加强医护人员手卫生干预对医院感染发生率的影响  

Effect of strengthening intervention to hand hygiene on incidence of nosocomial infections

作　　者：程莉莉[1] 张秀月[1] 臧彬[2] 李国福[2] 于晓江[2] 赵鹤[3] 张丹晔[3] 

机构地区：[1]中国医科大学附属盛京医院医院感染管理办公室,辽宁沈阳110004 [2]中国医科大学附属盛京医院医院重症监护室,辽宁沈阳110004 [3]中国医科大学临床医学系,辽宁沈阳110001

出　　处：《中华医院感染学杂志》2012年第15期3300-3302,共3页Chinese Journal of Nosocomiology

基　　金：中华医学基金会基金项目(09-997);辽宁省自然科学基金项目(20102284)

摘　　要：目的评估ICU医护人员手卫生依从性的改进对医院感染率的影响。方法收集2010年8月-2011年4月527例入住成人ICU患者的医院感染相关数据,采用渐进式的手卫生干预措施,具体包括对医护人员手卫生行为存在的主要问题进行告知、提醒、督导,并将监测结果进行反馈。结果干预期间医务人员手卫生依从率有明显的提高;干预期间的医院感染率为18.3%,低于干预前的22.0%及干预后的22.0%,但差异无统计学意义;干预前后,尿道插管相关性尿路感染发生率及动静脉插管相关性血流感染发生率变化均不显著,呼吸机相关性肺炎发生率下降明显(χ2=9.267,P=0.010);干预期间鲍氏不动杆菌及铜绿假单胞菌引起的呼吸机相关性肺炎发生率下降明显,鲍氏不动杆菌引起呼吸机相关性肺炎发生时的插管天数较干预前后有所延长(t=-2.808,P=0.013)。结论医护人员手卫生依从性的改进可以降低医院感染发生率,但干预效果的持续性较差,在今后手卫生干预研究中,仍有待于探索长效的多模式手卫生干预措施。OBJECTIVE To evaluate the effect of interventions to hand hygiene on compliance of hand hygiene. METHODS The related data on healthcare-associated infections in ICU patients from Aug 2010 to Apr 2011 were collected, the progressive interventions to hand hygiene were adopted during this period, including notification, caution, supervision, and feedback of monitoring result aiming at main problems in hand hygiene behavior. RESULTS During the period of intervention, the compliance of hand hygiene of the medical staff was significantly improved; the rate of nosocomial infection was 18.3 % during the period of intervention, lower than 22.0 % before intervention and 22.0% after the intervention, but the difference was not statistically significant; the incidence of urinary tract catheter-related infections and venous catheter-related bloodstream infections did not change significantly, and the incidence of VAP remarkably decreased （x2 = 9. 267, P = 0. 010）; the incidence of VAP caused by Acinetobacter baumannii and Pseudomonas aeruginosa decreased obviously, and the time to VAP onset caused by A. baumannii was prolonged as compared with that before the intervention（t=- 2. 808, P=0. 013）. CONCLUSION To improve the hand hygiene compliance of the medical staff can decrease the incidence of nosocomial infections, but the effect of the progressive intervention is poor, so it is necessary to explore multimodal interventions to hand hygiene in the future study of hand hygiene interventions.

关 键 词：手卫生 依从率 干预 医院感染 发生率 

分 类 号：R197.323[医药卫生—卫生事业管理]