不同材质的干手物品应用于外科免冲洗手消毒方法的卫生学和经济学评价

Hygienic and economic evaluation on different hand-drying materials in non-rinse surgical hand antisepsis

目的研究外科免冲洗手消毒方法涂抹手消毒液之前使用擦手纸替代灭菌擦手巾干手的可行性,进行灭菌擦手巾和擦手纸的卫生学和经济学评价。方法 2016年7月-9月,采用整群抽样的方法,以每个星期四在手术室进行外科免冲洗手消毒的所有医护人员手样本为研究对象,将医护人员按照工作内容分配至干预组(使用擦手纸干手)和对照组(使用灭菌擦手巾干手),其中干预组再根据工号单双号分为A组(使用利康擦手纸)、B组(使用清风擦手纸);在完成外科免冲洗手消毒方法后进行手卫生采样检测。调查库房干手物品单包装规格和成本,调查手术室平均每台手术上台人数、每人外科手消毒使用灭菌擦手巾或擦手纸的张数,计算每台手术不同干手物品的成本。最后对外科免冲洗手消毒方法使用擦手纸干手的卫生学和经济学效果进行评价。结果对照组、A组、B组手卫生样本量分别为30、39、30例,各组检测细菌菌落总数均<5 cfu/cm^2,符合《医务人员手卫生规范》(WS/T 313-2019)外科手消毒卫生学要求,合格率均为100%。按照每台手术最少需要4名医护人员参与计算,每台手术消耗灭菌擦手巾8张,成本为15.2元;如使用擦手纸,每台手术消耗擦手纸16张,成本为0.8元。结论外科免冲洗手消毒方法涂抹手消毒液之前使用擦手纸干手对外科手消毒卫生学效果无影响;使用擦手纸替代灭菌擦手巾,可以显著降低医院手术室运营成本。

Objective To study the feasibility of using paper hand towels instead of sterilized hand towels in nonrinse surgical hand antisepsis, and make a hygienic and economic evaluation on sterilized hand towels and paper hand towels. Methods From July to September 2016, a cluster sampling method was used to study the hand samples of all health care workers who performed surgical hand sanitization in the operating room on Thursday. According to their work contents, they were asigned into the intervention group(using paper hand towels to dry hands) and the control group(using sterilized hand towels to dry hands);further, according to the odd or even number of the staff identification number, the intervention group was divided into Group A(using Likang hand towels to dry hands) and Group B(using Qingfeng hand towels to dry hands). The packing specifications and costs of hand-drying items in the warehouse were surveyed, as well as the average number of medical workers performing an operation and the number of sheets of sterilized hand towels or paper hand towels used per person, and the cost of different hand dryers for each procedure was calculated. Finally, the hygienic and economic effects of using paper hand towels were evaluated. Results There were30, 39, and 30 hand hygiene samples collected in the control group, Group A, and Group B, respectively. The total bacterial count of each group was less than 5 cfu/cm^2, which met the hygienic requirements of surgical hand disinfection in the manual hygiene standard for medical personnel(WS/T 313-2019), i.e., the passing rate of each group was 100%.According to the calculation that each operation required at least 4 medical workers, each operation consumed 8 sterilized hand towels at a cost of 15.2 yuan;if using paper hand towels, each operation consumed 16 sheets at a cost of 0.8 yuan.Conclusion The hygienic effect of surgical hand disinfection is not affected by the use of paper hand towels before applying hand sanitizer, while the operating cost of hospital operating room can be significantly reduced by using paper hand towels instead of sterilized hand towels.