应用中断时间序列分析评价医院等级评审对医务人员手卫生依从性的影响

目的 应用中断时间序列分析模型, 评价综合干预措施对医务人员手卫生依从性的影响。 方法 选取某三级医院全部临床和医技科室的工作人员为研究对象, 在三级医院等级评审迎检筹备期间, 实施培训、调查、竞赛等多种形式的手卫生综合干预措施。收集干预前后手卫生依从性监测数据, 应用中断时间序列方法进行模型构建, 评价干预的即刻效果和远期效果。 结果 医务人员手卫生依从率由干预前的67.58%提升至干预后的81.43%。中断时间序列分析结果显示, 干预实施后总体医务人员的手卫生依从率即刻提升19.717%(t=5.473, P < 0.001);但其斜率改变量为-1.995(t=-2.249, P=0.048), 提示干预实施后手卫生依从率的下降趋势扩大; 干预对不同岗位工作人员均有即刻提升效果, 以医生群体提升幅度最大; 对不同岗位工作人员的斜率改变量均为负值, 以护士群体的改变量绝对值最小。 结论 综合干预措施可以有效提升医务人员手卫生依从性, 但其远期效果不甚理想。中断时间序列模型可有效用于手卫生依从性监测数据的分析。

Effect of hospital accreditation on hand hygiene compliance of health care workers: evaluation with the interrupted time-series analysis

Objective To evaluate the effect of comprehensive intervention measures on hand hygiene (HH) compliance of health care workers (HCWs) with the interrupted time-series (ITS) analysis. Methods Staff from all clinical and technical departments of a tertiary hospital were selected as the research subjects, during the preparation period for the tertiary hospital accreditation, HH comprehensive intervention measures, including training, investigation, competition, and etc.were implemented.The monitoring data of HH compliance before and after intervention were collected, and the ITS analysis was applied to construct a model for evaluating the immediate and long-term effect of intervention. Results HH compliance rate of HCWs increased from 67.58% before intervention to 81.43% after intervention.ITS analysis result showed that overall HH compliance rate of HCWs increased by 19.717%(t=5.473, P < 0.001) immediately after the intervention, but the slope change was-1.995(t=-2.249, P=0.048), indicating an expanding downward trend in HH compliance after implementation of intervention.The intervention had immediate improvement effect on staff with different jobs, with the doctor group having the greatest improvement.The slope change for staff with different jobs was negative, with the absolute value of the change for the nurse group being the smallest. Conclusion Comprehensive intervention measures can effectively improve HH compliance of HCWs, but the long-term effect is not ideal.ITS model can be effectively used to analyze the monitoring data of HH compliance.