手卫生依从性对ICU医院感染控制的影响

<正>医务人员的手是医院感染传播的重要途径之一,因此医务人员手卫生质量直接关系到医院感染防控措施的效果。据报道,通过清洁、抑制或杀死手部微生物的手卫生方法可以降低30%的医院内感染,所以医务人员的手卫生越来越引起人们的关注〔1-3〕。世界卫生组织(WHO)历来倡导医务人员手卫生,许多国家卫生管理部门乃至世界卫生组织都先后颁布医疗机构人员手卫生指南和相应的规范或标准〔4〕。2009年4月我国专门颁布了《医护人员     

手卫生控制对ICU医院感染的影响

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2007年的42.70%下降到2008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。     

医护人员手卫生依从性调查

目的了解本医院医护人员手卫生依从性状况,以便加强手卫生管理。方法采用随机抽样和填写调查表方法,对本医院2007～2008年在岗医护人员手卫生依从性的情况进行了调查。结果2007年共监测医护人员497人次,手卫生执行率为22.07%;2008年共监测2251人次,手卫生执行率为77.92%。该医院2007年医院感染发生率为4.56%,2008年医院感染发生率为2.78%。结论该医院医务人员手卫生依从性比较低,但2008年度明显高于2007年度,手卫生依从率与医院感染率呈负相关关系。     

强化干预与视频监测NICU医务人员手卫生依从性的管理探索

目的 探索在新生儿重症监护室(NICU)实施手卫生管理的方法和意义。方法 根据2009年WHO颁布的手卫生指南中“5个手卫生时机”,2017年2月-2017年7月为干预前,采用院感专职人员暗访的形式进行手卫生监测,作为干预前的基线水平;2017年8月-2018 年1月采取强化干预结合视频监测的方法进行手卫生依从性管理,作为干预后。比较干预前后NICU手卫生依从率及医院感染率。结果 NICU医务人员手卫生依从率由干预前的23.50%提高到干预后的71.32%,同时医院感染率也显著下降,前后比较均具有统计学差异(均P＜0.05)。医生、护士、医技、保洁的手卫生依从率经干预后均显著提高(均P＜0.05),其中护士提高幅度最大,由28.23%提高至82.11%。医技和保洁人员手卫生依从性不高,干预后分别为44.44%和48.57%,其中戴手套进行手消毒是主要问题。结论 强化干预结合视频监测可以显著提高NICU手卫生依从性,良好的手卫生策略是降低NICU医院感染的重要手段。     

提高医护人员手卫生依从性的方法研究

目的 探讨提高医护人员手卫生依从性的方法,以降低医院感染.方法 采取手卫生知识培训、提供干手纸巾及速干手消毒剂、安装电子监控、鼓励患者积极参与等多方式联合运用的手部卫生促进措施对283名临床医护人员手卫生行为进行干预,将干预前后医护人员的手卫生状况进行对比分析.结果 干预前后16个临床科室手卫生设备配置情况比较差异有统计学意义（P〈0.05）;干预前后283名医护人员洗手率及干手方式比较差异有统计学意义（P〈0.01或P〈0.05）;干预后医护人员手卫生知识明显提高,差异有统计学意义（P〈0.05）;医护人员手卫生依从率由原来的（69.23±30.76）%提高到（89.56±18.41）%,差异有统计学意义（P〈0.05）.结论 采用多种方式联合的手部卫生促进策略能够有效提高医护人员的手部卫生依从性.     

综合重症监护病房医护人员手卫生调查

目的了解重症监护病房医务人员手卫生现状,研究影响手卫生的因素。方法通过问卷调查和现场观察的方法 ,对本医院重症监护病房医务人员手卫生消毒情况进行了调查。结果本医院ICU部分医务人员对手卫生知识概念模糊,但对手卫生指征及洗手方法掌握较好。有96%的医务人员认为手卫生重要;有90%的医务人员最习惯的手卫生方式是洗手,只有10%的医务人员习惯快速手消毒剂擦手消毒方式。影响手卫生依从性的因素主要是没有时间,洗手频率太高,怕损伤皮肤,洗手设施不方便等。结论 ICU医务人员手卫生知识欠缺,洗手执行率受主客观因素影响明显,应加强相关知识培训和制度落实。     

直观教育对提高医护人员手卫生依从性的效果研究

目的研究监护室医护人员手卫生教育方式,提高手卫生依从性。方法采用手卫生直观教育的方法,对医护人员手卫生进行培训,并观察医护人员手卫生依从性和质量监测。结果通过手卫生直观教育,重症监护室医护人员日洗手次数由教育前的16次提高到36次;手上带菌数由平均14 cfu/cm2,降低到≤5 cfu/cm2。检测结果显示,医护人员手卫生质量合格率由教育前的18.75%,提高到93.75%。结论通过手卫生直观教育,有效提高了重症监护室医护人员洗手依从性和手卫生质量。     

