手卫生整合管理对手术切口感染率的影响

目的了解针对手术人员实施手卫生整合管理后,对手术切口感染发生率的影响。方法自2009年1月起对手术医护人员实施以手术间内实行手消毒剂干洗手法、外科手消毒揉搓、无触式戴无菌手套方法及戴双层手套等为主要措施的规范化手卫生整合管理,并回顾性分析实施前后手术切口感染发生率的变化情况。结果通过对参加手术人员手卫生进行整合管理方法后,手术人员的手卫生清洁消毒合格率和洗手依从性得到提高,手术切口感染发生率由2007-2008年的0.87%降至2009-2010年的0.18%,差异有统计学意义(χ2=12.463,P<0.01)。结论规范的手卫生整合管理措施有利于提高消毒隔离质量,减少外源性接触感染,对降低手术切口感染率具有重要意义。     

进修人员外科手消毒效果监测与管理

目的调查进修人员外科手消毒状况,发现存在的问题,制定改进措施,进而提高外科手消毒达标率,降低医源性感染率。方法选取刚到院进修外科医师100名,对其外科手消毒效果进行检测。结果有10名进修外科医师手部样本细菌培养阳性。结论完善进修人员管理制度,加强进修医师的外科手消毒培训,规范外科手消毒流程,采取有效措施进行监控管理,从而提高外科手消毒达标率,防止手消毒不达标而引发手术部位感染。     

免刷手方法在外科手消毒中的应用

目的 比较免刷手与刷手两种外科手部消毒方法的效果和对皮肤的影响,以提高洗手依从性.方法 研究医院2011年参加手术的医护人员,随机分为对照组和试验组,每组50人,医师、护士各25人;应用同一种外科手洁肤柔免洗手消毒凝胶消毒剂,对照组采用传统的刷手方法进行手部消毒,试验组采用免刷手方法进行手消毒,余均按2009年《医务人员手卫生规范操作》执行,并对手消毒前后对皮肤作细菌和病原菌检测,对同期的600例患者手术切口的感染率进行同步分析.结果 两组手消毒后杀菌率分别为98.12％和97.77％,经检验比较二者差异有统计学意义(P＜0.05);对照组手部消毒时间为(10.28±1.23)min,试验组为(5.65±0.78)min,,试验组与对照组相比手部消毒时间明显缩短,二者差异有统计学意义(P＜0.05);消毒后对照组和试验组的医护人员手部细菌总数明显减少,未测出致病菌,符合消毒技术规范要求;切口感染对照组15例感染率5,0％,试验组12例感染率4.0％,两组比较差异无统计学意义.结论 免刷手与刷手两种手部消毒方法均能达到杀菌要求,消毒效果和手术切口感染率无差异,但免刷手比刷手式手部消毒方法时间缩短,减少了医护人员皮肤的损害,提高了医护人员依从性,值得在临床推广.     

手术部位感染相关因素研究进展

随着19世纪术前洗手、手消毒、消毒手术器械,到20世纪早期外科医师戴手套成为常规、使用抗菌药物预防手术部位感染等,尽管采取了各种不同的预防手术部位感染措施,使手术部位感染率有了明显降低,但手术部位感染依然存在,人们也因此从未停止对手术部位感染相关因素的研究.     

医用橡胶手套渗漏与洗手依从性的研究

目的研究医用橡胶手套的渗漏性和医务人员手卫生的关系,提高医务人员手卫生的依从性。方法针对医务人员普遍认为戴无菌手套后手不被污染及摘手套后手仍是干净的,可以不用洗手或手消毒的问题进行医用橡胶手套渗漏性的研究和目前影响洗手依从性的研究。结果医用橡胶手套具有渗漏性,医务人员戴医用橡胶手套操作时,随着诊疗操作时间的延长和操作种类的不同,渗漏的菌尘致使医务人员双手污染,如果不及时进行手卫生,摘手套后双手将成为医院感染的隐患。结论通过对医用橡胶手套渗漏性的研究,提高医务人员摘手套后手卫生的依从性,降低医院感染发病率。     

