某教学医院重症监护病房物体表面清洁依从性干预研究

Intervention Studies on Object Surface Cleaning Compliance in the Ward Environment

目的分析重症监护病房(ICU)清洁依从性的现状、问题及薄弱环节,通过各ICU高接触频率的物体表面清洁质量评价干预措施的效果。方法 2014年9月1日—12月1日分别使用荧光笔对选定病房护理人员和保洁人员清洁的医疗仪器、物体表面进行标记,通过荧光标记的残余情况来评估清洁的依从性,并对效果不佳者进行2次针对性强化干预。结果干预前,综合ICU、神经ICU(NICU)、胸外ICU医疗仪器彻底清洁率分别为43.3%、31.4%、23.8%,物体表面彻底清理率分别为67.1%、60.5%、48.4%。经第1期干预后,综合ICU医疗仪器彻底清洁率为47.1%,与干预前差异无统计学意义(P=0.345),NICU、胸外ICU医疗仪器彻底清洁率分别提高为65.3%和35.1%,与干预前差异均有统计学意义(P<0.05);综合ICU、胸外ICU物体表面彻底清洁率分别为73.3%和58.1%,与干预前差异无统计学意义(P>0.05),NICU物体表面彻底清洁率提高为85.5%,与干预前差异有统计学意义(P<0.05)。对科室进行第2期干预后,综合ICU、NICU、胸外ICU医疗器械彻底清洁率分别为66.9%、83.3%和57.4%,较干预前差异均有统计学意义(P<0.05);NICU、胸外ICU物体表面彻底清洁率提高分别为85.6%和84.2%,较干预前差异均有统计学意义(P<0.05),综合ICU物体表面彻底清洁率为65.7%,较干预前差异无统计学意义(P=0.767)。结论通过对物体表面清洁消毒依从性的观察、监督和适当的反馈,可提高清洁的依从性,有利于控制和预防医院感染。

Objective To analyze the status quo, problems and weak points of cleaning compliance in the Intensive Care Unit（ICU）, and assess the intervention effects by evaluating the object surface cleaning quality in the ICU. Methods Between September 1st and December 1st, 2014, fluorescence marker was used to mark the surfaces of medical instruments and objects in the ward which were supposed to be cleaned by the nursing and cleaning staff. The assessment of cleaning compliance was performed through observing the residual fluorescence. Then, targeted intervention was carried out for situations with a low cleaning compliance. Results Before the intervention, the thorough cleaning rates of medical instruments in the Comprehensive ICU, Neurological ICU（NICU）, and Chest ICU were respectively 43.3%, 31.4%, and 23.8%, and the thorough surface cleaning rates for those units in order were 67.1%, 60.5%, and 48.4%, respectively. After the first intervention, the cleaning rate of medical instruments in the Comprehensive ICU was 47.1%, which had no significant change（P=0.345）, but the rate in the NICU and Chest ICU reached respectively 65.3% and 35.1%, which was significantly improved（P〈0.05）. The object surface cleaning rates were 73.3% and 58.1% in the Comprehensive ICU and Chest ICU after the first intervention, and there was no significant difference compared with those before the intervention（P〈0.05）, but the object surface cleaning rate in the NICU was significantly improved to 85.5%（P〈0.05）. After thesecond intervention, the medical equipment cleaning rates were 66.9%, 83.3%, and 57.4%, respectively for those three units, and compared with those before intervention, all the three were significantly improved（P〈0.05）. The object surface cleaning rates for NICU and Chest ICU were signif icantly raised to 85.6% and 84.2%（P〈0.05）, while it was 65.7% in the Comprehensive ICU and was not significantly improved（P=0.767）. Conclusion Observation and supervision through a feedback system can raise the cleaning compliance, which is helpful in controlling and preventing nosocomial infection.