手法,通过手部微生物采样监测,发放调查表对皮肤舒适度和接受程度进行调查,并对两种洗手法的成本进行分析.结果 葡泰免洗手泡沫消毒液消毒作用持久,抑菌时间＞6 h,洗手成本(0.50元/人次)低于聚维酮碘手消毒法(0.62元/人次),皮肤不良反应少,医务人员接受度高,为8 8.5%.结论 葡泰免洗手泡沫消毒液洗手法是一种好的洗手方法,值得推广.     

不同手卫生方式及干手措施对手卫生效果的影响

 

目的 调查不同手卫生方式和干手措施对手卫生效果的影响,提高手卫生质量。方法 选择河南省8所哨点医院不同科室的医务人员为调查对象。观察医护人员手卫生方式及干手措施,比较不同手卫生方式及干手措施的手卫生微生物检测合格率。结果 共调查医护人员699人次,执行手卫生者572人次,手卫生依从率为81.83%。洗手是最常用的手卫生措施,占39.34%。监测结果显示,采用速干手消毒剂进行卫生手消毒的合格率最高,为97.92%,不同手卫生方式的手卫生合格率比较,差异有统计学意义（χ²=20.203,P<0.001）。干手措施以自然风干为主（79.37%）,一次性纸巾、自动风干机和其他方式所占比率分别为14.69%、1.75%和4.20%。不同干手措施后的手卫生合格率比较,差异有统计学意义（P=0.013）。洗手组和先洗手后卫生手消毒组别中,均为使用一次性纸巾干手后的合格率最高,分别为80.70%、96.30%。结论 涂抹速干手消毒剂进行卫生手消毒效果可靠,最佳干手措施应首选一次性干手纸巾。

     

爱护佳洗手液与传统皂液刷手消毒效果的对照研究

部菌落数(4.10±4.03)CFU/cm2,洗手后即刻菌落数(0.08±0.26)CFU/cm2,洗手后2 h菌落数(0.49±1.31)CFU/cm2;两组间各项评价指标的差异均有统计学意义(均P＜0.01).结论 爱护佳皮肤清洁剂+免洗外科手消毒液,有助于洗手后长时间抑菌,并且在皮肤舒适度、挥发速度、整体接受程度方面均优于传统外科手消毒方法.     

重症监护室医务人员手卫生状况及干手措施对洗手效果的影响

目的了解重症监护室（ICU）医务人员手卫生状况及干手措施对洗手效果的影响。方法选择2013年2-4月某院ICU医务人员210人次,将其随机分为ABC三组,A组采用干手纸巾法、B组采用干手器法、C组采用个人小毛巾法干手,分别对其洗手前、洗手后和干手后进行手卫生现场采样检测。结果A、B、C 3组医务人员接触患者后洗手前手部菌落数分别为(29.10±15.08) CFU/cm2、(31.42±14.76)CFU/cm2和(30.36±15.52) CFU/cm2,3组比较,差异无统计学意义（F=0.048,P＞0.05）;按六步洗手法洗手后湿手采样,医务人员手部菌落数分别为(3.26±0.61) CFU/cm2、(2.98±0.59) CFU/cm2和(3.87±0.67) CFU/cm2,与洗手前比较,差异均有统计学意义（均P＜0.01）。采用不同的干手方式干手后,3组医务人员手部菌落数比较,差异有统计学意义（F=1.892,P＜0.05）;A组菌落数［(1.29±0.58) CFU/cm2］低于B、C组,B组［(9.51±0.73) CFU/cm2］低于C 组［(22.76±4.11) CFU/cm2］;A组合格率（90.00%）高于B、C组,B组合格率（68.57%）高于C 组（47.14%）。医务人员手分离病原菌居前5位的是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和凝固酶阴性葡萄球菌,与2013年度该院ICU分离居前5位的多重耐药菌高度一致。结论ICU医务人员进行各种诊疗护理操作后,手部污染严重;若干手方法不当,会导致手二次污染;其手分离的病原菌与患者分离的多重耐药菌高度一致。及时、正确地洗手和干手是保证手卫生质量的关键环节,对降低ICU患者多重耐药菌感染具有重要意义。     

护理人员操作前手消毒方法的探讨

目的　加强护理人员静脉操作前手的清洁和消毒 ,预防医院感染与穿刺处的不良反应。方法　对 15个普通病房护理人员 90人 ,分 3组进行监测 (对照组 1∶ 5 0 0“84”消毒液毛巾擦洗手、0 .2 %活力碘消毒液毛巾擦洗手 )。结果　未洗手暂居菌量 >2 0 0 CFU / cm2 34例 ,检出 7种细菌共 10 9株 ;实验 1组除菌率 96 .74 % ,实验 2组除菌率 10 0 %。结论　护理人员每次静脉操作前运用两组实验方法消毒手皮肤 ,可以达到良好的消毒效果     

