医务人员手卫生现状与医院感染相关性调查

Current status of hand hygiene of medical staff and its correlation with nosocomial infections

目的调查医务人员手卫生状况与医院感染发生率,探讨医务人员手卫生状况与医院感染的相关性。方法选取2011年7月-2012年7月医院各类环境下工作的528名医务人员,手部采样后进行细菌培养;采取调查问卷及现场调查方法进行调查手卫生依从性,并对同期医院感染发生情况进行分析。结果医务人员手卫生取样标本合格份数451份,合格率为85.42%,其中合格率临床医师为87.88%、临床护士为85.25%、医技人员为79.49%,各类医务人员手卫生消毒合格率比较差异无统计学意义;医务人员诊疗操作前、诊疗操作后、接触患者前、接触患者后手卫生依从性分别为40.34%、59.47%、30.11%、50.19%,诊疗操作前与诊疗操作后、接触患者前与接触患者后比较,差异有统计学意义(P<0.05),其中临床医师分别为44.50%、62.88%、32.58%、53.79%,临床护士分别为39.78%、59.94%、29.97%、49.86%,医技人员分别为30.77%、43.59%、23.08%、41.03%,各类医务人员诊疗操作前与诊疗操作后、接触患者前与接触患者后比较,差异均有统计学意义(P<0.05);同期住院患者共17 486例次,发生医院感染者1042例次,医院感染发生率为5.96%,医院感染与医务人员手消毒合格率直线相关分析,两者间具有负相关(r=-0.84,P=0.000)。结论医务人员手卫生状况尚可,但手卫生依从性在诊疗操作前、接触患者前较差,同期医院感染发生率较低,加强手卫生依从性是进一步降低医院感染的关键环节。

OBJECTIVE To investigate the current status of hand hygiene of medical staff,analyze the incidence of nosocomial infections and observe the correlation between the status of hand hygiene and the incidence of nosocomial infections.METHODS A total of 528 cases of medical personnel,who worked under various conditions from Jul 2011 to Jul 2012,were enrolled in the study,then the bacterial culture was performed after the hand sampling;the questionnaire and field investigation method were adopted to investigate the hand hygiene compliance,and the incidence of nosocomial infections at the same period was analyzed.RESULTS A total of 451 hand hygiene specimens sampled were qualified with the qualified rate of 85.42%,the qualified rate of the clinicians was 87.88%,the clinical nurse 85.25%,the medical technician 79.49%,the difference in the qualified rate of hand hygiene disinfections between the various groups of medical staff was not significant.The hand hygiene compliance of the medical staff was 40.34% before the diagnostic operation,59.47% after the diagnostic operation,30.11% before contacting the patients,and 50.19% after contacting the patients,the difference was significant（P0.05）,the hand hygiene compliance of the clinicians were 44.50%,62.88%,32,58%,and 53.79%,respectively,the hand hygiene compliance of the clinical nurses were 39.78%,59.94%,28.97%,and 49.86%,respectively,and the hand hygiene compliance of the medical technician were 30.77%,43.59%,23.08%,and 41.03%,respectively,the difference was significant（P0.05）.Of totally 17 486 case-time of patients investigated,the nosocomial infections occurred in 1042 case-time of patients with the incidence rate of nosocomial infections 5.96%,the linear analysis of correlation between the nosocomial infections and the qualified rate of hand disinfection showed that the two were negatively correlated（r=0.84,P=0.000）.CONCLUSION The status of hand hygiene of the medical staff is acceptable,however,the hand hygiene compliance is poor before the diagnostic operation or before contacting the patients,the incidence of nosocomial infections is low during the same period,and it is crucial to strengthen the hand hygiene compliance so as to reduce the incidence of nosocomial infections.