基于WHO多模式手卫生促进策略在新生儿重症监护病房医务人员手卫生干预中的应用研究

目的分析基于世界卫生组织(WHO)多模式手卫生促进策略干预在新生儿重症监护病房(NICU)预防医院感染中的应用效果。方法选择2016年1月至2017年12月NICU医务人员24名、新生儿150例为研究对象,根据实施WHO多模式手卫生促进策略时间分为干预前(2016年1—12月) 72例、干预后(2017年1—12月) 78例。干预前采用医院院感督导、全员培训等常规措施,干预后联合应用基于WHO多模式手卫生促进策略进行干预。比较两组医务人员手卫生知信行水平、关键时间节点手卫生依从性、患儿医院感染率。结果 WHO多模式手卫生促进策略干预后,医务人员手卫生知识、态度、行为评分均明显高于干预前(均P 0. 05);直接接触患儿前、进行清洁或无菌操作前、直接接触患儿后、接触患儿分泌物后、接触患儿周围环境及物品后手卫生依从率明显高于干预前(P 0. 05);患儿皮肤感染、脐部感染、呼吸道感染等医院感染发生率明显低于干预前(均P 0. 05)。结论实施基于WHO多模式手卫生促进策略的干预措施,有助于促进NICU医务人员手卫生知信行能力的养成,增强其关键时间节点手卫生依从行为,降低NICU患儿医院感染发生率。     

精细化管理ICU医护人员手卫生依从性中的应用

目的:探讨集束化护理干预策略对提高ICU医护人员手卫生依从性的影响。方法:对医护人员实施精细化管理:(1)建立管理机构;(2)改善设施;(3)患者问询制;(4)检查落实,榜样激励法;(5)组织全员培训。将2014年1~12月未实施的医护人员作为实施前,2015年1~12月实施精细化管理的医护人员作为实施后,实施前后要求调查员每周不定期对科室医护人员手卫生依从性至少观察调研两次,每次观察至少5人,每人至少观察10 min。对实施前后医护人员手卫生依从性进行比较分析。结果:实施后医护人员手卫生依从率为83.56%,明显高于实施前的53.66%,差异有统计学意义(P0.05)。结论:精细化护理可提高ICU医护人员手卫生依从性,减少院内感染的发生。     

某院外科医护人员手卫生现状调查

目的了解某院外科医护人员手卫生现状。方法通过观察和发放调查表掌握医护人员手卫生的依从性、手卫生相关知识和手卫生相关影响因素。结果调查发现护士的手卫生执行率高于医生;接触患者后手卫生执行率为64.66%,远高于接触患者前的41.98%;医生、护士对六步洗手法知晓率较高,分别为86.30%和91.30%;医生对洗手指征的掌握高于护士;影响外科医务人员洗手原因前3位分别是工作量大顾不上洗手(74.47%),洗手用品等洗手设施少(71.27%),担心频繁洗手对皮肤过度刺激(42.02%)。结论应加强对外科医护人员手卫生管理,开展手卫生知识宣传和培训,切实提高医护人员手卫生依从性,控制院内感染。     

医务人员手卫生依从性影响因素与干预对策

目的了解医院临床医护人员手卫生依从性状况,分析影响手卫生依从性的因素,以便实施干预对策。方法由感控科专职人员,采用自行设计的调查表,对各个科室医务人员手卫生执行情况进行现场调查,从而评估医务人员手卫生的依从性。结果医护人员手卫生依从性：接触患者前洗手占21.9%;接触患者后洗手占35.9%;无菌操作前、接触清洁、无菌物品前占30.2%;摘手套后占17.9%;接触患者血液、体液、分泌物及伤口敷料后洗手占78.3%。结论医务人员手卫生依从性的执行率较低,护士手卫生执行率好于医生,医院应针对影响因素采取干预措施,提高医护人员手卫生的依从性,降低医院感染率。     

医护人员手卫生依从性影响因素分析及对策

目的:探讨临床医护人员在诊疗护理活动中手卫生依从性现状、影响因素及对策。方法:随机抽取160名医护人员,直接观察记录诊疗护理活动中六步洗手法洗手次数和使用速干手消毒剂次数,并随机对其中60名医护人员的手采样进行细菌学监测。结果:医护人员手卫生执行率78.96%,按六步洗手法洗手执行率30.90%,使用速干手消毒剂执行率48.06%;接触患者前后及接触患者黏膜、破损皮肤前后手卫生执行率比较差异均有统计学意义(P<0.01),使用速干手消毒剂手卫生合格率高于六步洗手法合格率(P<0.05)。结论:医护人员对手卫生认识不足,应加强宣传、培训、检查、监督手卫生执行,寻求行政支持,配置洗手设施,充实医护人员数量,提高手卫生依从性,降低医院感染发生。     

