Analysis of Compliance and Barriers for Hand Hygiene Practices among Health Care Workers during COVID-19 Pandemic Management in Tertiary Care Hospital of India—An Important Step for Second Wave Preparedness

Introduction: Hands of health care workers play an important part in infection transmission in a healthcare setting infections. Even though it is a simple and effective procedure, it is many times ignored by the health care workers (HCWs) due to lack of knowledge and interest, time constraints, skin irritation, understaffing, etc. There are no specific drugs and vaccines available for COVID-19 pandemic management, so as control measures, hand hygiene is an essential measure. It will be helpful even for the second wave preparedness. So this study was planned for analysis of barriers and practices of hand hygiene among health care workers which determine the adherence of hand hygiene in medical practice. Methods: This was a cross-sectional study designed during COVID-19 pandemic management to analyze the barriers and knowledge, attitude and practices in health care workers for hand hygiene. Semi-structured questionnaires based study based on previous experience of seasonal flu outbreak was make to know barriers as well as to analyze the knowledge, attitude and practices of Health care workers. 215 participants were enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Results: The “Barriers” related questions’ analysis showed that hand hygiene facilities, with the supply of soap, hand rub, basins with adequate as well as clean water, are available at various places in the Hospital. In knowledge related questions, major gaps are found in 5 moments of hand hygiene and regarding aspects of alcohol-based hand-rub. Majority HCWs show a good attitude towards questions that hand hygiene is an important thing to do along with other works and they feel frustrated when others or they themselves omit hand hygiene. But the attitude toward hand hygiene when hands are not visibly soiled and when working with gloved hand showed a wrong attitude. There is a major gap in practices of hand hygiene. The majority feel hand hygiene is difficult due to work pressure, sometimes they forgot, they feel it difficult to adhere due to more steps during an emergency. Discussion: Hand hygiene is an essential part of COVID-19 pandemic management. Less compliance was observed due to a lack of knowledge and awareness. Such ignorance leads to an increase in Hospital-acquired infection. Conclusion: Good preparedness by Government and Institute for supplying adequate hand hygiene facilities in the work area for health care workers. But there were few gaps found in knowledge and attitude-related questionnaires and major gaps in practices were found which should be corrected by repeated training, awareness programs, demonstrations for hand hygiene and hands-on training. Conducting Periodic Webinar can be the most useful, convenient and safe method to provide training during the COVID-19 pandemic.

Health Care Personnel’s Attitude toward Hand Hygiene in Regard to the Prevention of Health-Care Associated Infections: A Cross Sectional Study at the University Hospital Pristine

Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).

Assessment of Hand Hygiene Attitude, Knowledge and Practice among Health Science Students in Aden University

Background: A proper hand washing of community health care worker (CHCW) is universally accepted as an important factor in reducing Heath Care Associated Infections (HCAIs). This cross sectional study was done to assess the knowledge, the attitude and practice on hand hygiene among health science students in Aden University. Method: 329 participants from medical, dental and nursing schools completed the questionnaire (43.8% female and 56.2% males). 1st, 2nd and internship years were excluded from the study. The questionnaire is adapted from World Health Organization (WHO) tools for hand hygiene surveys. Epi info., an epidemiological software from the Centre of Disease Control (CDC), was used for data analysis. Results: Responses of the participants in the study indicated that the majority of the students were aware of Hand hygiene (>90%) and 60% have had some sort of training. There is an obvious lack of knowledge on hand movement i.e. my five moments of hand hygiene, particularly on the main source and route of cross contamination with pathogens in hospital setting. In hand hygiene practice, 95% of participants wash their hands before and after food intake, 85% of participants use soap and water, but 8% of participants use only water and very few use alcohol base cleansing agent. 84% of participants wash their hands after handling patient. There was no significant difference between males and females in hand hygiene practice. Conclusion: The study on assessment of knowledge, attitude & practice of students of medical sciences revealed that almost all participants were aware of hand hygiene. However, at this stage of assessment, knowledge and practice are below 100% score for the correct response in particular knowledge and practice.

