The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit

This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.     

集束照护策略对提高NICU医护人员手卫生依从性的作用

目的 探讨集束照护策略对提高新生儿重症监护病房(NICU)医护人员手卫生依从性的作用.方法 通过开展品质罔活动,实施医护人员手卫生的集束照护策略(care bundle),即:(1)加强培训和管理,增强手卫牛意识,强化手卫牛观念;(2)进行环境改造和流程再造,创建手卫生的氛围和方便的洗手设施;(3)加强监督,医护人员共同参与,保证洗手的正确性.对实施集束照护策略前后NICU医护人员入室及接触患儿前手卫生的落实情况进行比较分析. 结果NICU医护人员入室、接触患儿前手卫生实施率分别由集束照护策略实施前的32.1%、92.0%上升至实施后的97.4%、99.3%;新生儿院内感染的发生率由实施前的2.22%下降到实施后的1.38%.结论 集束照护策略能有效提高医护人员手卫生的依从性,预防医院内感染发生.     

手卫生干预措施提高新生儿重症监护室手消毒依从性的观察与效果

目的研究提高新生儿重症监护室的手消毒依从性。方法建立手卫生干预措施,并用视频监测手段观察干预前后共13个月的各类接触。结果实施手卫生干预措施后手消毒依从性从25．15％上升为88．20％;培训后护理员的手消毒依从性较医生和护士低,夜间护士和护理员的手消毒依从性低于白班（P〈0．01）。结论手卫生干预措施能有效提高手消毒的依从性。     

浅谈手卫生与儿童重症监护病房医院感染率及三管感染率的相关性

目的探讨手卫生与儿童重症监护病房(PICU)医院感染率及三管感染率的相关性。方法选择2017年4月至2019年9月我院儿内二科PICU医护人员与所有患儿为研究对象。观察调查期间各季度医院感染、三管感染发生情况及医护人员手卫生依从率、正确率与合格率;分析医护人员手卫生与PICU医院感染率、呼吸机相关肺部感染率的相关性。结果我院2017年4月至2019年9月PICU医院感染率在0~9.91%,2017年第三季度、2018年第一季度医院感染率最突出;呼吸机相关肺部感染在2017年第三季度明显增加;PICU医护人员手卫生依从率在68.57%~92.83%,正确率在81.98%~92.95%,合格率在79.07%~91.67%。相关性分析结果显示,医护人员手卫生依从率与PICU医院感染率、呼吸机相关肺部感染率均有显著的负相关性(P<0.001)。结论医护人员手卫生依从性与PICU医院感染率、呼吸机相关肺部感染率有显著的负相关性,严格执行手卫生可明显降低医院感染率与三管感染率。     

Hand hygiene compliance of nurses: a 5-unit observational study in North-Eastern Anatolia

In five neonatal intensive care units (NICUs) in two cities, the hand hygiene applications of 72 nurses included in this observational study have been investigated. The research was conducted between February and June 2007. It was found that before entering the NICUs, majority of nurses have washed their hands but used much less alcohol-based antiseptics; more than half of the nurses did not use gloves, and 50 of them did not wash their hands before care and one-third of the nurses did not wash their hands after care after neonatal treatments. The results obtained from our research showed that most of the nurses paid more attention to hand washing before applying medical treatment.     

Effects of hand hygiene education and individual feedback on hand hygiene behaviour,MRSA acquisition rate and MRSA colonization pressure among intensive care unit nurses

This study was conducted to increase the frequency and level of thoroughness of hand hygiene practice by nurses, and to assess the influence of the methicillin‐resistant Staphylococcus aureus (MRSA) acquired incidence rate and the MRSA colonization pressure in a medical intensive care unit (MICU). A total of 24 MICU nurses received hand hygiene education and individual feedback of hand hygiene frequency and method after a session of education, and two posteducation evaluations were followed. The frequency of hand hygiene (P = 0.001) and the methodology score of hand hygiene increased significantly (P = 0.001). The MRSA acquisition rate decreased significantly, from 11.1% before the education to 0% after (P = 0.014). The MRSA colonization pressure decreased significantly from 39.5% to 8.6% after the education sessions (P = 0.001). This indicates that providing individual feedback after hand hygiene education was very effective in increasing nurses' hand hygiene frequency and improving hand hygiene method; furthermore, it was expected to decrease health care‐associated infections.     

Hand hygiene compliance and behavioural determinants in a paediatric intensive care unit: An observational study

Background

Hand hygiene is considered the single most effective means of reducing healthcare-associated infections, but improving and sustaining hand hygiene compliance remains a great challenge.