新生儿重症监护室医务人员手卫生与医院感染防控

目的加强新生儿重症监护室医护人员手卫生管理,防控新生儿医院感染。方法通过观察医务人员手卫生执行情况,找出存在的问题,改进和提高手卫生依从性。结果通过各项改进措施的落实,NICU医务人员手卫生行为得到规范,掌握了洗手操作方法和快速手消毒剂使用方法。洗手设施得到改善,安装了非接触式水龙头,提供了足够和方便快捷的手消毒剂和干手用品,从而明显提高了手卫生执行率和手卫生质量。结论提高医务人员手卫生的依从性是降低新生儿重症监护室医院感染的关键。     

知信行管理模式对儿童医院急诊科医护人员手卫生质量的影响

目的 探讨知信行管理模式在提高儿童医院急诊科医护人员手卫生质量中的应用效果.方法 选取我院急诊科65名医护人员为研究对象,为了提高手卫生的质量,对该组医护人员实施知信行管理,从知识、信念、行为三个方面强化手卫生的管理,比较管理前后该组医护人员洗手依从性、手卫生健康知识得分以及手卫生质量的情况.结果 知信行管理后,医护人员接触患儿前后、无菌操作前、体液暴露后等洗手率高于管理前,医护人员洗手符合程序规范、使用消毒液的情况高于管理前,差异具有统计学意义(P<0.05).医生和护士的手卫生健康知识得分高于管理前,手卫生消毒合格率、洗手时间≧15 s、手卫生监测合格率均高于管理前,差异具有统计学意义(P<0.05).结论知信行管理模式能够提高儿科医护人员手卫生的依从性,改善手卫生质量.     

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。     

品管圈在提高医护人员手卫生依从性中的效果评价

目的探讨品管圈(QCC)活动在提高医护人员手卫生依从性中的应用效果。方法按照品管圈的步骤和方法发动圈员自我管理,分析医护人员手卫生依从性低的原因和制订改进措施并实施。将2014年2-3月(实施前)与2014年9-10月(实施后)医护人员洗手率及影响手卫生依从性的因素高低进行比较。结果 QCC活动实施后,医护人员洗手率从36%升至79%;同时,洗手率分别在诊疗操作前、诊疗操作后、无菌操作前及脱手套后这4个层面上均明显高于QCC实施前。并且,影响医护人员手卫生依从性的主要因素通过持续改进后也有很大改善。结论品管圈的管理方法对提高医护人员手卫生依从性有良好效果。     

PDCA循环管理下儿科医护人员洗手依从性与医院感染发生率相关性研究

目的:探讨PDCA循环管理下儿科医护人员洗手依从性与医院感染发生率的相关性。方法:选取2015年6月~2016年6月本院儿科43名在岗医护人员作为研究对象,其中包括医师16名,护理人员27名;另选同期在本院住院治疗的患儿作为本次研究医院感染观察对象。记录PDCA循环管理实施前后医护人员洗手执行情况、医院感染发生情况并进行Spearman相关性分析。结果:在儿科实施PDCA循环管理1年后,无菌操作前后、接触患儿前、接触患儿后、脱手套后以及其他需要洗手时的洗手依从率均显著高于实施前,具有统计学意义(P0.05);而实施前与实施PDCA循环管理1年后,接触患儿体液后洗手依从率均为100%,不具有统计学意义(P0.05)。PDCA循环管理实施后医护人员洗手依从率依次升高,医院感染发生率依次降低,4个周期之间比较差异具有统计学意义(均P0.05)。对医护人员洗手依从性与医院感染发生率经Spearman相关性分析表明两者呈负相关(r=0.874,P0.05)。结论:儿科医护人员洗手依从性与医院感染发生率呈负相关,对儿科医护人员应用PDCA循环管理模式可提高医护人员的洗手依从性,显著降低医院感染发生率,值得推广应用。     

对新生儿重症监护室医护人员手卫生执行情况的调查研究

目的了解新生儿重症监护室医护人员手卫生执行情况。方法对新生儿重症监护室的40名医护人员手卫生执行情况进行实地观察,通过手部细菌培养对其手卫生进行评价。结果医护人员手卫生执行率操作前28.2%,操作后93.2%;手卫生监测合格率操作前22.7%,操作后95.3%,操作后手卫生执行情况及效果均好于操作前（P〈0.01）。结论应加强医护人员责任心,加强操作前手卫生执行情况监督管理。     

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.     