Hand Hygiene Knowledge, Practices and Attitudes among Nurses and Physicians

Background: Hand hygiene is one of the most effective ways to control health care related infection. Nurses and physicians are the main health care workers contacting with patients, representing the vector in the chain of infection. Thus, assessing their knowledge, practice and attitudes regarding hand hygiene is very important to decrease the incidence of health care related infection and to improve quality of care. Aims: The aim is to assess the knowledge, practice and attitude of Palestinian physicians and nurses regarding hand hygiene in hospitals. Methods: The study adopted a cross-sectional, quantitative design. Nurses and doctors who worked in the major governmental and private hospitals in the West Bank (Palestine) were targeted. Data was collected using Hand Hygiene Questionnaire. Results: 200 nurses and physicians participated in this study. The results showed that the participants had a moderate knowledge regarding the hand hygiene (m = 6, SD = 1.7). They had a better attitude score than practice with a mean of 82.5 ± 8.8. There was a significant difference between male and female only in practice score (p = 0.015). Older participants had better attitudes, and private hospitals had significantly higher scores for compliance, importance of hand hygiene and practice than governmental hospitals (p < 0.05). Conclusion: The results of the current study showed that there was a further need to focus on the practices of hand hygiene by continuous education for both Palestinian nurses and physicians.

Simulated Microbe Removal around Finger Rings Using Different Hand Sanitation Methods

Aim It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only ＂recommend＂ removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. Methodology A gloved robber hand manikin was made and fitted with a flesh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20℃ and 40℃ water alone, or with liquid hand soap. Light levels （in lux） of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance （ANOVA） was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey＇s post hoc honestly significant difference （HSD） test was applied to significant factors to examine pair-wise differences between factor levels. Results It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. Conclusion The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.

上海市74所医疗机构ICU手卫生用品消耗量及依从性相关分析

目的 了解上海市二级及以上医疗机构重症监护病房(ICU)手卫生用品消耗量与依从性,为进一步开展医务人员手卫生监测工作提供依据。方法 通过医院感染监测系统,对2017—2021年上海市二级及以上医疗机构ICU手卫生用品消耗量及依从性监测结果进行分析。结果 共纳入74所医疗机构105个ICU,手卫生用品平均消耗量为79.24(44.88~258.63)mL/(床·日),不同类型ICU手卫生用品平均消耗量比较,差异具有统计学意义(P<0.001);手卫生用品平均消耗量从2017年的65.75 mL/(床·日)增至2021年的87.55 mL/(床·日),呈逐年增加趋势(P<0.001)。医务人员手卫生依从率为82.13%,护士手卫生依从率最高(86.59%),医技最低(48.90%),不同职业医务人员手卫生依从率比较,差异具有统计学意义(P<0.001)。手卫生实施的方式中,采取流动水洗手占39.86%,速干手消毒剂擦手占42.27%,未采取手卫生措施占13.22%,戴手套未采取手卫生措施占4.65%,不同ICU医务人员手卫生实施方式比较,差异具有统计学意义(P<0.001)。手卫生用品平均每床日消耗量与医务人员手卫生依从率存在正相关关系(r=0.703,P<0.05)。结论 上海市ICU手卫生用品平均每床日消耗量与医务人员手卫生依从率均逐年增加,不同类型ICU手卫生用品平均每床日消耗量和手卫生依从率存在差异,可通过连续监测手卫生用品平均每床日消耗量评估手卫生执行情况。

2014—2022年手卫生干预对医院感染例次发病率的影响

目的 观察多模式手卫生干预对手卫生依从性的影响,以及手卫生依从性与医院感染例次发病率之间的关系。方法 2014—2022年,某三甲医院感染控制团队对全院医务人员实施多模式手卫生干预,回顾性分析手卫生监测数据的变化趋势、手卫生依从率与医院感染例次发病率的相关性。结果 病房手卫生用品消耗量呈稳定上升趋势;手卫生依从率从2014年64.98%提高到2022年85.01%(P<0.001),医院感染例次发病率从1.21%下降至0.83%(P<0.05),手卫生依从率与医院感染例次发病率之间存在负相关(r=-0.369,P=0.027)。各季度不同区域及不同岗位的手卫生依从率均有所提高(P<0.001)。各季度5个时刻手卫生依从率中,无菌操作前与接触患者后的手卫生依从率小幅波动;接触患者周围环境后的手卫生依从率呈上升趋势;接触患者前与接触患者体液后的手卫生依从率在2020年之后有所下降(P<0.001)。结论 多模式手卫生干预能提高医务人员的手卫生依从性,提高医务人员手卫生意识有利于降低医院感染例次发病率。