Reducing nosocomial infection in neonatal intensive care: An intervention study

Nosocomial infection is a common cause of morbidity and mortality for hospitalized neonates. This report describes measures taken to reduce the prevalence of nosocomial infection within a 34‐bed neonatal intensive care unit in Malaysia. Interventions included a one‐to‐one education programme for nursing staff (n = 30); the education of cleaners and health‐care assistants allocated to work in the unit; and the introduction of routine (weekly) screening procedure for all infants with feedback given to staff. The education programme for nurses focused on the application of standard precautions to three common clinical procedures: hand washing, tracheobronchial suctioning and nasogastric tube feeding. These were evaluated using competency checklists. The prevalence of nosocomial blood and respiratory tract infections declined over the 7‐month study period. This study highlights the importance of education in contributing to the control of nosocomial infection in the neonatal intensive care unit.     

基层医院医务人员手卫生依从性调查

目的:了解基层医院医务人员洗手行为的依从性,探讨相应的管理对策。方法:采用自行设计的调查问卷并结合现场观察洗手过程的方法,调查不同科室医务人员洗手知识的知晓情况及其洗手执行率。结果:医务人员的手卫生依从性不容乐观,接触患者前为58.4%,戴手套前仅为47.5%,儿科手卫生依从性最高,为78.8%,急诊科最低,为47.3%,护士的手卫生依从性高于医生。结论:实施灵活多变的培训方式及措施;及时、实事求是地反馈医院感染监测结果;进行医务人员手卫生依从性的调查;完善、改造和配备洗手设施;提供"伸手可得"的速干手消毒剂,规范洗手行为,确保洗手到位,有效降低医院感染的发生。     

ICU患者医院感染病原菌耐药性变化的临床观察

目的：观察两种抗生素轮换策略指导下ICU患者医院感染的病原菌及其耐药性变化特点。方法：根据抗生素轮换方案将2011-01-2011-12我院ICU收治的22例医院感染患者分为升阶梯治疗组和降阶梯治疗组,观察医院感染病原菌及其耐药性特点,并与我院全年流行病学数据进行比较。结果：两组检出致病菌耐药率及中敏率均显著高于全年流调水平,敏感率显著低于全年流调水平。结论：两种抗生素轮换策略均不能减少耐药菌的产生,但耐药菌的种属及耐药谱存在差异。     

基于系统评价的三级公立医院医护人员手卫生依从性状况调查

目的评价我国三级公立医院医护人员手卫生依从性及正确率,为疫情常态化形势下医疗机构采取院感防控措施提供依据。方法在PubMed、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方及维普(VIP)数据库中,检索2017年11月—2020年11月的文献,使用NoteExpress 3.3筛选研究,Stata15进行Meta分析。结果共纳入研究18篇,医生和护士手卫生依从率分别为0.49(0.40~0.58)和0.61(0.52~0.69)。基于漏斗图的begg偏倚检验及Egger偏倚检验显示,医生组和护士组结果分别为,医生组P=0.876和0.807(>0.05),护士组P=1.00和0.790(>0.05),两组均不存在发表偏倚。医护手卫生依从率分别为50.00%和60.7%(χ^(2)=60.952,P<0.05);医护手卫生正确率分别为66.00%和76.90%(χ^(2)=75.759,P<0.05)。结论我国三级公立医院医护人员手卫生依从性较低,医院应采取措施,加强管理,降低医院感染风险。     

Long-term effectiveness evaluation of an action-research intervention to improve hand hygiene in an intensive care unit

ObjectivesTo evaluate the long-term effectiveness of an action research intervention aimed at improving hand hygiene in an intensive care unit of a public hospital in Italy.MethodsAn observational, prospective before-after study was carried out. Compliance with hand hygiene was estimated by measuring the utilization of hand hygiene products before the intervention and four years after the end of the project. Products used were the following: detergent liquid soap, antiseptic liquid soap and alcohol-based hand gel. Endpoints were quantity consumed (in grams) for each product category. Quantitative consumptions per workshift were compared.ResultsIn 2017 the median consumption of antiseptic liquid soap and alcohol-based hand gel per workshift was significantly higher than in 2012 (111.5 g vs 72.5 g, p = 0.014, and 18.0 g vs 5.0 g, p < 0.001). Odds in favour of a higher value in 2017 were 1.99:1 (CI95%: 1.19:1 to 3.73:1) for antiseptic solution, and 5.39:1 (CI95%: 3.09:1 to 13.61:1) for antiseptic gel. Covariates were not associated with consumption of products, and this made it possible to compare the measurements in the two data collections.ConclusionsResults of this study support the long-term effectiveness of the action research intervention to improve practices of hand hygiene in an intensive care setting.     

