Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review

Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.     

Adoption of alcohol hand disinfection in the United States: a personal perspective

Even though alcohol-based hand disinfectants have been used for decades as a routine measure in Europe, in the USA until recently handwashing was the procedure of choice. Alcohol-based rub products were recommended only if no handwashing facility or running water was available. It was only during the late 80s and early 90s that the advantages of alcohol-based products began to elicit interest. In 1995 Larsen published new application guidelines for hand disinfection and in 1996 the CDC included alcohol-based hand disinfection in its “Isolation guideline”. However, these recommendations were rarely implemented in practice. In 1996 Didier Pittet first gave me a demonstration of alcohol-based rub products at his Geneva hospital, and the following year experts at Lausanne University provided me with the products available at that time. In 1998 and 2000 I had the opportunity to exchange information and experiences with numerous European experts, including Dr. Molitor, who also gave me additional insights into the mechanism of action of such products. As a result of myriad scientific demonstrations, interest in these rub products now began to be expressed in the USA too. In 1999 an interdisciplinary working group for hand hygiene was set up, comprising representatives from CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), the Society for Healthcare Epidemiology of America, the Association for Professionals in Infection Control and the Infectious Diseases Society of America, whose intention was to formulate new guidelines for hand hygiene in the healthcare sector. The insights that I gained from Dr. Molitor and from other European experts were of enormous value and helped to weigh up the pros and cons of alcohol-based hand disinfection, both in respect of the different products available and on comparing them with hand washing. The new CDC guideline for hand hygiene was published in 20002 and for the first time in the USA it featured the requirement that alcohol-based rub products be used as the method of choice provided that the hands were not visibly soiled or contaminated with protein-based material. Unfortunately, we have no reliable data, but it is estimated that today up to 95% of doctors and nurses in American hospitals preferentially use alcohol-based rub products – thus reflecting a situation that has long been common practice in Europe.     

State-of-the-art hand hygiene in community medicine

Hand hygiene becomes more important in community medicine not only since antibiotic resistant bacteria such as MRSA spread within the community. Hands may be colonized with transient microorganism in up to 75%. Among those transient pathogens S. aureus, C. difficile or the hepatitis C virus may be found. During patient care the number of microorganisms on the hands steadily increases. In addition hands may be contaminated with different kinds of germs even if only “clean” activities are carried out. Gloves may be worn but do not provide complete protection from contamination due to leaks. Therefore hands should always be treated after gloves are taken off. State-of-the-art treatment of hands is the hygienic hand disinfection with alcohol-based hand rubs. They are more effective, quicker to carry out, better tolerated by the skin, with a positive effect on compliance, and cost effective in comparison to antiseptic soaps based on chlorhexidine or triclosan and in comparison to normal non-medicated soaps. Healthy skin easily tolerates alcohol-based products from the beginning on. Only health care workers with an underlying irritative contact dermatitis which is often caused by bar or liquid antiseptic soaps may have difficulties to use alcohol-based products initially. In such a case treatment of the underlying skin condition is the way to go and not staying with a preparation which has caused the dermatitis. All this knowledge is now reflected in current guidelines on hand hygiene. Beside liquids alcohol-based gels can be used if they have an antimicrobial activity equal to alcohol-based liquid preparations. Hand hygiene remains the single most important tool to avoid cross transmission of microorganisms between patients. This state-of-the-art hand hygiene should also be emphasized more in community medicine. This review may help to go the first step into this direction.     

Physician handwashing: what do parents want?

Transmission of micro-organisms from the hands of healthcare workers to patients is a major cause of healthcare-acquired infections. In 2002, the US Centers for Disease Control and Prevention (CDC) published guidelines for healthcare workers that included the recommendation for alcohol-based hand rub for hand hygiene during patient visits. In this prospective study we surveyed parental and healthcare workers' preferences for the hand hygiene practices of emergency physicians. The study comprised 99 parents of ill or injured children presenting to our emergency department and 100 healthcare providers (64 nurses, 29 physicians and seven nurse practitioners) within the department. There was a clear and similar preference by parents and healthcare workers for hand hygiene using soap and water over alcohol cleansing rubs. Furthermore, both groups preferred hand hygiene before and after the examination and wanted to observe the physician perform this procedure. In conclusion, families and healthcare worker preferences for hand hygiene are not in keeping with recommendations published by the CDC. Educational interventions are needed to disseminate the CDC's guidelines and to promote compliance with evidence-based recommendations for hand hygiene.     

Hand disinfection: how irritant are alcohols?

Irritant contact dermatitis is commonly found on hands of healthcare employees and is often explained by contact to water and detergents. Studies on the dermal tolerance clearly show that the degree of skin irritation is significantly lower after application of alcohol in comparison to detergents. It has also been shown in standardised wash tests using a foam roller that the application of alcohol or water immediately after a detergent-based wash can significantly decrease the degree of skin irritation, probably due to a wash-off of residual detergent. If evidence-based hand hygiene is taught early during nurses training it can substantially reduce irritant contact dermatitis supporting initiatives of primary prevention among healthcare employees. The irritant potential of commonly used alcohols in hand antiseptics is very low. If the skin is pre-irritated, e.g. by detergents or water, alcohols can cause a burning sensation which is, however, not an allergic reaction and does not further harm the skin. True allergic reactions to alcohols have so far not been confirmed. From the dermatological point of view the use of alcohols for hand hygiene has clear advantages over washing with water and detergents.     