某三级甲等医院ICU工作人员手卫生依从性及正确性调查分析

目的 研究某三级甲等医院重症监护病房(ICU)工作人员手卫生依从性及正确性,为手卫生干预提供理论基础。方法 2023年4月,专职感染监控人员对该院17个ICU的工作人员进行现场调查,填写手卫生依从性和正确性监测表。结果 使用隐蔽观察法共观察874次手卫生时机,执行手卫生时机501次,依从率57.32%,正确执行273次,正确率54.49%。不同ICU工作人员手卫生依从率及正确率差异较大。不同岗位工作人员手卫生依从率和正确率比较差异有统计学意义,保洁员的手卫生依从率(31.97%)低于护士(63.83%)、医生(58.77%)和其他人员(58.14%);保洁员的手卫生正确率(30.77%)低于护士(58.17%)。不同岗位人员及不同手卫生时刻未执行手卫生的原因差异有统计学意义:接触患者后未执行任何手卫生措施的比率(84.75%)高于接触患者前(41.27%)、清洁无菌操作前(30.00%)、接触血液体液后(45.45%);接触患者周围环境后未执行任何手卫生措施的比率(66.67%)高于接触患者前和清洁无菌操作前。不同岗位工作人员手卫生步骤不全的比率及时间不够的比率比较差异有统计学意义,其他人员的手卫生步骤不全的比率(82.35%)高于医生(52.63%);医生(82.46%)及护士(78.18%)手卫生时间不够的比率高于保洁员(51.85%)。结论 在ICU,不同职业的人群、不同时刻手卫生执行情况存在明显差异,需要综合其特点进行干预。

2019年全国医疗机构医务人员诊疗过程手卫生监测报告

目的建立医务人员诊疗过程手卫生监测数据的评价体系。方法2019年9月1—30日采用手卫生观察员现场调查方法获取综合重症监护病房(ICU)、呼吸内科病区、骨科病区、感染科病区、儿科门急诊、血液透析室医生和护士手卫生执行情况,并统计同期调查科室工作量、手卫生用品消耗量以及医疗机构实际开放床位数,计算手卫生依从率和手卫生用品床日消耗量。结果共有1480所医疗机构手卫生调查资料审核合格,应执行手卫生1353531次,执行手卫生1076639次,正确执行手卫生891185次,手卫生依从率为79.54%,手卫生执行正确率为82.77%。不同规模医疗机构手卫生依从率为76.26%~82.84%,以实际开放床位数600~899张者手卫生依从率最低;手卫生正确率为81.87%~84.01%,以实际开放床位数≥900张者手卫生正确率最低。调查科室手卫生依从率为76.80%~84.44%,以儿科门急诊手卫生依从率最低;手卫生正确率为81.19%~84.98%,以骨科手卫生正确率最低。五个手卫生时机手卫生依从率为67.59%~89.84%,以接触患者周围环境后手卫生依从率最低;手卫生执行正确率为81.51%~86.76%,以接触患者周围环境后手卫生执行正确率最低。综合ICU、呼吸内科、骨科、感染科手卫生用品消耗量分别为56.62、10.76、9.50、14.54 mL/床日,儿科门急诊、血液透析室手卫生用品消耗量分别为2.02、9.06 mL/人次。不同规模医疗机构中,综合ICU以实际开放床位数600~899张者手卫生用品消耗量最多(61.15 mL/床日),呼吸内科、骨科、感染科均以实际开放床位数>900张者手卫生用品消耗量最多(分别为13.61、10.96、16.55 mL/床日),儿科门急诊、血液透析室均以实际开放床位数300~599张者手卫生用品消耗量最多(分别为2.53、10.76 mL/人次)。结论此次调查获取的不同规模医疗机构手卫生依从率及手卫生用品床日消耗量可作为标杆,为各医院机构提供手卫生执行情况的对照体系,以促进全国医疗机构手卫生持续改进。

