应用六西格玛质量管理方案改善医护人员手卫生依从性的研究

Six Sigma quality management method on the improvement of hand hygiene compliance of medical staff in operation rooms

目的应用六西格玛质量管理方案改善手术室医护人员手卫生依从性,从而达到降低手术室感染的目的。方法选取2013年10月-2014年11月进入医院手术室的326名医务人员为研究对象,将六西格玛质量管理应用于手术室医护人员的手卫生依从性改善,针对前期对医护人员手卫生依从性的调查,分析目前医护人员手卫生依从性低的原因,采取针对性措施,并进行质量监控;观察改善前后手术室医护人员手卫生依从率及正确洗手情况,比较改善前后手术室患者感染率。结果应用六西格玛质量管理改进前手术室医护人员洗手率为52.01%,正确使用六步洗手法的医护人员为47.60%;改进后医护人员洗手率为93.89%,93.47%的医护人员可以正确使用六步洗手法,差异均有统计学意义(P<0.05);改进后医护人员手部菌落数为(2.3±0.5)CFU/cm2,显著低于改进前的(7.1±2.8)CFU/cm2;改进后手术室感染发生率为4.40%,显著低于改进前的7.91%,差异均有统计学意义(P<0.05)。结论六西格玛质量管理可以明显改善手术室医护人员手卫生依从性,提高医护人员对手卫生的重视度,减少手术室感染的发生。

OBJECTIVE To improve the compliance of hand hygiene in medical staff of operation rooms by Six Sigma quality management method, so as to achieve the purpose of reducing infection rates in operation rooms. METHODS Totally 326 medical staff in operation rooms, from Oct. 2013 to Nov. 2014, were selected for this study. Six-Sigma quality management was used to improve hand hygiene compliance of medical staff. According to the results of the early investigation for hand hygiene compliance in medical staff, the reasons for the low compli- ance of hand hygiene of medical staff was analyzed. Targeted measures and quality control were taken. The rate of hand hygiene compliance and the rate of correct hand washing before and after the improvement were observed, and the infection rates of the operation room before and after the treatments were compared. RESULTS Before ap- plied Six Sigma quality management, hand washing rates of staff in operating rooms was 52. 01%, the rate of proper use six-step washing method was 47.60%. After the improvement measures, the rate of hand washing was 93.89%, and 93.47% of the medical staff could correctly use six step hand washing method; the differences were significant （P〈0.05）. The average number of colonies of the medical workers after the improvement was （2.3 ±0.5） CFU/cm2 , and was significantly lower than that before the improvement of （7.1±2.8） CFU/cmz. After the improvement, the incidence of infections in the operation rooms was 4.40%. It was significantly lower than that before the improvement （7.91%） （P〈0.05）. CONCLUSION Six-Sigma quality management can effectively improve the hand hygiene compliance in medical staff of operation rooms and their attention on it, which can re- duce the infection rate of operation rooms.