医疗综合目标评估对医务人员手卫生依从率的影响

目的评价医疗综合目标评估管理体系对医务人员手卫生依从率的影响。方法采用医疗综合目标评估管理体系对某三级甲等综合医院医务人员手卫生依从率进行干预,比较干预前(2012年12月)和干预后(2013年1月—2014年6月)医务人员手卫生依从率和每床日速干手消毒剂使用量。结果干预后医务人员手卫生依从率为85.17%(18 208/21 379),高于干预前的39.92%(853/2 137),干预后较干预前提升了113.35%(χ2=2 590.81,P0.001)。干预后,不同科室、岗位、手卫生时刻医务人员手卫生依从率均高于干预前,差异有统计学意义(均P0.001);干预后,全院医务人员手卫生依从率呈逐月上升的趋势,且自2013年10月起,一直稳定在较高水平(90%)。速干手消毒剂使用量干预后为10.54 mL/床日(9 323.5L/884 489床日),较干预前增加了3.30 mL/床日[干预前为7.24 mL/床日(4 200 L/579 841床日)],提升了45.58%。结论医疗综合目标评估能有效提升手卫生依从率,并持续保持在较高水平;该项措施也可能通过霍桑效应影响医务人员手卫生行为,是一项长期有效提升手卫生依从率的管理举措。

Effect of comprehensive medical goal appraisal on hand hygiene compliance rate of health care workers

ObjectiveTo evaluate the comprehensive medical goal appraisal system on hand hygiene compliance rate of health care workers(HCWs). MethodsComprehensive medical goal appraisal system was adopted to intervene hand hygiene compliance rate of HCWs  in a comprehensive hospital , hand hygiene compliance rates of HCWs and consumption of instant hand sanitizer per bed day before (December 2012) and after intervention (January 2013-June 2014) were compared. ResultsHand hygiene compliance rate after intervention was higher than before intervention (85.17% ［18 208/21 379］vs 39.92%［853/2 137］)，hand hygiene compliance rate enhanced by 113.35%（χ2=2 590.81，P＜0.001）.Hand hygiene compliance rates of HCWs of different departments, different occupations and different hand hygiene moments were all higher than before intervention (all P＜0.001）; after intervention , hand hygiene compliance rate revealed a increased tendency, and has maintained high since October 2013 (>90%), consumption of instant hand sanitizer before and after intervention was 7.24 mL/ bed day（4 200 L/579 841 bed day） and 10.54 mL/bed day（9 323.5L/884 489 bed day）respectively, the consumption after intervention increased by 45.58% compared with that before intervention.  ConclusionComprehensive medical goal appraisal can effectively enhance hand hygiene compliance rate , and maintains at a high level; the measure can affect hand hygiene behavior of HCWs by hawthorne effect, and is an effective and long term measure to improve hand hygiene compliance of HCWs.