多个医疗中心工作人员手卫生依从性调查及影响因素分析  

Analysis of multi-medical center staff hand hygiene compliance and influence factors

作　　者：罗艳君[1] 罗艳姣[2] 周丹[3] 付玲[4] 刘抗寒[5] 姜玲[6] 李蓉蓉[7] 罗沙阳[8] 周柯夫[9] 杨明华[10] 

机构地区：[1]中南大学湘雅医院重症医学科,湖南长沙410008 [2]中南大学湘雅三医院血液科,湖南长沙410013 [3]中南大学湘雅二医院心胸外科,湖南长沙410008 [4]湖南省妇幼保健院儿科,湖南长沙410008 [5]湖南省人民医院肾内科,湖南长沙410005 [6]中南大学湘雅医院新生儿科,湖南长沙410008 [7]中南大学湘雅医院移植中心,湖南长沙410008 [8]中南大学湘雅医院乳腺外科,湖南长沙410008 [9]中南大学湘雅三医院急诊科,湖南长沙410013 [10]中南大学湘雅医院儿科,湖南长沙410008

出　　处：《现代医学》2013年第5期289-293,共5页Modern Medical Journal

基　　金：国家自然科学基金资助项目(81100359)

摘　　要：目的:调查多个省级医疗中心工作人员对手卫生的认识及依从性,并探讨影响依从性的因素,为改进手卫生提供科学依据。方法:随机调查湖南省内5家大型三甲医院12个临床科室各类工作人员不同时刻的手卫生依从性情况,并对相关人员进行问卷调查,分析影响手卫生依从性的因素。调查问卷采用de Wandel等设计基于行为理论模式的56项调查问卷的中文修改版。结果:共随机调查416名医务人员(医师143名,护士192名,护工及卫生清洁人员81名),手卫生总的依从性为47.78%;护士的依从性最高为58.95%,医师为41.96%,护工及卫生员的依从率仅为21.62%,三者两两比较差异具有统计学意义。在不同洗手时刻的依从性方面,直接接触病人之前、进行无菌操作或护理程序之前、接触血液或体液之后、直接接触病人之后、接触病人直接范围之后的洗手依从率分别为27.59%、49.32%、63.37%、61.68%、38.62%。ICU、移植中心及新生儿科的手卫生依从性明显高于其他普通科室。问卷调查显示,对手卫生的重要性认识不足、工作时间紧、洗手设施不足、手卫生的人文关怀少、部分医务人员自律性差等因素是影响手卫生依从性的重要因素;同时护工等辅助人员的手卫生知识和依从性急需加强。结论:我省省级医院医务人员尤其是护工及辅助人员的手卫生依从率仍有待提高,需从增强手卫生的知识、提高对手卫生重要性的认识、改善洗手设备、加强人文关怀和管理等方面改进手卫生。Objective： To investigate the knowledge, compliance and the influencing factors of hand hygiene of multiple provincial medical centers＇ staffs, and explore the factors affecting compliance, to provide the scientific basis for improvement of hand hygiene. Methods： All categories of medical personnel were observed and recorded by using single-blind method from twelve clinical departments of five top hospitals in Hunan Province to survey their hand hygiene compliance, and inquired with questionnaire. Chinese modified version of de Wandel D＇s questionnaire based on a behavioral theory model was filled out by staffs to reveal the influencing factors. Results： The hand hygiene practices of 416 medical personnel（ 143 doctors, 192 nurses, 81 care workers and health cleaning staffs） were observed and recorded. Total rate of hand hygiene compliance （HHC） of medical personnel was 47.78%, compliance of nurses was 58.95% , compliance of physicians was 41.96% , compliance of care workers and health workers was only 21.62% （ P 〈 0.001 ）. The rates of HHC ＂before direct contact with the patients＂, ＂before operation or nursing program＂, ＂after blood or body fluids exposure＂, ＂after contacting with patients＂, ＂after contact with the surroundings of patients＂ were 27.59%, 49.32 % ,63.37%, 61.68% and 38.62% respectively. ICU, neonatology and transplant center＇s hygiene compliance was significantly higher than that of other departments. The questionnaire showed the lack of realization of hand hygiene, tight working hours, lack of hand-washing facilities, less of humane care, and poor self-discipline were affecting factors of hand hygiene compliance; Hand hygiene knowledge of auxiliary was urgent need to be strengthened. Conclusion： The compliance rate of hand hygiene of medical personnel in the Hunan＇s top hospitals needs to be improved. The pertinent measures to improve hand hygiene should be taken according to enhance hand hygiene knowledge, raise realization, improve handwashing f

关 键 词：手卫生 依从性 医院感染 影响因素 

分 类 号：R16[医药卫生—公共卫生与预防医学] R197.323.4