集束化管理对重症监护室医护人员手卫生依从性的影响

[目的]探讨集束化管理对重症监护室(ICU)医护人员手卫生依从性的影响。[方法]选择2015年5月—2016年5月在ICU工作的医生、护士作为研究对象,从2015年11月开始对我科手卫生进行集束化管理,通过观察干预前后半年医护人员手卫生依从性的情况,对干预前后医护人员手卫生依从性及医院感染率进行统计学统计。[结果]干预后医护人员手卫生依从性优于干预前,干预后医院感染率低于干预前,差异有统计学意义(P0.05)。[结论]对ICU医护人员手卫生实施集束化管理能提高其依从性,降低医院感染率。     

提高ICU手卫生依从性方法的研究进展

本文主要从手卫生的定义与依从性分析、提高ICU手卫生依从性的方法2个方面进行综述,总结近年来国内外采取的提高ICU手卫生依从性的方法,旨在为相关研究者、决策制定者提供参考和依据。     

医护人员手卫生执行状况调查

目的了解扬州友好医院医护人员手卫生执行情况。方法采用隐蔽式现场观察的方法,对医院部分科室医护人员手卫生的执行率进行调查。结果该医院医护人员手卫生总平均执行率为65.7%;临床医生、护士执行率分别为62.9%和67.8%;儿科手卫生执行率最高,为80.8%;医技科室最低,为55.8%。结论扬州友好医院医护人员手卫生执行率的状况有待改善,需要提高医护人员手卫生意识,完善手卫生基础设施。     

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。     

Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit

Nosocomial infections are a significant problem in neonatal intensive care units (NICUs) and hand hygiene (HH) has been stated as an effective mean to prevent spread of infections. The aim of study was to assess the baseline compliance HH practices and to evaluate the impact of hand washing educational programme on infection rate in a NICU. Continuous surveillance of nosocomial infections was done. A total of 15 797 and 12 929 opportunities for HH were observed in pre‐intervention and postintervention phases, respectively. Compliance of health‐care workers for all HH opportunities combined was 46% before intervention and improved significantly to 69% in postintervention (RR 1.49, CI 1.46–1.52, P < 0.0001). Compliance for nurses and doctors was similar. Nosocomial sepsis rate showed a significant decline from 96 per 1000 patient‐days in pre‐intervention to 47 per 1000 patient‐days in postintervention phase (RR 0.44, CI 0.33–0.58, P < 0.0001). We conclude that effective HH practices can serve as an economical and effective nosocomial infection control approach especially important in developing nations.     

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.     

新生儿重症监护病房医院感染的因素探讨及防控对策

目的探讨新生儿重症监护病房医院感染的原因及对策。方法采用回顾性调查研究的方法,对2007年1月至2008年12月我院新生儿重症监护病房收治的981例患儿的病例资料进行统计学分析。结果发生医院感染23例,感染率2.33%,感染部位以胃肠道为主,其次为呼吸道、皮肤黏膜、口腔、其他等,病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主。结论采取严格的消毒隔离制度,合理使用抗生素,尽量缩短住院时间等相应措施可有效减少新生儿医院感染的发生。     

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.

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.     

表格式出院指导在NICU的应用

目的：探讨表格式出院指导在早产新生儿监护（ NICU）的应用效果。方法针对NICU特点,制定表格式出院指导。使用前加强护士培训,完善规章制度和工作流程,比较使用口头式出院指导（n＝560）和表格式出院指导（n＝500）患儿家长对护理工作的满意度、对出院指导的依从性的差异。结果使用表格式出院指导后,患儿家属对服务可及性、健康教育、人文关怀满意度得分别为（4．13±0.27）,（4．52±0．33）,（4．56±0．34）分,均高于实施前,差异有统计学意义（t值分别为47．30,27．53,41.74;P＜0．01）。使用表格式出院指导后患儿各项复查率均高于使用前,差异有统计学意义（ P＜0.01）。结论 NICU使用表格式出院指导,可以提高家属对健康教育的满意度,提高对健康教育的依从性。     

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.     

袋鼠式护理对新生儿重症监护室早产儿操作性疼痛的影响

目的:探讨新生儿重症监护室(NICU)早产儿执行疼痛性操作时应用袋鼠式护理对改善操作性疼痛的效果.方法:将本院N IC U收治的90例早产儿按入科顺序分为对照组和观察组.对照组45例早产儿接受N IC U常规护理,观察组45例早产儿接受常规护理和袋鼠式护理.比较两组早产儿操作性疼痛评分及血氧饱和度(SPO2)、心率(H...     

循征医学在新生儿重症监护病房感染控制中的应用

目的 应用循征医学的方法建立新生儿重症监护病房（NICU）感染控制流程.方法 通过对NICU感染控制相关资料的调查,确定存在的问题,利用医学文献数据库（Medline）等相关医学网站检索相关文献,进行评价整合证据,以系统科学的方法建立NICU感染控制流程.结果 对照组和观察组对比：奶瓶奶嘴清洁消毒合格率,空气、物体表面、保温箱湿化水监测以及两组医护人员洗手依从性,各项监测指标差异均具有统计学意义（P＜0.05或P＜0.01）.结论 应用循征医学的方法建立NICU感染控制流程,是科学、有效的方法.