门诊医护人员手卫生的调查分析及应对策略

Investigation of hand hygiene of medical staff in outpatient department and coping countermeasures

目的对医院门诊医护人员的手部清洗及消毒情况进行调查,并提出相应的策略,降低医院感染率。方法对医院门诊78名医护人员手部携带的病原菌分布进行分析,并对手卫生的认知、消毒方法进行调查,同时进行宣传教育、方法指导,比较宣讲前后手部带菌情况。结果共分离出病原菌69株,排名前5位的依次为大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、屎肠球菌分别占26.1%、21.7%、17.4%、13.1%、8.7%;医护人员对手部卫生的认知差异较大,护理人员能够认真洗手、手消毒以及知晓正确洗手方法的比例为87.5%、80.0%,明显好于医师对应的比例68.4%、52.6%(P<0.05);通过宣讲及方法指导,医师及护士均能够自觉地进行手消毒,手消毒前后医师合格率分别为52.6%、94.7%,护士为70.0%、97.5%,两组人群手消毒前后合格率比较差异均有统计学意义(P<0.05)。结论医护人员对于手卫生均有较深刻的认识,但在具体的执行力度和方法还需进一步改进,通过宣讲、监管等应对措施,医护人员手卫生的合格率明显提高,该策略值得推广应用。

OBJECTIVE To investigate the status of cleaning and disinfection of hands of the medical staff in outpa- tient department and propose corresponding coping countermeasures so as to reduce the incidence of nosocomial in- fections. METHODS The distribution of pathogens isolated from the hands of 78 medical staff was analyzed, then the awareness of hand hygiene and the disinfection methods were investigated, the preaching education was con- ducted for guidance of disinfection, and the colonization of bacteria on the hands was observed and compared before and after the preaching education. RESULTS A total of 69 strains of pathogens have been isolated, among which the Escherichia coli , Staphylococcus aureus , Staphylococcus epidermidis , Pseudomonas aeruginosa , and Entero- coccus feces ranked the top five, accounting for 26.1%, 21.7%, 17.4%, 13.1%, and 8.7%, respectively. The awareness of the hand hygiene varied significantly among the medical staff; 87.5 % of the nursing staff could wash and disinfect the hands carefully, significantly higher than 68.4% of the physicians; 80.0% of the nursing staff could grasp the right hand washing method, significantly higher than 52. 6% of the physicians （P〈0.05）. Through the preaching education, both the physicians and nurses could conscientiously disinfect their hands; the qualified rate of the physicians was 52.6% before the hand disinfection, the nurses 70.0%; the qualified rate of the physicians was 94.7 % after the hand disinfection, the nurses 97.5 % ; the difference in the qualified rate before or after the hand disinfection between the two groups was significant （P〈0. 05）. CONCLUSION The medical staff have profound awareness of the hand hygiene but need to further promote the execution power and improved spe- cific method. The qualified rate of the hand hygiene of the medical staff has been significafitly improve through the coping strategies such as preaching education and supervision, and the strategies are worthy to be promoted.