流动采血车不同岗位医务人员手卫生监测 FREE

目的方法结果结论调查流动采血车医务人员手细菌及乙型肝炎病毒（HBV）污染状况。对流动采血车医务人员手消毒后工作状态下未戴手套及戴手套的手指采样,进行细菌培养和乙型肝炎表面抗原（HBsAg）检测（酶联免疫吸附试验）。结果显示,未戴手套操作时,采血人员、检验人员、后勤人员、体检人员的手平均菌落数分别为4.20、7.30、8.60、10.50 CFU/cm2,手合格率分别为82.72%、64.17%、52.26%、45.33%;HBsAg阳性检出率分别为0.00%、2.08%、0.00%、0.00%。采血人员和检验人员戴手套操作时手（于手套上采样）平均菌落数分别上升至6.80 CFU/cm2和12.60 CFU/cm2,检验人员手HBsAg污染率上升至9.38%。提示流动采血车医务人员手细菌污染严重,戴手套操作时手消毒不规范增加了微生物污染的危险性。     

检验科医源性感染的预防与管理

检验科是医院重要的医技科室,也是一个很容易发生医源性感染的科室。做好检验人员和实验室的医院感染管理,制定预防医源性感染的措施,保障医疗安全具有重要意义。1检验科对医院感染的认识与存在的问题1.1自我防护意识淡薄对检验标本的生物危害性认识不足,操作时不戴手套、帽子及口罩,检测后标本随意处置,受污染的台面地面不及时消毒,检验人员的手污染严重。1.2规章制度不健全医院感染知识教育滞后,检验科内     

CT影像手术间脊柱手术患者感染的预防控制措施

目的探讨CT影像手术间脊柱手术患者感染的预防控制措施,以降低手术感染率。方法实施科学的CT手术间感染控制及完善CT扫描机清洁消毒措施,进行CT手术间专业人员岗前培训,规范外来器械及植入物检查消毒流程,落实术前术后患者检查治疗措施,严格执行术中无菌操作等控制措施。结果 2012年1月-2013年5月366例CT手术间完成的骨科脊柱手术患者,发生手术切口感染1例,感染率为0.27%。结论建立科学的手术感染预防管理制度,加强各级人员的培训,术中严格无菌操作,规范外来器械管理、完善患者术前术后检查治疗等相关围术期预防感染措施,对降低脊柱内固定手术的感染率有重要意义。     

PDCA循环法对消毒供应室人员手卫生的影响

目的探讨PDCA循环法对消毒供应室工作人员手卫生状况的影响。方法随机选取汕头大学医学院附属肿瘤医院消毒供应室20名工作人员作为调查对象,将20 1 8年6-1 2月实施PDCA循环法进行手卫生管理前作为对照组,20 1 9年1-6月实施PDCA循环法进行手卫生管理后作为观察组。比较两组消毒供应室工作人员手卫生状况,包括手卫生知识知晓率、洗手方法正确率、洗手依从率及手部微生物检测情况。结果实施PDCA循环法管理消毒供应室工作人员手卫生后,手卫生知识知晓率、洗手方法正确率、洗手依从率及手部微生物检测合格情况均高于实施PDCA循环管理前,差异均有统计学意义(P0.0 5)。结论 PDCA循环法可提高消毒供应室工作人员手卫生状况,值得临床推广应用。     

加强护理管理执行力提高手卫生依从性

我院为加强护理管理执行力,提高手卫生依从性,从手卫生的基本要求、手卫生设施、洗手与手卫生消毒、外科消毒、手卫生监测等方面给予规范,取得良好效果. 1手卫生依从性 我院新护士上岗前首先进行手卫生依从性培训;护理部组织由感染控制科专职人员进行授课,系统地讲解洗手的重要性、洗手指征、戴手套指征、速干消毒剂使用要点和方法,系统学习六步洗手法. 2强化手卫生理念提高洗手意识     

