手卫生依从性教育联合PDCA循环对医院感染的影响

The influence of the education for hand hygiene compliance combined with PDCA circle on the nosocomial infection

目的探讨手卫生依从性教育联合PDCA循环对医院感染的影响。方法自2013年3月至2015年9月，于本院呼吸内科、肿瘤科、妇科门诊进行临床实验，对护理人员进行手卫生依从性教育以及PDCA循环相关措施，整理和观察结果，对比实验前后的医院环境监测合格率、医院感染预防措施执行率、相关指标感染发生率。结果实施后妇产科门诊的感染率由16．29％降到了2．47％；肿瘤科的感染率由27．12％降到了16．10％；呼吸内科的感染率由51．16％降到了21．71％；以上差异均有统计学意义。在实行临床实验前后对院内的环境进行检测发现，治疗室空气培养和物体表面细菌学监测的合格率显著提升，治疗室空气培养的合格率从91．21％提升到96．76％；物体表面细菌学监测的合格率从86．78％提升到93．44％。差异均有统计学意义。对比实施前后医护人员的操作规范合格率，医护人员在进行完PDCA循环后，各项操作规范率有显著提升，实施后的合格率都接近100％，对比前后数据，差异有统计学意义。对实施相关实验前后患者感染途径的比较，在妇产科门诊，通过阴道、泌尿道和皮肤切口的感染例数显著降低，肿瘤科与呼吸内科呼吸道感染率显著下降，以上感染途径前后对比差异有统计学意义。结论手卫生依从性教育联合PDCA循环能有效降低医院感染率，改善医院环境，提高医护人员操作规范性以及对微生物感染途径方面的研究有一定意义，值得临床推广和进一步研究。

Objective To explore the influence of the education for hand hygiene compliance combined with PDCA circle on the nosocomial infection. Methods From March 2013 to September 2015, nursing staffs in our hospital from respiration medicine, oncology department and gynecological clinic were given the hand hygiene compliance educa-tion and PDCA circle. And the results were cleared up and observed. The qualification rate of hospital environment mo- nitoring, the implementation rate of the prevention measures for hospital infection, the infection incidence of relevant indicators before and after the experiment were compared. Results After implementing, it was evident that the infection rate of clinic of gynaecology and obstetrics was decreased from 16.29% to 2.47%. The infection rate of oncology depart- ment was decreased from 27. 12% to 16. 10%. The infection rate of respiration medicine was decreased from 51.16% to 21.71%. And the differences were statistically significant. It was found that the air culture of the treatment room and the qualification rate of bacteriology monitoring of the objects＂ surface were significantly improved after monitoring the hospital＇s environment after the implementation of clinical experiment. The qualification rate of air culture of the treatment room was promoted from 91.21% to 96.76%. The qualification rate of bacteriology-monitoring of objects＂ sur- face was promoted from 86.78% to 93.44%. And the differences were statistically significant. The practice qualification rate of the medical staffs before and after the implementation were compared. The practice qualification rate was signifi- cantly improved after the implementation of PDCA circle. The qualification rate after the implementation was nearly 100%. And the difference was statistically significant by comparing the data before and after the implementation. In terms of the comparison of the way of infection of the patients before and after the implementation of the relevant experi- ment, the infection rate caused by the vagina, urinary tract and skin incision was significantly decreased in the obstetrics and gynecology department. The respiratory tract infection rate of the oncology department and respiration medicine was significantly decreased. There was statistical significance in terms of the differences between the above ways of infec- tion. Conclusions Hand hygiene compliance education combined with PDCA circle can effectively reduce the incidence of hospital infection, improve the normalization of operation of medical staffs. It is meaningful for the research of microbial infection. It worth a clinical promotion and further study.