重症监护室医务人员手卫生状况及干手措施对洗手效果的影响

Hand hygiene status and effect of hand-drying measures on hand-washing of health care workers in an intensive care unit

目的了解重症监护室(ICU)医务人员手卫生状况及干手措施对洗手效果的影响。方法选择2013年2—4月某院ICU医务人员210人次,将其随机分为ABC三组,A组采用干手纸巾法、B组采用干手器法、C组采用个人小毛巾法干手,分别对其洗手前、洗手后和干手后进行手卫生现场采样检测。结果 A、B、C3组医务人员接触患者后洗手前手部菌落数分别为(29.10±15.08)CFU/cm2、(31.42±14.76)CFU/cm2和(30.36±15.52)CFU/cm2,3组比较,差异无统计学意义(F=0.048,P>0.05);按六步洗手法洗手后湿手采样,医务人员手部菌落数分别为(3.26±0.61)CFU/cm2、(2.98±0.59)CFU/cm2和(3.87±0.67)CFU/cm2,与洗手前比较,差异均有统计学意义(均P<0.01)。采用不同的干手方式干手后,3组医务人员手部菌落数比较,差异有统计学意义(F=1.892,P<0.05);A组菌落数[(1.29±0.58)CFU/cm2]低于B、C组,B组[(9.51±0.73)CFU/cm2]低于C组[(22.76±4.11)CFU/cm2];A组合格率(90.00%)高于B、C组,B组合格率(68.57%)高于C组(47.14%)。医务人员手分离病原菌居前5位的是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和凝固酶阴性葡萄球菌,与2013年度该院ICU分离居前5位的多重耐药菌高度一致。结论 ICU医务人员进行各种诊疗护理操作后,手部污染严重;若干手方法不当,会导致手二次污染;其手分离的病原菌与患者分离的多重耐药菌高度一致。及时、正确地洗手和干手是保证手卫生质量的关键环节,对降低ICU患者多重耐药菌感染具有重要意义。

Objective To realize hand hygiene status and effect of hand-drying measures on hand-washing of health care workers（HCWs）in an intensive care unit（ICU）.Methods From February to April 2013,210 HCWs in an ICU were selected and randomly divided into three groups,group A dried hands with paper towel,group B with hand drier,and group C with personal towel,specimens from hands before hand-washing,after hand-washing,and after hand-drying were taken and performed detection.Results Hand microorganism count in group A,B and C before washing hands after contacting patients was（29.10±15.08）CFU/cm^2,（31.42±14.76）CFU/cm^2 and（30.36±15.52）CFU/cm^2 respectively,the difference was not statistically different（F=0.048,P〉0.05）;After six-step hand-washing,hand microorganism count before hand drying in group A,B and C was（3.26±0.61）CFU/cm^2,（2.98±0.59）CFU/cm^2 and（3.87±0.67）CFU/cm^2 respectively,compared with hand microorganism count before hand-washing,the difference was statistically different（all P〈0.01）.After adopting different hand-drying methods,microorganism count in three groups was statistically different（F=1.892,P〈0.05）,group A（[1.29±0.58]CFU/cm^2）was significantly lower than group B and C,group B（[9.51±0.73]CFU/cm^2）was significantly lower than group C（[22.76±4.11]CFU/cm^2）;the qualified rate in group A（90.00%）was significantly higher than group B and C,group B（68.57%）was significantly higher than group C（47.14%）.The top 5 pathogens isolated from HCWs＇ hands were Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli,and Coagulase negative Staphylococcus,these strains were highly consistent with the top 5 multidrug-resistant organisms（MDROs）isolated from ICU patients in this hospital in 2013.Conclusion HCWs＇ hands are seriously contaminated after all kinds of medical performance;if hands are improperly dried,secondary contamination may occur;pathogens isolated from HCWs＇ hands are highly consistent with MOROs from patients,timely and correct hand-washing and hand-drying is the key link to ensure the quality of hand hygiene,and is of great significance to reduce the occurrence of MDROs infection in ICU patients.