2017—2019年妇产科重症监护病房院内感染的特征分析

目的 分析2017—2019年妇产科重症监护病房(MICU)院内感染的特征,为产科管理服务新模式下院内感染的预防及控制工作提供参考。方法 选取2017年1月1日至2019年12月31日西北妇女儿童医院MICU院内感染患者作为研究对象,对其特征进行分析。结果 4 681例患者中,发生院内感染61例,其中3例发生2次院内感染,共发生院内感染64次。2017—2019年院内感染发生率分别为1.02%、1.32%、1.51%,2017—2019年院内感染发生率比较,差异无统计学意义(P>0.05)。感染部位以生殖道为主,占40.62%,其次为血液系统,占26.56%;2017—2019年,生殖道、血液、尿管相关部位、盆腹腔、呼吸道、导管血流、皮肤感染例次占比比较,差异无统计学意义(P>0.05)。送检标本中导管阳性检出率最高,占61.11%,血阳性检出率最低,占30.91%;2017—2019年,血、生殖道分泌物、尿、引流液等体液、导管阳性检出率比较,差异无统计学意义(P>0.05)。病原菌以G⁺菌为主,占56.67%,其中肠球菌占G⁺     

血液病患者家属手卫生依从性及影响因素研究

摘要 目的 调查血液病患者家属手卫生依从性并分析其影响因素。方法 采用非参与式观察法及问卷调查法对200名血液病患者家属手卫生依从性进行调查,并分析影响因素。结果 血液病患者家属手卫生依从性为38.05%,白血病患者家属依从性最高,为58.90%。79.00%的患者家属不知道正确的洗手时机,62.00%的患者家属认为手没有被污染不用洗手。患者家属手卫生依从性随着患者化疗疗程的增加而增加,使用层流床、既往发生过感染、居住在城市的患者家属手卫生依从性相对较高。结论 血液病患者家属手卫生依从性较低,缺乏对手卫生的正确认知,护士应加强手卫生健康教育,重点宣教来自农村、初次化疗以及之前未发生过感染的患者家属。     

护理干预在预防急诊重症监护室导管相关性感染的效果观察

目的:分析护理干预在预防急诊重症监护室导管相关性感染中的效果。方法:选择本院急诊重症监护室自2014年1月至2017年12月收治的834例患者,将其随机分为两组,对照组和观察组,每组417例。对照组给予常规护理,观察组给予综合护理措施,对两组护理效果进行比较。结果:两组呼吸机相关性肺炎、导管相关尿道感染及中心导管相关血液感染对比,差异明显(P<0.05),体现在观察组发生率均较低。观察组导管使用天数、EICU天数与对照组对比,前者均明显少于后者(P<0.05)。结论:给予急诊重症监护室留置导管者有效的护理措施,可使导管相关感染发生率降低,可以借鉴。     

2013年重庆渝中区市属三甲医院重症医学科院感调查分析

目的：了解渝中区市属三甲医院重症医学科（ICU）医院感染的现状,分析常见病原菌及其易感原因,为降低医院感染的发生率提供指导。方法收集2013年重庆市渝中区5所医院ICU医院感染相关资料,研究其发病率、常见感染部位、常见病原菌,并分析其感染发生原因。结果2013年平均感染例次率6．58％,平均日感染发生率12．51‰;呼吸（58．91％）、泌尿（28．29％）及血液（8．91％）为常见感染系统;长时间留住ICU,疾病危重程度,高龄,使用“三管”是ICU医院感染的易感因素;对有创机械通气患者施行声门下吸引、床头抬高、早期开展肠内营养、气囊测压、洗必泰口腔护理可有效预防呼吸机相关性肺炎（VAP）的发生（P＜0．05）;铜绿假单胞菌（27．81％）、鲍曼不动杆菌（20．86％）及大场埃希菌（15．56％）为常见感染细菌,且耐药率高。结论渝中区三甲医院ICU院感率符合院感控制标准且低于全国平均水平;结合本地区特点,应重点做好VAP的预防工作,采取切断非发酵菌的传播途径、限制广谱抗菌药物的滥用等预防措施以控制ICU医院感染的发生。     

神经外科重症监护室侵入性导管感染发生情况分析及对策

目的了解神经外科重症监护室侵入性导管感染发生情况,分析其感染特点,为制订预防感染措施提供理论依据。方法回顾性分析和总结本科室563例次留置侵入性导管患者的临床资料。结果 563例次留置侵入性导管中,发生导管感染106例次,发生率为18.8%。各管道感染发生率以尿管居高,发生率为24.5%;其次是硬膜外引流管,发生率为16.9%。病原菌主要为凝固酶阴性葡萄球球菌。结论提高医护人员对侵入性操作感染危害性的认识,操作时遵守各种导管的护理操作规程和加强各种管道护理,对降低侵入性导管感染发生率,确保患者的安全具有重要的作用。     

Prevention of catheter-related bloodstream infections in the neonatal intensive care setting

Nosocomial infection causes substantial morbidity and mortality among neonates treated in the neonatal intensive care setting. Colonization and subsequent infection of central venous catheters leading to catheter-related bloodstream infection is among the most common causes of nosocomial sepsis in this patient population. Prevention of catheter-related bloodstream infection is a major challenge and numerous strategies have been attempted in this context with varying success. Given the dynamic epidemiology of nosocomial infection among neonates and the emergence of antimicrobial resistance, novel prevention strategies are urgently required.