基于风险识别与聚类分析的医疗机构保洁人员手卫生监测指标研究

Hand hygiene monitoring indication of cleaners in medical institutions based on risk identification and cluster analysis

目的拟借助风险识别与聚类分析方法探索适用于医疗机构保洁人员手卫生监测的指征与时机,为保洁人员手卫生依从性的监测提供工具及标准。方法通过随机抽样方法匿名观察50名保洁人员工作流程及行为,遴选10名专家判别工作流程,借助风险识别工具划分风险带,通过聚类分析确定手卫生指征。结果保洁人员17类工作行为风险得分均达到纳入聚类分析标准,具有手卫生指征,其中最高风险评分为逐一拖洗病房每床物体表面、厕所、走廊等(4.50±0.53)和擦拭洗手池、扶手、墙面、窗台等(4.50±0.53)。聚类分析显示工具准备、清洁消毒、个人防护、医疗废物及环境整理为5个主要行为节点。进一步归纳分析后,确定保洁人员的手卫生指征为“一前五后”,即清洁消毒前、准备工具后、清洁消毒后、个人脱卸防护用品后、转运医疗废物后、环境整理后。结论建立医疗机构内保洁人员“一前五后”手卫生监测指标体系,不仅可为保洁人员手卫生培训提供适用的量化参考指标,同时可为监测和干预保洁人员手卫生提供参考工具。

Objective To explore the indications and opportunities applicable for hand hygiene(HH)monitoring of cleaners in medical institutions through risk identification and clustering analysis method,provide tools and stan-dards for the monitoring of HH compliance of cleaners.Methods The workflow and behavior of 50 cleaners were observed anonymously by random sampling method,10 experts were selected to judge the workflow,risk belts were defined with risk identification tools,HH indications were determined by cluster analysis.Results Risk scores of 17 types of work behavior of cleaners met the standard of cluster analysis and had HH indications,the highest risk score was mopping object surface of each bed,toilet,corridor,and so on in the ward one by one(4.50±0.53)as well as wiping the sink,handrail,wall,windowsill,and so on(4.50±0.53).Cluster analysis showed that tool preparation,cleaning and disinfection,personal protection,medical waste and environmental sorting were 5 main behavior nodes.After further inductive analysis,it is determined that HH indications of cleaners were“one before and five after”,that is,before cleaning and disinfection,after preparing tools,after cleaning and disinfection,after taking off personal protective equipment,after transferring medical waste and after environmental sorting.Conclusion The establishment of“one before and five after”HH monitoring indication system for cleaners in medical institutions not only provides applicable quantitative reference indication for HH training of cleaners,but also provides a reference tool for monitoring and intervention of HH of cleaners.