不同检查方式对麻醉喉镜清洁程度的影响

目的 评价不同检查方式对麻醉喉镜清洁程度的影响.方法 按国家卫生部《内镜清洗消毒技术操作规范》要求清洗麻醉喉镜后,随机抽取40套,每套分别检测清洗后及经佩戴清洁手套、免冲洗手消毒、皂液洗手及清洁手处理后再检查喉镜后的三磷酸腺苷(ATP)相对发光值.结果 皂液洗手、免冲洗手消毒和清洁手处理检查前后ATP相对发光值差异有统计学意义(P＜0.05),配戴清洁手套检查其ATP相对发光值差异无统计学意义.结论 麻醉喉镜在检查时应采用佩戴清洁手套的方法,以降低手对喉镜的污染.     

手术室消毒灭菌管理与医院感染控制

目的 通过加强手术室消毒灭菌管理,控制医院感染的发生.方法 按照《消毒技术规范》规定的操作对消毒灭菌效果进行监测;采用回顾性和现场临床观察方法,观察患者术后伤口情况.结果 2010年医院手术室空气灭菌合格率为98.9％,灭菌物品与消毒物品灭菌合格率均为100.0％,医护人员手卫生合格率为100.0％,与2009年相比,手术室消毒灭菌合格率明显提高;2010年我院Ⅰ类切口术后感染率为0.4％,Ⅱ类切口感染率为2.0％,Ⅲ类切口感染率为5.6％,与2009年相比,医院术后感染率明显降低.结论 加强手术室消毒灭菌管理是有效控制医院感染的关键.     

Anaesthetists' role in computer keyboard contamination in an operating room

To store anaesthetic records in computers, anaesthetists usually input data while still wearing dirty wet gloves. No studies have explored computer contamination in the operating room (OR) or anaesthetists' awareness of the importance of handwashing or hand hygiene. We investigated four components of keyboard contamination: (1) degree of contamination, (2) effect of cleaning with ethyl alcohol, (3) bacterial transmission between gloves and keyboards by tapping keys, and (4) frequency of anaesthetists' performing hand hygiene. Most of the bacteria on keyboards were coagulase-negative staphylococci and Bacillus spp.; however, meticillin-resistant Staphylococcus aureus was also found. Cleaning keyboards with ethyl alcohol effectively reduced bacterial counts. Wet contaminated gloves and keyboards transmitted meticillin-susceptible Staphylococcus epidermidis from one to the other more readily than dry contaminated gloves and keyboards. Only 17% of anaesthetists performed hand hygiene before anaesthesia, although 64% or 69% of anaesthetists performed hand hygiene after anaesthesia or before lunch. To prevent cross-contamination, keyboards should be routinely cleaned according to the manufacturer's instructions and disinfected once daily, or, when visibly soiled with blood or secretions. Moreover, anaesthetists should be aware that they could spread microbes that might cause healthcare-associated infection in the OR. Anaesthetists should perform hand hygiene before and after anaesthesia and remove gloves after each procedure and before using the computer.     

Bactericidal power's assessment of eight antiseptic products intended to surgeon's hand-washing (author's transl)]

A standard hand-washing technique was used in order to test the relative effectiveness of eight both detergent and alcoholic preparations intended to surgeon's hands disinfection. A single four or seven minutes washing with alcoholic solutions was shown to eliminate a much larger proportion of the skin flora than could be removed by a single four or seven minutes hand-washing with detergent antiseptic preparations. Authors have also determined effect of wearing surgical rubber gloves after skin disinfection and compared viable bacterial counts in hand washings immediately after the antiseptic treatment and when gloves had been worn for one hour.     

