Analysis of the Deep Reasons for the Differences of Hand-hygiene Compliance among the ICU Medical Staff
-
摘要:
目的 调查北京协和医院ICU医务人员手卫生依从性现状,并分析其存在差异的深层次原因。 方法 采用单盲、便利抽样法,对2019年1月至12月北京协和医院经手卫生多维度培训后的ICU医务人员进行手卫生现状调查,计算手卫生依从率,并比较不同手卫生时刻及不同类别/来源的医务人员手卫生依从率的差异。 结果 共285名符合纳入和排除标准的ICU医务人员入选本研究。其中医生85名、护士171名、护理员21名、保洁员8名;本院医护人员104名、进修医护人员152名。共观察手卫生指征总数23 661次、手卫生执行总数21 360次,总体手卫生依从率为90.28%(21 360/23 661)。世界卫生组织规定的5个手卫生时刻依从率由高至低依次为接触患者体液后(95.63%,765/800)、无菌操作前(94.39%,2121/2247)、接触患者后(91.59%,7916/8643)、接触患者周围环境后(88.91%,4026/4528)、接触患者前(87.76%,6532/7443),差异有统计学意义(P<0.001);不同类别人员的手卫生依从率由高至低分别为护士(94.52%,11 186/11 834)、护理员(93.49%,1665/1781)、医生(84.78%,8427/9940)、保洁员(77.36%,82/106),差异有统计学意义(P<0.001)。本院医护人员的手卫生依从率(93.45%,7844/8394)高于进修医护人员(87.96%,11 769/13 380), 差异有统计学意义(P<0.001)。 结论 北京协和医院ICU医务人员手卫生依从性总体较好,但不同手卫生时刻及不同类别人员之间仍存在一定差异,可能与医务人员的手卫生防护意识、科室对不同类别医务人员的培训和监督力度不同有关。 Abstract:Objective To investigate the hand-hygiene compliance of ICU medical staff in Peking Union Medical College Hospital(PUMCH) and analyze the reasons for the differences. Methods A single-blind and convenient sampling-method was used to investigate the status of hand hygiene of the ICU medical staff who received hand-hygiene training in PUMCH from January to December 2019. The rate of hand-hygiene compliance was calculated, and the differences in the rate of hand-hygiene compliance of different time and personnel types were compared. Results A total of 285 ICU medical staff who met the inclusion and exclusion criteria were enrolled in this study. There were 85 doctors, 171 nurses, 21 nurse-assistants, 8 cleaners; 104 doctors and nurses of our hospital and 152 refresher doctors and nurses. The total number of hand-hygiene indications was 23 661, and the total number of hand-hygiene implementation was 21 360. The overall rate of hand-hygiene compliance was 90.28% (21 360/23 661). The compliance rates of the five hand-hygiene moments stipulated by the World Health Organization were 95.63% (765/800) after contacting the body fluid of the patients, 94.39% (2121/2247) before aseptic operation, 91.59% (7916/8643) after contacting the patients, 88.91% (4026/4528) after contacting the surrounding environment of the patients, and 87.76% (6532/7443) before contacting the patients, with statistically significant differences (P < 0.05). The compliance rates of nurses, nurse-assistants doctors, and cleaners were 94.52% (11 186/11 834), 93.49% (1665/1781), 84.78% (8427/9940), and 77.36% (82/106), respectively, with statistical significance (P < 0.05). The rate of hand-hygiene compliance of the medical staff of our hospital was 93.45% (7844/8394), which was higher than that of the refresher medical staff (87.96%, 11 769/13 380), and the difference was statistically significant (P < 0.05). Conclusions The hand-hygiene compliance of the ICU medical staff in PUMCH is good, but there are still some differences in the hand-hygiene time and personnel types, which may be related to the awareness of hand-hygiene protection of the medical staff and the difference in training and supervision of different departments for different types of medical staff. -
