手卫生干预对降低重症监护室医院感染率的影响

目的对某院重症监护室（ICU）医务人员手卫生进行干预，了解其对医院感染率的影响。方法对某院ICU医务人员手卫生进行干预，并建立有效的监督管理机制，比较干预前（2012年1-12月）和干预后（干预后第1阶段：2013年1-6月；干预后第2阶段：2013年7-12月）医务人员手卫生依从率和医院感染率。结果共调查4 066例患者，干预前医务人员手卫生依从率为50.03%，干预后第1、2阶段手卫生依从率分别为61.80%和64.57%，上升趋势具有统计学意义（rs=1.00, P<0.001）。干预前，ICU医院感染率为5.48%，干预后第1、2阶段分别为3.86%和3.30%，医院感染率的下降趋势具有统计学意义（rs=-1.00，P<0.001）。ICU导管相关血流感染率、导尿管相关尿路感染率和呼吸机相关性肺炎感染率下降趋势均具有统计学意义（rs=-1.00，均P<0.001）。手卫生依从率与ICU医院感染率、导管相关血流感染率、导尿管相关尿路感染率、呼吸机相关性肺炎感染率间存在负相关（均P<0.05）。结论提高手卫生依从性，可有效降低ICU病房医院感染发生率。

Hand hygiene intervention to reduce healthcare associated infection rate in an intensive care unit

Objective To investigate the influence of health care workers＇（HCWs）hand hygiene intervention in healthcare-associated infection（HAI）in an intensive care unit（ICU）.Methods Intervention measures of hand hygiene were adopted,effective supervision and management systems were established,hand hygiene compliance and HAI rate before intervention（January-December 2012）and after intervention（the first stage：January-June 2013;the second stage：July-December 2013）were compared.Results A total of 4 066 patients were surveyed,HCWs＇ hand hygiene compliance rate before intervention was 50.03%,the first and second stage after intervention was 61.80%and64.57%respectively,there was increasing trend（rs=1.00,P〈0.001）.HAI before intervention was 5.48%,the first and second stage after intervention was 3.86% and 3.30%respectively,there was decreasing trend（rs=-1.00,P〈0.001）.Significant decreasing trends were found in rates of catheter-related bloodstream infection（CRBSI）,catheter-associated urinary tract infection（CAUTI）and ventilator-associated pneumonia（VAP）（rs=-1.00,P〈0.001）.There were negative correlations between hand hygiene compliance rate and the infection rate of ICU,infection rate of CRBSI,CAUTI and VAP（P〈0.05）.Conclusion The improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.