医务人员手卫生依从性现状调查

目的了解西安市某三级甲等综合医院医务人员手卫生依从性现状。方法采取直接观察法,对该院73个临床科室医务人员手卫生现状进行现场观察。结果观察404名医务人员,手卫生时刻404次,实施手卫生255次,正确执行手卫生181次,依从率为63.12%,正确率为44.80%。ICU医务人员手卫生依从率(91.89%)和正确率(81.08%)均高于普通病房(分别为60.22%、41.14%),差异具有统计学意义(χ2=14.485,P<0.001;χ2=5.671,P=0.017)。不同人员类别中,护士手卫生依从率(73.76%)和正确率(60.18%)最高,辅助人员的手卫生依从率(40.90%)和正确率(10.20%)最低;5个手卫生时刻中,"接触患者血液体液后"的手卫生依从率最高(80.00%),"清洁或无菌操作前"的手卫生正确率最高(62.96%)。结论该医院医务人员手卫生依从率较高,但正确率较低。不同科室、职业类别和手卫生时刻的手卫生依从率和正确率不同,应重视全面提高医院工作人员的手卫生依从性。

重症监护病房医务人员手卫生依从性多中心干预效果

目的通过多中心研究评价综合干预措施对提升重症监护病房(ICU)医务人员手卫生依从率的效果。方法选取12个省市47所医院,按照世界卫生组织(WHO)颁布的手卫生调查方法,于2013年10月—2014年9月采用直接观察法,对ICU医务人员手卫生依从率进行调查,并比较干预前后手卫生依从率的变化。结果 ICU医务人员手卫生依从率从干预前的73.70%(11 155/15 135)提升至干预后的78.70%(18 206/23 132),差异有统计学意义(χ2=128.16,P<0.01);干预后,不同地区中,除东北地区外,其他地区/系统医务人员手卫生依从率均较干预前提升(均P<0.05);综合ICU、呼吸ICU、急诊ICU和外科ICU干预后手卫生依从率均较干预前提升(均P<0.05);不同岗位医务人员干预后手卫生依从率均较干预前提升(均P<0.05);直接接触患者前、进行清洁或无菌操作前、直接接触患者后及接触患者周围环境后的手卫生依从率均较干预前提升,差异均有统计学意义(均P<0.01)。结论采取综合干预措施,有助于提升ICU医务人员手卫生依从率。

某三级甲等医院医务人员手卫生依从性现状调查

目的了解某三级甲等医院医务人员手卫生依从性现状,探讨提高手卫生依从性的有效措施。方法采用直接观察法,于2012年9—12月对该院23个临床科室医务人员的手卫生依从性及手卫生方式进行现场调查,并填写手卫生依从性监测表。结果共观察721次手卫生时刻,手卫生依从率为58.53%,其中选择速干手消毒剂擦手者占32.18%,流动水洗手者占26.35%,戴手套未采取其他手卫生措施者占19.42%。不同岗位医务人员以护士手卫生依从率(68.65%)最高,保洁员最低(39.25%)。"5个时刻"手卫生依从率以"接触患者体液后"最高(73.75%),其次是"接触患者后"(65.00%),"接触患者周围环境后"最低(47.85%)。结论该院医务人员手卫生依从性有待提高,应进一步加强手卫生管理,针对不同岗位人员采取相应的改进措施。

第三方调查的绩效考核对改进医务人员手卫生依从性的效果

目的了解医务人员手卫生执行的真实情况,为改进手卫生管理提供依据。方法某院2016年度实行手卫生绩效考核,同时邀请第三方(外院医院感染专职人员)对全院医务人员手卫生进行4次匿名调查,并比较医务人员手卫生依从率的变化。结果第三方调查的医务人员手卫生依从率为60.68%,其中上半年和下半年的手卫生依从率分别为52.72%、68.62%,差异有统计学意义(P<0.001)。重点科室(各重症监护病房、新生儿科)的手卫生依从率(87.44%)高于外科科室(64.71%)和内科科室(53.74%),差异均有统计学意义(均P<0.05)。医务人员在接触患者前、接触患者后以及接触患者周围环境后的手卫生依从率较低(分别为53.59%、58.07%、43.97%)。结论第三方手卫生调查能有效降低手卫生观察过程中的霍桑效应。手卫生绩效考核有助于改进医务人员手卫生依从性。

