化疗患儿陪护人员手卫生调查与干预效果

Investigation of hand hygiene among caretakers of children with chemotherapy and intervention effect

目的：调查化疗患儿陪护人员手卫生的认知和执行情况,探讨有效的干预对策。方法选择血液肿瘤科化疗患儿的陪护人员60名进行手卫生情况问卷调查,进行六步洗手法培训,跟踪观察洗手执行情况。比较培训前后洗手合格率。结果陪护人员对直接接触患儿、喂药或喂食物前洗手的认知率为88.33%和93.33%,执行率分别为76.67%和89.13%；对于接触患儿相关物品前、与其他人接触后洗手的认知率分别为21.67%和41.67%,执行率分别为14.89%和28.95%。六步洗手法培训前后陪护人员手卫生的菌落数分别为（82.36±53.32）,（16.21±18.83）cfu/ cm2,差异有统计学意义（t =9.061, P＜0.01）；培训后致病菌检出率为31.67%,合格率为61.67%,与培训前比较差异均有统计学意义（χ2值分别为28.420,27.638；P＜0.01）。结论化疗患儿陪护人员手卫生认知较低、执行情况差、洗手合格率低,应进一步加强陪护人员手卫生知识的宣传教育和洗手方法培训,督促手卫生的执行,提高陪护人员的洗手合格率,减少经手传播医院感染,保障化疗患儿的健康和安全。

Objective To investigate hand hygiene awareness and performance for caretakers of children with chemotherapy, and explore effective intervention measures. Methods For 60 caretakers of children with chemotherapy in Hematology Department, we carried out a questionnaire survey of hand hygiene, and tracked the hand washing implementation. Also we carried on a six steps hand washing technique training for the caretakers, then compared and analyzed the hand washing qualified rate before and after the technique training. Results The hand washing cognitive rate of the caretakers when they directly contacting with sick children and before feeding food or medicine for sick children were 88. 33% and 93. 33% , and the implementation rate of those situation were 76. 67% and 89. 13% respectively. In addition, the hand washing cognitive rates of before contacting sick children′s objects and after contacting other people （including other sick children） were just 21. 67% and 41. 67% , and the implementation rates were 14. 89% and 28. 95%respectively. Before and after the six steps hand washing technique training, the bacterial colony count of the caretakers hands were （82. 36 ± 53. 32）cfu/ cm2 and （16. 21 ± 18. 83）cfu/ cm2 （t = 9. 061,P 〈 0. 01）, but after training, the pathogenic bacteria detection rate was 31. 67% and the qualified rates 61. 67% with statistical difference （χ2 = 28. 420,27. 638, respectively; P 〈 0. 01）. Conclusions The hand hygiene cognition for caretakers of children with chemotherapy is relatively low, and the implementation and hand washing qualified rate are unacceptable. The health education propaganda of hand hygiene and hand washing technique training for caretakers should be further strengthen. Hospital should supervise and urge the hand hygiene implementation, in order to improve the hand washing qualified rate of caretakers, reduce the nosocomial infection through hand contact, and protect the health and safety of children with chemotherapy.