新生儿重症监护病房医务人员手卫生依从性多中心干预研究

A multicenter intervention study on hand hygiene compliance of health care workers in neonatal intensive care units

目的 通过采取一系列干预措施提高我国新生儿重症监护病房（NICU）医务人员手卫生依从性。方法 以多中心研究的方式,选取全国9个省及直辖市17所三级甲等医院,采用世界卫生组织（WHO）手卫生调查方法,每月对医务人员进行手卫生依从性调查。2013年10月1日—2014年3月31日为干预前;2014年4月1日—9月30日采取及时反馈与强化培训等干预措施,即为干预后。结果医务人员手卫生依从率干预前为80.29%,干预后为80.85%,干预前后比较,差异无统计学意义（P〉0.05）。不同规模NICU医务人员手卫生依从率干预前后比较,差异均有统计学意义（均P〈0.05）,其中〈20张、20-30张床位的NICU医务人员手卫生依从率干预后均高于干预前（均P〈0.05）,〉30张床位的NICU医务人员手卫生依从率干预后低于干预前（P〈0.001）。保洁人员手卫生依从率由干预前的58.82%提高至干预后的68.09%,差异有统计学意义（P〈0.05）;不同手卫生指征中除清洁或无菌操作前,其他手卫生指征医务人员手卫生依从率干预前后比较,差异均有统计学意义（均P〈0.05）。结论 我国NICU医务人员的手卫生依从性处于较高水平,采取强化培训、及时反馈等干预措施对不同规模NICU、不同岗位医务人员、不同手卫生指征的手卫生依从性有一定影响。

Objective To improve hand hygiene（HH）compliance of health care workers（HCWs）in neonatal intensive care units（NICUs）in China through a series of intervention measures.Methods A multicenter study was conducted,17 tertiary first class hospitals in9 provinces and cities were selected,HH compliance of HCWs in these hospitals were investigated every month according to HH investigation method of World Health Organization.From October 1,2013 to March31,2014 was pre-intervention stage;from April 1,2014 to September 30,2014 was postintervention stage,timely feedback and intensified training were conducted at post-intervention stage.Results HH compliance rates of HCWs before and after intervention were 80.29% and 80.85% respectively,there was no significant difference（P〉0.05）.HH compliance rates of HCWs in different sizes of ICUs were significantly different before and after intervention（all P〈0.05）,in NICUs with〈20 beds and 20-30 beds after the intervention were both significantly higher than before intervention（both P〈0.05）,while〉 30 beds were significantly lower than before intervention（P〈0.001）;HH compliance rate of cleaners increased from58.82% before intervention to68.09% after intervention（P〈0.05）;Of different hand hygiene indications,except before clean/aseptic task,compliance to the other HH indications were significantly different between before and after intervention（all P〈0.05）.Conclusion HH compliance is high among HCWs in NICUs in China,intervention measures,such as intensified training and timely feedback have certain influence in compliance to HH among HCWs at different sizes of ICUs,of different occupations,and at different HH indications.