成都市二级以上综合性医院医务人员手卫生执行情况及影响因素调查

Compliance on hand-hygiene among healthcare providers working at secondary and tertiary general hospitals in Chengdu

目的了解成都市二级以上综合性医院医务人员手卫生执行状况及影响因素。方法现场观察医务人员手卫生执行情况和手卫生设施，调查医务人员手卫生知识。结果医务人员手卫生执行率为17．8％（接触患者前执行率为12．8％、接触患者周围物品及环境后执行率为21．0％、接触患者后执行率为27．3％，脱手套后执行率为31．5％）；2．2％的医疗室有脚踏或感应式水龙头、24．5％有洗手产品，6．3％有干手物品；92．8％的医务人员知道六步洗手法，对手掌、手背、手指和指背等洗手部位的认知率均在90．0％以上，仅22．8％的人知道搓手时间为≥15S。副主任以上医师（14．6％）、主治医师（9．2％）和医师（15．6％）以及主管以上护师（25．0％）、护师（26．3％）和护士（20．5％）之间手卫生执行率差异均无统计学意义（P〉0．05）。副主任以上医师平均知识得分（12．4±3．2）、主治医师（13．6±3.3）和医师（13．4±2．9）以及主管以上护师（15．2±2．0）、护师（14．8±2．1）和护士（14-3±2．6）之间差异亦无统计学意义（P〉0．05）。护士的手卫生执行率（22．7％）明显高于医生（13．6％）；≥50岁者（7．4％）明显低于〈50岁各年龄组（17．1％～25．0％）；女性（19．5％）显著高于男性（13．8％）；差异均有统计学意义（P〈0．05）。护士的平均知识得分（14．7±2.3）显著高于医生（13．2±3．1）；50—59岁年龄组平均知识得分（12．2±3．8）显著低于20—29岁（14．0±2．6）、30。39岁（14.3±2．9）和40．49岁（13．8±2．7）组；女性（14．5±2．5）得分显著高于男性（12．7±3．2）；差异均有统计学意义（P〈0．05）。结论成都市二级以上综合性医院医务人员手卫生知识水平相对较高，但手卫生执行率偏低，医院手卫生设施不完善。应通过进一步加强培训，改善手卫生设施，以进一步提高手卫生执行率。

Objective To evaluate the compliance on hand-hygiene and related factors among healthcare providers working at secondary and tertiary hospitals in Chengdu. Methods On-site observations regarding hand-hygiene compliance and facilities were conducted in 6 hospitals in Chengdu. Doctors and nurses were asked and recorded about their knowledze reearding handhygiene. Results Of 1535 activities where hand-hygiene was deemed necessary, under observating healthcare providers would perform hand-hygiene procedures 17.8% of the time （ 12.8% of the time before touching a patient, 21.0% of the time before touching objects around a patient, 27.3% of the time after touching a patient, and 31.5% of the time after removing gloves）. Only 2.2% of the treating rooms were equipped with foot-operated or automatic faucets; of these only 24.5% had soap or alcohol-based hand-sanitizer, and 6.3% had paper towel or other hand-drying equipments. 92.8% of the healthcare providers knew of the six-step method on hand-washing. More than 90.0% of the healthcare providers knew that both palm and back of the hands as well as the front and back of the fingers should be washed. However, only 22.8% knew that the hand-washing procedure should last ≥ 15 seconds. Rates on hand hygiene among chief or more senior physicians （14.6%） , attending physicians （9.2%） and junior doctors （15.6%）, nurses in chief （25.0%）, senior nurses （26.3%） and junior nurses （20.5%） showed no significant differences （P〉0.05）. Similarly, scores on related knowledge between chief or senior physicians （12.4 ± 3.2）, attending physicians （13.6 ± 3.3） and junior doctors （13.4 ±2.9） , nurses in charge （15.2 ± 2.0） , senior nurses （14.8 ± 2.1） and junior nurses （ 14.3 ± 2.6） also showed no significant differences （P〉0.05）. Rate on hand hygiene among nurses （22,7%） was significantly higher than that of the doctors （ 13.6% ）. Rate of hand hygiene among 50-59 years old healthcare providers （7.4%） was significantly lower than those of all the other age groups （17.1±25.0% ） ; rate of female health care providers （19.5%） was significantly higher than that of males （13.8%）. Similarly, the nurse＇s knowledge score （14.7 ± 2.3） was significantly higher than that of the doctors （ 13.2± 3.1 ）. Among 50-59 years old healthcare providers, the rate was （ 12.2 ± 3.8） significantly lower than that of 20-29 （ 14.0 ± 2.6）, 30-39 （ 14.3 ± 2.9） and 40-49 year olds （ 13.8 ± 2.7）. Again, the knowledge score of females （ 14.5 ± 2.5） was significantly higher than that of males （12.7 ± 3.2）（P〈0.05）. Conclusion The high-level knowledge on hand-hygiene among healthcare providers in this area did not translate into good practices. Also, most of the hospitals had poor hand-hygiene equipments. We recommend that training and periodic monitoring be conducted, and hand-hygiene equipment be improved to facilitate hand-hygiene practices among healthcare providers.