干预措施对医护人员洗手行为的影响

目的研究有效干预管理措施对改善临床医护人员不规范洗手状况和提高洗手依从性的作用。方法以该院266名临床医务人员作为研究对象,采用观察法和问卷法收集观察对象洗手行为的情况,并对其中150人进行了洗手操作考核,针对研究对象存在的不规范洗手行为强化管理措施,实施有效干预,3w后采用同样的方法收集干预后洗手资料,评价干预前后的效果。结果干预前后医务人员洗手合格率有显著性差异,P<0.01,洗手方法和洗手时间的达标率明显提高,P<0.05,其中医生和护工临床干预效果尤其明显,P<0.01。结论通过采取有针对性的干预措施,强化管理力度,可有效提高医护人员规范洗手的依从性。     

手卫生培训对社区医护人员手部带菌含量的效果研究

目的:探讨手卫生培训对减少社区医护人员手部带菌含量的效果.方法:选择沙园社区卫生服务中心作为手卫生培训干预组,昌岗社区卫生服务中心作为对照组,每中心随机抽选医护人员各60名,对干预组的医护人员进行手卫生强化培训,培训前对两组医护人员在接触病人或操作后进行手微生物采样.在培训后分别对对照组和干预组进行手微生物采样进行追踪,比较分析、并提出对策,检查干预组成员手卫生的依从性及效果.结果:经过强化培训后,干预组与对照组相比,每平方厘米手部所含细菌菌落明显减少,医护人员洗手依从性增加,P＜0.05,差异有统计学意义.结论:手卫生培训能使社区医护人员掌握正确手卫生的方法,提高手卫生的依从性,有效降低社区医护人员手部细菌的含量,降低社区医院感染的发生率.     

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.     

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。     

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。     

Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience

A 1 year prospective study on routine gowning before entering a neonatal unit was conducted in a maternity hospital in Singapore. This study was done based on previous work by Donowitz, Haque and Chagla and Agbayani et al. , as there have been no known studies done in Singapore. The aim of the study was to test the hypothesis that routine gowning before entering a neonatal nursery does not reduce nosocomial infection and mortality rate. A total of 212 neonates from the neonatal intensive care unit (NICU) and 1694 neonates from the neonatal special care unit (NSCU) were studied. Neonates admitted during the 1 year study were assigned to the gowning (control) and no routine gowning (trial) group on every alternate 2 months. The hospital infection control nurse provided data on nosocomial infection. The overall nosocomial infection rate in the NICU was 24% (25 of 104 admissions) during gowning periods compared to 16.6% (18 of 108 admissions) when plastic aprons were not worn before entry. In the NSCU, the overall infection rate was 1.5% (12 of 800 admissions) during gowning periods compared to 2.1% (19 of 894 admissions) when no gown was worn before entry. Results of the study found no significant differences in the incidences of nosocomial infection and mortality in the neonates. The cost of gowns used during the no routine gowning periods was S$2012.8 compared to S$3708 used during the routine gowning procedure. The investigators recommend that routine gowning before entering a neonatal unit is not essential and cost effective for the purpose of reducing infection. Rather the focus should be on adequate handwashing by all hospital personnel and visitors before handling neonates.     

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.     

Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units

Aims. The authors developed a video‐centred teaching program based on social learning principles to demonstrate hand‐washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand‐washing skills. Background. Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital‐acquired infections. A number of studies have shown that increased compliance with hand‐washing guidelines for health‐care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first. Study design. Quasi‐experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention. Methods. A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups – one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand‐washing skills using simple illustrations. A 20‐item hand‐washing checklist was used to examine hand‐washing compliance and accuracy. Results. No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels. Conclusion. The video‐based teaching program was effective in increasing compliance and accuracy with a hand‐washing policy among families with children in intensive care units. Relevance to clinical practice. The education program is a simple, low‐cost, low technology intervention for substantially reducing the incidence of nosocomial infection.