免刷洗与刷洗两种不同外科手消毒效果监测及评价

目的比较免刷洗与刷洗两种不同外科洗手消毒方法效果,提高医护人员洗手依从性。方法随机抽取200名手术人员,将其分为刷手消毒法组100名、免刷手消毒法组100名;消毒后手术前用生物检测法进行手指采样送微生物室培养检测培养,并进行问卷调查,对手消毒效果进行监测及评价。结果免刷洗与刷洗手两组外科洗手人员手指皮肤细菌培养均获得同样的消毒效果,两组对照检测方法结果显示,差异无统计学意义,但手揉搓消毒剂由于含护肤成分和免刷手的消毒方法,对皮肤的损伤比需要刷手的消毒剂更小,两组对照检测方法结果显示,差异有统计学意义(P<0.05)。结论免刷洗手消毒具有一定的优势,既保证外科手消毒效果,又保证了手术人员的皮肤屏障的完整性,提高医护人员洗手依从性,因此免刷洗手是一种高效、安全、快捷的消毒方法,值得临床推广使用。     

3种不同手卫生方法效果观察

目的 观察3种不同手卫生处置方法的效果,为医务人员提供便利、可靠的手卫生方法.方法 选择临床医护人员90名,随机分为3组,设肥皂洗手组30人,卫生手消毒组30人,先洗手后卫生手消毒组30人;洗手组使用肥皂,卫生手消毒组使用速干手消毒剂,先洗手后卫生手消毒组是先用肥皂再用速干手消毒剂洗手,干后立即用含相应中和剂的无菌洗脱液的无菌棉拭子采样双手标本送检,37℃培养48 h,观察3组人员手部细菌菌落数.结果 肥皂洗手、卫生手消毒、先洗手后卫生手消毒合格率分别为76.7％、93.3％、100.0％,均未检出致病菌;肥皂洗手与卫生手消毒比较、卫生手消毒与先洗手后卫生手消毒比较差异无统计学意义,肥皂洗手与先洗手后卫生手消毒比较差异有统计学意义(P＜0.05).结论 3种手卫生方法均可用于临床医务人员的手部清洗除菌,先洗手后卫生手消毒效果最佳,卫生手消毒效果优于肥皂洗手.     

不同类别护手霜对洗必泰类外科手消毒剂消毒效果的影响

目的探讨不同护手霜对洗必泰类外科手消毒剂消毒效果的影响。方法将60名手术室医护人员随机分成A、B、C三组。受试者均按六步洗手法洗手1 min,用无菌擦手纸擦干双手。 A组不使用护手霜,B、C组分别使用3M爱护佳9260护手霜（水包油乳化液）及某品牌凡士林护手霜（油包水乳化液）。分别采集各组洗手后、使用护手霜后30 min及外科手消毒后的手部样本,进行细菌培养及菌落计数。结果洗手后各组间菌落计数比较,差异无统计学意义（P＞0.05）。擦护手霜后30 min,各组间［A组：（3.33±0.64）CFU/cm2;B组：（3.32±0.97）CFU/cm2;C组：（4.05±1.78）CFU/cm2］比较, 菌落计数差异有统计学意义,C组菌落计数显著高于A、B组(P<0.05);A、B两组差异无统计学意义（P＞0.05）。外科手消毒后,A、B两组受试者均达到外科手消毒要求,差异无统计学意义（P＞0.05）;C组有2人未达到外科手消毒要求,且菌落计数［（1.28±1.45）CFU/cm2］显著高于A组［（0.07±0.10）CFU/cm2］及B组［（0.06±0.12）CFU/cm2］ (P<0.05)。结论使用与乳胶及洗必泰兼容的护手霜（水包油乳化液）可有效保护手部皮肤,同时对外科手消毒无显著影响。     

外科手消毒规范执行过程中存在的问题及管理对策

目的 进一步规范、统一海南省外科手消毒操作与监督管理.方法 2010年5月对海南省6所三级甲等医院外科手消毒规范执行现状进行调查,将执行过程中存在问题进行汇总、分析,制定相应管理对策.结果 该次调查中,仅1所医院制作图文并茂的外科手消毒指引;内容包括洗手前着装要求、外科手消毒流程、关键步骤示意图等,使手术人员对该项调查的满意度由75.24％提高至92.63％.结论 建议各医院强化管理力度、提高外科手消毒质量,以保证手术患者安全.     

Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration

BACKGROUND: In most surgical theatres, a 1 min or even longer hand wash is routine as part of the pre-operative hand disinfection. But its benefit has recently been seen critically. METHODS: We have therefore investigated the effect of a 1 min hand wash on skin hydration and on the efficacy of consecutive surgical hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical hand disinfection, (ii) no pre-wash before surgical hand disinfection and (iii) no pre-wash but use of a brush for 1 min during disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the hand wash on skin hydration, 10 volunteers washed their hands with sapo kalinus for 1 min and dried hands with a paper towel. Skin hydration was measured with a corneometer before the hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of hands. We also tested the reduction of bacterial spores by a 15 s hand wash according to EN 1499 after artificial contamination of hands of 14 volunteers with spores of B. stearothermophilus. RESULTS: Propan-1-ol (60%) was most effective with a mean log10 reduction of 2.11, followed by ethanol (80%) with a mean log10 reduction of 1.76 and propan-2-ol (60%) with a mean log10 reduction of 0.57 (all immediate effect without hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min hand wash, but there is a trend towards better efficacy on dry hands. Using a brush for 1 min during disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol (p = 0.013) and propan-2-ol (p = 0.001) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min hand wash for up to 10 min despite drying hands with a paper towel. A 15 s hand wash reduced the number of bacterial spores significantly from log10 3.84 to log10 1.99 (p = 0.001). CONCLUSIONS: There is no benefit of a hand wash as part of surgical hand disinfection except that a short hand wash of 15 s can effectively reduce spores. The best time for this short hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based hand rub to give the skin enough time to dry.     

荆门市个体诊所医护人员手卫生状况调查

目的了解我市个体诊所医护人员手卫生知识掌握情况及洗手执行情况,寻找存在的问题,提出管理对策。方法采用问卷调查的方法,对L16家个体诊所医护人员进行手卫生知识、洗手指征、影响洗手的原因等进行调查,同时实地察看各诊所的洗手设施及医护人员的洗手行为。结果医护人员对洗手的重要性的认知率最高,为73．7％,对《医务人员手卫生规范》的认知率最低,为26．2％：接触患者血液、体液、分泌物之后的洗手率最高,为100％,接触患者周围环境和物品后的洗手率最低,为14．3％;影响洗手的主要原因是思想上不重视,认为洗不洗手关系不大,所占比例为75．6％,少数人是因工作忙忽视手的卫生或洗手设施不足所致。结论我市个体诊所医务人员存在的主要问题是对手卫生的重要性认识不足,洗手执行率低。必须加强专项培训,减少医院感染。     

Improving adherence to surgical hand preparation

At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.     

两种洗消液对护理人员手消毒效果观察

目的比较护士洗手使用快速手消毒液和洗手液两种不同手消毒剂的消毒效果。方法选取某医院120例护理人员,随机分为2组,每组各60例,1组使用快速手消毒液,另1组使用洗手液,观察2组洗手前后的细菌总数。结果快速手消毒液组和洗手液组对手带菌量〈50cfu/cm2的洗手后细菌群落数均较洗手前减少,差异有统计学意义（t=23.48,P〈0.01;t=20.37,P〈0.01）;洗手后2组细菌群落数比较,差异无统计学意义（t=0.02,P〉0.05）;2组合格率比较,差异无统计学意义（χ2=0.90,P〉0.05）。快速手消毒液组和洗手液组对手带菌量≥50cfu/cm2的洗手后细菌群落数均较洗手前减少,差异有统计学意义（t=37.10,P〈0.01;t=41.30,P〈0.01）;洗手后2组细菌群落数比较,差异有统计学意义（t=7.90,P〈0.01）;2组合格率比较,差异有统计学意义（χ2=4.62,P〈0.01）。结论两种手消毒剂的消毒效果显著,但手部污染明显（带菌量≥50cfu/cm2）时,应选用洗手液洗手。     

荆州市院前急救人员手卫生状况调查

目的了解荆州市院前急救医护人员手卫生状况及其影响因素。方法采用问卷调查方法,调查85名院前急救人员手卫生执行状况;采用手部菌落采样法调查试验组45人(加强六步洗手法教育和使用手消毒剂)、对照组40人的手部污染状况。并调查救护车上的洗手设备情况。结果院前急救人员手卫生执行率低。两组院前急救人员出诊中、洗手后的平均菌落数与手合格率差异均有统计学意义(P0.01)。14辆救护车上有洗手设备的仅6辆,但均不能正常使用。结论院前急救人员自我保护意识强于保护患者的意识。救护车上手卫生设施缺失严重,院前急救人员手部污染严重,出诊前按常规的六步洗手法洗手不现实,但在救护车上用快速手消毒剂擦手是切实可行的,是减少手部细菌污染的好办法。     

An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing

Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.