Key words:
- hand hygiene /
- compliance /
- nosocomial infection
作者贡献:孙小南、柴文昭负责提出研究思路、设计研究方案,并撰写论文;孙建华、马鸿鸣负责数据采集与分析;张媛媛负责数据记录与督查;苏龙翔、陆相云负责资料修改与内容审校。利益冲突: 无 -
[1] 王英. 医务人员手卫生现状监测分析[J]. 现代中西医结合杂志, 2009, 18: 1276-1277. doi: 10.3969/j.issn.1008-8849.2009.11.054 [2] 王坚, 宫献升, 刘加力. 2011年高密市医疗机构医护人员手卫生知识及卫生状况调查[J]. 预防医学论坛, 2013, 19: 280-281. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWX201304015.htm [3] 王作艳, 陈峰英. 开展手卫生在职教育强化医务人员手卫生意识[J]. 中国感染控制杂志, 2013, 12: 74-75. doi: 10.3969/j.issn.1671-9638.2013.01.024 [4] 贾会学, 贾建侠, 赵艳春, 等. 医务人员手卫生依从率及手卫生方法调查分析[J]. 中华医院感染学杂志, 2010, 20: 3341-3343. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201021048.htm [5] 国家卫生健康委员会, 国家中医药管理局. 新型冠状病毒感染的肺炎诊疗方案(试行第五版)[EB/OL]. (2020-02-05). http://www.nhc.gov.cn/xcs/zhengcwj/202002/3b09b894ac9b4204a79db5b8912d4440.shtml. [6] Sax H, Allegranzi B, Chraiti MN, et al. The World Health Organization hand hygiene observation method[J]. Am J Infect Control, 2009, 37: 827-834. doi: 10.1016/j.ajic.2009.07.003 [7] 沈燕, 胡必杰, 周晴, 等. 上海市66所医院手卫生依从性现状调查[J]. 中华医院感染学杂志, 2012, 22: 2585-2587. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201212051.htm [8] 李六亿, 吴安华, 胡必杰, 等. 重症监护病房医务人员手卫生依从性多中心干预效果[J]. 中国感染控制杂志, 2015, 14: 513-517. doi: 10.3969/j.issn.1671-9638.2015.08.003 [9] 田春梅, 龙子媛, 李德保, 等. 3种不同处理因素对医务人员手卫生依从率的影响[J]. 中国感染控制杂志, 2014, 13: 605-608. doi: 10.3969/j.issn.1671-9638.2014.10.007 [10] 赵庆华, 何蕾, 高岩, 等. 直观教育对提高医护人员手卫生依从性的效果研究[J]. 中国消毒学杂志, 2012, 29: 209-211. [11] 滕小云. 护理人员手卫生依从性的调查[J]. 中国消毒学杂志, 2012, 29: 427-428. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD201205035.htm [12] JayaramanSP, KlompasM, BascomM, et al. Handhygienecompliancedoesnotpredictratesofresistantinfections in criti-callyillsurgicalpatients[J]. Surg Infect(Larchmt), 2014, 15: 533-539. doi: 10.1089/sur.2013.128 [13] 徐丹慧, 刘晓, 陈夏容, 等. 北京市8所综合性医院手卫生隐蔽式调查分析[J]. 中国感染控制杂志, 2018, 17: 872-877. https://www.cnki.com.cn/Article/CJFDTOTAL-GRKZ201810005.htm [14] 韩黎, 张高魁, 朱士俊, 等. 医务人员接触患者前手卫生执行情况及其相关影响因素分析[J]. 中华医院感染学杂志, 2006, 16: 1135-1137. doi: 10.3321/j.issn:1005-4529.2006.10.022 [15] 吴华, 李丹. 重症监护病房临床与环境、手分离耐药革兰阴性杆菌的同源性研究[J]. 中华医院感染学杂志, 2008, 18: 909-912. doi: 10.3321/j.issn:1005-4529.2008.07.003 [16] 石松华, 刘秋云. 我国医务人员手卫生与医院感染现状及其研究进展[J]. 中华现代护理杂志, 2013, 19: 1358-1359. doi: 10.3760/cma.j.issn.1674-2907.2013.11.045 [17] 孙小南, 刘大为. 多维度培训策略提高ICU进修人员手卫生依从性[J]. 基础医学与临床, 2018, 38: 1665-1668. doi: 10.3969/j.issn.1001-6325.2018.11.035 [18] 李静, 胡爱香, 张越巍, 等. 重点科室护士医院感染防控知识水平调查[J]. 中华现代护理杂志, 2019, 25: 357-359. [19] Wetzker W, Bunte-Schönberger K, Walter J, et al. Compliance with hand hygiene: reference data from the national hand hygiene campaign in Germany[J]. J Hosp Infect Vol, 2016, 92: 328-331. doi: 10.1016/j.jhin.2016.01.022 [20] Landford MG, Zembower TR, Trick WE, et al. Influence of role models and hospital design on hand hygiene of heal care workers[J]. Emerg Infect Dis, 2003, 9: 217-223. doi: 10.3201/eid0902.020249