某三级综合教学医院手卫生暗访调查现状及对策研究

目的了解珠海市某三级甲等医院医务人员手卫生现状。方法采用隐蔽观察法,2016年10—11月组织临床实习同学观察全院随机抽取的15个临床科室医生、护士、保洁员手卫生依从性。结果全院临床科室手卫生依从率为33.44%(1 131/3 382)、正确率为59.86%(677/1 131),各类别医务人员手卫生依从率比较,差异有统计学意义(χ~2=12.610,P=0.002),依从率由高到低依次为护士(35.85%)、保洁人员(32.28%)、医生(29.50%)。5个手卫生时刻中,接触患者体液后医务人员手卫生依从率最高(69.74%),接触环境后手卫生依从率最差(25.03%)。不同类别医务人员不同手卫生时刻的依从率比较,差异均有统计学意义(均P0.05),其中在无菌操作前和接触患者体液后医生的手卫生依从率高于护士(分别为71.25%vs 32.44%,82.86%vs 69.78%),接触患者后护士的手卫生依从率最高(40.06%)。结论该院手卫生情况不容乐观,手卫生依从率、正确率均较低,且不同职业类别人员、不同手卫生时刻的手卫生依从率均存在差异,有待提高。

Concealed investigation on status and countermeasures of hand hygiene of health care workers in a tertiary comprehensive teaching hospital

ObjectiveTo understand the status of hand hygiene(HH) of health care workers(HCWs) in a tertiary hospital in Zhuhai.MethodsHH compliance of doctors, nurses, and cleaners randomly selected from 15 clinical departments in the whole hospital was observed through concealed observation by medical interns in October November 2016. ResultsHH compliance rate and correct rate of clinical departments in the whole hospital were 33.44%(1 131/3 382) and 59.86%(677/1 131) respectively, there was a significant difference in the compliance rate of HH among different types of HCWs （χ2=12.610，P=0.002），HH compliance rate from high to low was nurses (35.85%), cleaners (32.28%), and doctors (29.50%). Of five HH moments, HCWs’ HH compliance rate after patient’s body fluid exposure was the highest (69.74%), while after touching patient surroundings was the worst (25.03%). HH compliance rates of HCWs with different occupations at different HH moments were all significantly different (all P<0.05), HH compliance rates of doctors before aseptic procedure and after patient’s body fluid exposure were higher than nurses(71.25% vs 32.44%; 82.86% vs 69.78%, respectively), HH compliance rate of nurses was highest after touching a patient(40.06%).ConclusionHH status in this hospital is not optimistic, HH compliance rate and correct rate are low, HH compliance rates of HCWs with different occupations and at different HH moments are both different, which need to be improved.