The influence of hand hygiene prior to insertion of peripheral venous catheters on the incidence of complications

Using two studies of a simple design it has been possible to furnish proof of the influence of hand hygiene prior to insertion of peripheral venous catheters on the incidence of complications. In the first study detailed data were collected anonymously for each patient on the procedure used for catheter insertion or on any complications. Data were collected for around 64% of patients in one hospital. Evaluation of the questionnaires revealed that there was a significant increase in the incidence of complications in line with an increasing duration of the indwelling period of between 24 and 96 hours. The unexpected finding of this evaluation study was that in the case of catheters with an indwelling period of more than two days there were highly significantly lower complication rates in those cases in which hand disinfection was carried out or gloves donned before catheter placement. The second study, based on the former, documented the cases giving rise to complications. The proportion of peripheral venous catheters implicated in complications was 24%. Here, too, there was a sharp rise in the risk of complications in line with the duration of the indwelling period. Catheters placed in the OR during the patient’s hospital stay showed a significantly lower risk of complications than those inserted on wards, or even in the outpatient department. Conductance of hygienic hand disinfection or the wearing of disposable gloves resulted in significantly lower complication rates compared to normal handwashing or omission of a hand hygiene measure. The most plausible explanation for this positive effect exerted by the wearing of disposable gloves or conductance of hygienic hand disinfection prior to catheter placement is that there was no recontamination during repalpation, as often seen, of the prepared venepuncture site.     

Investigations into the efficacy of different procedures for surgical hand disinfection between consecutive operations.

In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min.     

The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications.

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter, were filled in at the time of insertion and removal of catheters.In comparison with simple hand washing, disinfection of hands before the insertion or wearing of gloves resulted in significantly fewer complications (relative risk 0.59 and 0.66, respectively). Normal hand washing was no better than no hand hygiene (relative risk 1.13), with regard to reduction of complications. This underlines the necessity of employing more effective measures of hand hygiene. The frequency of complications was dependent on the duration of peripheral venous catheterization. Catheters inserted in the operating room had a significantly lower risk of complications than catheters inserted on the ward or in the outpatient unit.     

手术室消毒灭菌监测与医院感染控制讨论

[目的]探讨加强手术室消毒灭菌监测管理,控制医院感染。[方法]对我院医院环境和消毒灭菌效果、手术切口感染率进行监测,并进行数据分析。[结果]医院环境和消毒灭菌效果及手术切口感染率取得理想效果。[结论]通过控制手术室消毒灭菌,减少医务人员手污染,加强医务工作者的感染知识学习,严格执行无菌操作,减少手术感染的机会,为我院感染控制提供可靠保障,为患者创造良好就医环境。     

The procedures of hygiene to control hospital-acquired diarrhoea in paediatric wards: a multicentre audit

An audit was carried out in paediatric wards to study the compliance of healthcare workers (HCWs) to the procedures recommended for the control of hospital-acquired diarrhoea. Thirty-two paediatric wards in the southeast of France participated on a voluntary basis in this prospective observational study after completing a self-administered questionnaire recording measures of hygiene. All the observations were made by the same investigator and focused on preventive procedures: use of single room, handwashing, hand disinfection, overclothing, single-use gloves and masks. Two hundred and seventy patient-HCW contacts were observed, including mainly diapering, temperature measurement, collection of blood sample and catheter care. The isolation of patients in a single room and use of gowns by HCWs were significantly associated with diarrhoea. Whereas handwashing before care was performed by HCWs in more than 95% of all the procedures, the compliance in the use of disposable gloves by HCWs was only of 39.4% for technical procedures (including those with potential exposure to blood) and 20.3% for diapering or temperature measurement. A substantial agreement between reported and observed measures of hygiene was observed for handwashing before contact and hand disinfection with antimicrobial soap before contact. In contrast, this agreement was moderate for use of single room, handwashing after contact, overclothing and wearing disposable gloves after a diaper change. Despite the excellent compliance of HCWs to handwashing, clearer recommendations for the indication and use of disinfectants and disposable gloves are urgently needed.