Efficacy of an alcohol-based healthcare hand rub containing synergistic combination of farnesol and benzethonium chloride

Healthcare workers are required to disinfect the hands several times a day using hand disinfectants, which leads to chronic hand exposure to high levels of antimicrobials contained in the disinfectants, which could compromise the skin integrity. This problem may be addressed by developing hand disinfectants containing synergistic combinations of small amounts of antimicrobials and other agents. The synergistic effect of farnesol and essential oils with several antimicrobials was studied in vitro to select an effective antimicrobial system in preservative concentration for use in healthcare hand rub. Farnesol and lemon oil showed synergistic activity against S. aureus, in combination with benzalkonium chloride and benzethonium chloride, but not with other antimicrobials studied. All essential oils studied showed synergy with benzethonium chloride against Staphylococcus aureus and Escherichia coli. An alcohol-based healthcare hand rub (ZBF hand rub) containing this unique synergistic combination of farnesol and benzethonium chloride was then developed and its efficacy as a healthcare hand rub was evaluated in human volunteers according to the US FDA-TFM protocol using Serratia marcescens as a marker organism. The ZBF hand rub showed a 3.22 log(10) reduction in the microbial count after the first application and a 5.49 log(10) reduction after the tenth application in vivo and exceeds the US FDA-TFM criteria for healthcare hand rub. The ZBF hand rub did not irritate the hands when tested on human volunteers when applied 10 times everyday for five consecutive days. The ZBF hand rub exhibits more than 5.5 log(10) reduction in the microbial count within 15s and more than 2.8 log(10) reduction in the two types of viruses tested within 30s in vitro. When evaluated in an in vitro pig skin model, the ZBF hand rub shows better prolonged activity (20-35 min post-application) against transient bacteria (S. aureus and E. coli) compared to other alcohol-based hand rubs. These findings suggest that the use of the ZBF hand rub amongst health care workers may lower the risk of chronic hand exposure to high levels of antimicrobials without compromising the efficacy.     

Dermal tolerance of Sterillium, a propanol-based hand rub

Alcohol-based hand rubs have been used for hygienic hand disinfection in hospitals for decades. In order to achieve good compliance with hand hygiene practices in the healthcare setting, dermal tolerance of a hand rub product is crucial. Sterillium, which is used in many European countries for hygienic hand disinfection, is based on iso-propanol, n-propanol and mecetronium etilsulphate. The potential for dermal irritation and sensitization of commercially available propanol-based hand rubs containing emollients has not been studied systematically. We therefore studied the dermal tolerance of Sterillium in a repetitive occlusive patch test on 55 subjects. Sterillium was applied to one site on the back under an occlusive patch during an induction phase (total of nine applications over a three-week period) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after removal of the patches (induction phase and challenge phase), and in addition, after 48 and 72 h (challenge phase), the sites were graded for skin reactions using a standardized scoring scale. In the induction phase, two of the 55 subjects had a barely perceptible minimal erythema at one of nine time points. The remaining 53 subjects had no skin reaction at any time. In the challenge phase, all 55 subjects had no skin reaction at all. The absence of significant reactions with respect to severity and frequency demonstrates the favourable dermal tolerance of the hand rub product. The lack of irritation or sensitization potential could enhance compliance with hand hygiene among healthcare workers.     

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。

     

Introducing alcohol-based hand rub for hand hygiene: the critical need for training.

BACKGROUND: Use of an alcohol-based hand rub for hand hygiene has recently been recommended by the Centers for Disease Control and Prevention. However, the proper technique for using hand rub has not been well described and is not routinely taught in hospitals. OBJECTIVE: To evaluate the impact of training on proper technique as outlined by the European Standard for testing alcohol-based hand rubs (European Norm 1500) in a clinical study. DESIGN, SETTING, AND PATIENTS: Prospective study including 180 healthcare workers (HCWs) in a 450-bed, university-affiliated geriatric hospital where alcohol-based hand rub was introduced in the late 1970s. INTERVENTION: Structured training program in hand hygiene with alcohol-based hand rub. Technique for using hand rub was tested by the addition of a fluorescent dye to the disinfectant and the number of areas missed was quantified by a validated visual assessment method. In addition, the number of bacteria eradicated was estimated by calculating the difference between the log(10) number of colony-forming units (cfu) of bacteria on the fingertips before and after the procedure, and reported as reduction factor (RF). MAIN OUTCOME MEASURE: Log(10) cfu bacterial counts on fingertips before and after training in the appropriate technique for using hand rub. RESULTS: At baseline, only 31% of HCWs used proper technique, yielding a low RF of 1.4 log(10) cfu bacterial count. Training improved HCW compliance to 74% and increased the RF to 2.2 log(10) cfu bacterial count, an increase of almost 50% (P<.001). Several factors, such as applying the proper amount of hand rub, were significantly associated with the increased RF. CONCLUSION: These results demonstrate that education on the proper technique for using hand rub, as outlined in EN 1500, can significantly increase the degree of bacterial killing.     

Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.     

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.     

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.     

An alcohol hand rub containing a synergistic combination of an emollient and preservatives: prolonged activity against transient pathogens

A new alcohol-based hand antiseptic (Octoxy hand rub) containing a synergistic combination of an emollient (Octoxyglycerine) and preservatives was developed and evaluated for immediate and prolonged activity against transient bacteria. The in vitro and in vivo antimicrobial efficacy was compared with other alcohol hand rubs containing preservative/antimicrobial (Prevacare and Avagard). In vitro evaluation was carried out using a tube-dilution method and a pig-skin model. Rapid and prolonged efficacy in vivo was evaluated against Staphylococcus epidermidis on the hands of volunteers. Octoxy hand rub was 100% effective in rapidly killing pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium in vitro. In volunteers, all three hand rubs gave a significant reduction in microbial count within 15s. Octoxy hand rub showed significantly higher efficacy against S. aureus and Escherichia coli than Avagard and Prevacare 15 min after application to the pig-skin model, and against S. epidermidis in both the pig-skin model and in volunteers. Use of Octoxy hand rub with broad-spectrum immediate and prolonged antimicrobial activity may be a very effective way of improving hand hygiene without exposing the hands to higher concentrations of antimicrobials.     

Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit

This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.     

Risk factors for dryness or irritation of staff hands in nine healthcare institutions

Objective

We performed a prospective multicenter study to assess dryness and irritation of hands of staff in care facilities, and to show that disinfection with alcohol-based hand rub is better tolerated than classic hand washing with mild soap.

Method

Dryness and irritation were self-evaluated by volunteers and hetero-evaluated by a team of investigators. The study took into account most of the individual and environmental risk factors of dryness and irritation (season, age, gender, use of protective agent, constitutional, personal and external factors, institution, function, number of consecutive working days).

Results

The results from the 1932 assessments collected showed that traditional hand washing was a risk factor for dryness or irritation, while alcohol-based hand rubs caused no skin deterioration and had a protective effect even when used intensively.

Comment

These results should help to fight non-adherence to the use of alcohol-based hand rubs.     

手部卫生与医院感染的研究进展

医疗机构中医务人员手上携带的细菌已成为医院感染的主要致病源,这些病原体不仅可从已感染伤口或引流伤口处获得,还可从正常、完整的皮肤区域获得。手的清洗和消毒是防止医院感染的最重要措施之一。论文概述了手清洗、卫生手消毒和外科手消毒的分类定义。并对目前使用的酒精、洗必泰葡萄糖酸盐、碘伏、六氯酚、三氯生等各类手卫生产品的作用机理、效果对比及其特点进行了讨论。总结了手卫生存在的一些问题,包括医护人员手卫生遵守率低下,医疗机构对手卫生的重视不足,细菌对消毒剂敏感度的降低和消毒剂使用中发生的接触性皮炎等。并就如何降低接触性皮炎的发生率、减少杀菌剂不利效果的方法、提高手卫生遵守率等一些最新的旨在改进手卫生状况的策略和对策进行阐述。     

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     

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.     

基于point-of-care理念的手卫生设施设置现状调查

 目的 基于point-of-care （POC）理念调查某三级甲等综合性教学医院手卫生设施的设置现状。方法 采用横断面方法调查该院各诊疗区域主要供医务人员使用的手卫生设施种类、数量、位置、设施完备程度,以及速干手消毒剂的消耗量。结果 调查102个区域,1 165间诊疗用房,手卫生设施配置率为96.48%,洗手池完备率为91.37%%,不同区域完备率比较,差异有统计学意义（P<0.01）。80.53%的速干手消毒剂设置符合POC理念,59.51%的普通病区病室速干手消毒剂设置符合POC理念,速干手消毒剂设置符合POC理念比例高的科室手消毒剂消耗量相对较高。结论 手卫生设施的设置和改进应强化POC理念,以提高手卫生依从性和预防医院感染的发生。     

医务人员接触患者后手卫生执行情况的调查分析

目的了解医务人员接触患者后的手卫生执行情况及不同条件对医务人员手卫生执行率的影响。方法对北京、上海、广州3城市8所三级医院不同职务、不同科室的医务人员进行现场观察。结果医务人员接触患者后的手卫生执行率为56．5％，医生为61．0％、护士为53．8％。在提供手套时医务人员手卫生执行率为52．8％，不提供手套为82．0％，差异有统计学意义；在提供醇类快速手消毒剂、肥皂和洗手液时医务人员手卫生执行率（58．7％、61．3％）比不提供的手卫生执行率（51．2％、48．4％）高（P〈0．05、P〈0．01）。医务人员接触患者后使用肥皂（洗手液）和流动水洗手时间≥15s的占74．6％。结论我国大城市、大医院医务人员接触患者后的手卫生执行情况相对较好，洗手时间和流程较为规范，但仍存在手卫生意识薄弱、硬件设施不足等缺陷，尚需加强手卫生教育，采取干预措施，提高医院感染控制水平。