ICU医务人员手卫生依从性差异的深层次原因分析

孙小南; 柴文昭; 孙建华; 张媛媛; 马鸿鸣; 苏龙翔; 陆相云

doi:10.3969/j.issn.1674-9081.2020.00.023

ICU医务人员手卫生依从性差异的深层次原因分析

Analysis of the Deep Reasons for the Differences of Hand-hygiene Compliance among the ICU Medical Staff

摘要

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.

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