手卫生促进活动的实施及效果评价

目的探讨切实可行的手卫生干预方法,以提高医务人员手卫生依从性。方法在武汉地区20所医疗机构开展手卫生促进活动,同时采用问卷调查和现场观察的方法评价干预前后的变化。结果经干预后,医务人员手卫生知识水平明显提高,直接接触患者前的医务人员手卫生执行率从60.59%(143/236)上升至84.08%(243/289)(χ2=36.82,P<0.001);干预科室的医院感染率从干预前的39.33%(118/300)下降至干预后的31.20%(83/266)(χ2=4.07,P=0.04),差异均有统计学意义。结论采取积极有效的手卫生促进活动,对提高医务人员手卫生依从性有明显的促进作用,可降低医院感染发生率。

应用品管圈提高重症医学科医务人员手卫生正确率

目的探讨品管圈(QCC)在提高重症医学科医务人员手卫生正确率的应用效果。方法成立QCC活动小组,确立活动主题,监测2014年3月(活动前组)医务人员手卫生正确率,分析导致手卫生行为不正确的原因,设立目标;2014年5月开始实施QCC活动,将活动前手卫生正确率与2014年9月(活动后组)进行比较。结果 QCC活动前调查医务人员手卫生834例次,活动后调查900例次,活动前后手卫生正确次数分别为360、714例次,活动后手卫生正确率高于活动前(79.33%vs 43.17%),差异有统计学意义(χ2=240.19,P<0.05)。本科室及外来学习的医务人员手卫生正确率活动后均高于活动前(χ2分别为264.44、6.36,均P<0.05)。活动前后手卫生行为不正确的主要情况均为有手卫生指征时未执行。结论应用QCC对重症医学科医务人员手卫生行为进行管理,能有效提高重症医学科医务人员手卫生正确率。

综合重症监护病房医护人员手卫生干预效果分析

目的：对某院重症监护病房（ICU）医护人员手卫生进行干预，评估医护人员手卫生依从性及其影响因素。方法选取某三级甲等教学医院 ICU 37名医护人员作为调查对象，采用直接与间接法对其干预前后的手卫生情况进行观察、分析。结果手卫生监测第一阶段中，基线调查期手卫生依从率（46．96％）和干预后观察期（63．30％）比较，差异有统计学意义（χ2＝7．344，P ＝0．007）；手卫生监测第二阶段中 ICU 手卫生依从率从57．85％上升至88．58％。手卫生依从率与平均每床日手卫生用品消耗量呈正相关（r＝0．725，P ＜0．001），与医院感染发病率、例次发病率均呈负相关关系（r 值分别为－0．983、－0．990，均 P ＜0．001），使用含乙醇免洗手消毒剂手卫生依从率与平均每床日手卫生用品消耗量呈正相关（r＝0．391，P ＜0．001）。结论手卫生依从性监测和干预需要长期连续性进行，直接观察法与间接手卫生产品消耗评估法相结合，可以对医护人员手卫生依从性进行有效的监测和干预。

不同培训方式对医护人员手卫生依从性的影响

目的采用常规培训与联合手污染状况调查的培训方法对医护人员进行宣教,评价两种方法对医护人员手卫生依从性的影响。方法 2013年11月—2014年4月,选择心血管内科两个病房的全体医护人员作为宣教对象并分别设为实验组与对照组。培训前1个月对两组进行手卫生依从性摸底调查,培训后第1个月两组均采用常规宣教培训方法,第2个月至第5个月在常规宣教培训方法的基础上实验组增加手卫生污染状况调查培训方法,分别统计两组医护人员的手卫生依从率。结果培训前实验组与对照组手卫生依从率分别为42.63%(107/251)、41.80%(102/244),差异无统计学意义(P>0.05);培训后第1和第2个月,实验组医护人员手卫生依从率分别为55.70%(132/237)、63.11%(154/244),对照组分别为56.52%(130/230)、62.61%(149/238),与培训前比较,差异均有统计学意义(均P<0.05),但两组间差异无统计学意义(P>0.05);培训后第3个月至第5个月,实验组医护人员手卫生依从率分别为60.73%(150/247)、61.44%(145/236)、61.22%(150/245),对照组分别为51.68%(123/238)、51.02%(125/245)、52.32%(124/237),两组间差异有统计学意义(P<0.05)。结论采用常规培训同时联合手污染状况调查的培训方式可以更好地促进医护人员手卫生依从性的提高。

