隐蔽式现场观察器官移植医务人员手卫生的依从性

Concealed field observation on hand hygiene compliance among health care workers in organ transplant department

目的调查器官移植科医务人员手卫生依从现状。方法 2017年1—6月采用隐蔽式现场观察法,使用统一的WHO手卫生观察表格,每周一次对某院器官移植科医务人员手卫生依从性进行调查,应用SPSS 18.0软件进行统计分析。结果共调查37名医务人员,共观察应执行手卫生次数380次,实际执行次数86次,手卫生依从率22.63%,正确率53.49%。不同岗位医务人员手卫生依从率比较,差异无统计学意义(χ~2=1.003,P=0.80)。不同岗位医务人员手卫生正确率比较,差异有统计学意义(χ~2=8.411,P=0.038);医生手卫生正确率最高为88.89%,护工最低为0。在不同职称的医务人员中,副主任医师和主治医师手卫生正确率最高,为100%。不同指征手卫生依从率比较,差异有统计学意义(χ~2=15.082,P=0.005);接触血液、体液后的手卫生依从率最高为27.27%,无菌操作前的依从率最低为9.91%。不同指征手卫生正确率比较,差异无统计学意义(χ~2=7.150,P=0.128)。不同时间段医务人员手卫生依从率和正确率比较,差异均无统计学意义(均P>0.05)。医务人员手卫生不合格的主要原因是揉搓时间不足(19次,占47.50%)及揉搓方法不对(21次,占52.50%)。结论器官移植科医务人员手卫生依从性低,不同岗位医务人员手卫生依从率、正确率均存在较大差异,医务人员手卫生依从性仍有很大的提升空间,需采取相应的有效干预措施。

Objective To investigate status of hand hygiene（HH）compliance among healthcare care workers（HCWs）in an organ transplant department.Methods HH compliance among HCWs in an organ transplant department was investigated with concealed field observation once a week from January to June 2017,unified WHO HH observation forms were filled out,and SPSS 18.0 software was used for statistical analysis.Results A total of 37 HCWs were investigated,380 times of HH should be implemented during observation,86 times of actual implementation of HH was observed,compliance rate and correct rate of HH were 22.63% and 53.49% respectively.Difference in HH compliance rate among HCWs of different occupations was not significant（χ~2=1.003,P=0.80）.Difference in HH correct rate among HCWs of different occupations was significant（χ~2=8.411,P=0.038）;doctors had the highest correct rate of HH（88.89%）,patient care workers had the lowest correct rate of HH（0）.Among HH with different professional titles,correct rate of HH among associated chief doctors and attending doctors was highest（100%）.There was a significant difference in HH compliance rate under different HH indications（χ~2=15.082,P=0.005）;compliance rate of HH after exposure to blood and body fluid was highest（27.27%）,compliance rate before aseptic manipulation was lowest（9.91%）.There was no significant difference in the correct rate of HH under different indications（χ~2=7.150,P=0.128）.There was no significant difference in HH compliance rate and correct rate among HCWs during different periods（both P〉0.05）.The main reason for the disqualification of HH of HCWs was inadequate time for rubbing（19 times,47.50%）and the wrong method of rubbing（21 times,52.50%）.Conclusion Compliance of HH among HCWs in organ transplant department is low,compliance rate and correct rate of HH among HCWs of different occupations is significantly different,compliance of HH among HCWs needs to be improved,and corresponding effective intervention measures should be taken.