重症监护室医务人员手卫生干预效果研究

目的了解重症监护室(ICU)医务人员手卫生干预效果及其影响因素,探讨切实可行的手卫生干预方法,以提高医务人员手卫生执行率。方法 2008年为第1阶段,对综合ICU、神经外科ICU、新生儿ICU均实行教育干预和产品干预;2009年为第2阶段,在上述基础干预之上开展个性化的干预措施。采用自行设计的调查表并结合现场观察手卫生过程的方法,调查上述ICU医务人员手部卫生执行情况,分析干预前后手卫生的执行率变化。结果在干预前,ICU医务人员的手卫生执行率为25.06%,经过教育干预、产品干预后,手卫生执行率上升至41.52%,其中医务人员在不同工作状态下的手卫生执行率以医疗护理操作之间提高最明显,由干预前的10.11%上升至28.33%(P=0.01)。干预后,3个ICU医务人员手卫生执行率均有所提高,且3种不同教育干预之间差异存在高度显著性(P=0.01)。结论提供产品干预、基础及个性化教育干预对ICU医务人员手卫生依从性有一定的促进作用。

3种不同处理因素对医务人员手卫生依从率的影响

目的探讨不同处理因素对临床医务人员手卫生依从率的影响。方法选择2012年7—12月某院8个临床科室作为研究对象,7月份对其进行手卫生依从率本底资料调查;8—10月,对其中6个临床科室免费提供手消毒剂＋综合干预,其中2个科室仅采取综合干预;11—12月对入选科室仅采取综合干预,不免费提供手消毒剂。比较医护人员手卫生依从率及医院感染情况。结果 2012年7—12月临床科室手卫生依从率为59.50%,各月份手卫生依从率比较,差异有统计学意义（P〈0.01）,其中7月份手卫生依从率最低（36.73%）;采取免费提供手消毒剂＋综合干预措施后,各月份医务人员手卫生依从率（57.20%-72.08%）明显提高,且取消免费手消毒剂后,各月份手卫生依从率（65.20%-65.50%）仍维持在较高水平。8—10月各科室手卫生依从率（45.41%-73.63%）均高于7月份（18.97%-47.17%,均P≤0.05）;除重症监护室（ICU）北区外,11—12月各科室手卫生依从率（61.67%-72.73%）高于7月份（均P〈0.05）。医院感染率由7月份的3.39%降至11—12月的1.75%,呈下降趋势（χ^2=5.122,P=0.024）。结论免费提供手消毒剂对提高医务人员手卫生依从性有积极推动作用,但不是必要条件;反复强化医务人员手卫生意识是提高手卫生依从性的关键措施。

应用ATP生物荧光法调查医院环境物体表面及医务人员手清洁度

目的了解医院环境物体表面及医务人员手清洁度。方法采用ATP生物荧光检测法,于2015年1—7月随机抽取某三甲综合医院环境物体表面及医务人员手进行检测并现场反馈干预。结果医院环境物体表面合格率为58.14%(200/344),呼吸机相关物体表面合格率为69.88%(116/166),其中呼吸机气管插管口合格率较低(29.17%);合格率最低的医院环境物体表面为电话(27.27%)。呼吸机相关物体表面合格率:连续使用≥48 h为56.70%(55/97),连续使用<48 h为88.41%(61/69),两者比较差异有统计学意义(χ2=19.26,P<0.01)。医务人员手合格率干预前为34.18%,RLU为(1 033.46±106.20),干预后为85.58%,RLU为(80.46±10.68),干预前后合格率及RLU比较,差异均有统计学意义(均P<0.01)。结论医院动态环境中物体表面及医务人员手污染严重,应用ATP生物荧光检测法检测并进行现场反馈干预,有助于提高环境物体表面清洁度及手卫生依从性。