提高手卫生依从性并改善感染控制指标的一项新技术  

A new technology improves hand hygiene compliance and indicators of nosocomial infection control

作　　者：孙惠英[1] 付菊芳[1] 于方方[1] 戴丽文[1] 刘冰[1] 白艳玲[2] 史皆然[1] 

机构地区：[1] 第四军医大学西京医院疾病预防控制科,西安710032 [2] 解放军第307医院疾病预防控制科,北京100071

出　　处：《中华老年多器官疾病杂志》2016年第9期653-656,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：第四军医大学西京医院临床高新技术项目(XJGX13LC19)~~

摘　　要：目的：评价手卫生智能提醒管理系统引入重症监护病房（ ICU）对医务人员手卫生依从性的管理效率及其对该部门主要医院感染指标的影响。方法以某三级甲等医院外科综合ICU为目标部门，研究分两个阶段，基线阶段：指派经培训的观察员通过暗访方式，统计该部门医务人员的手卫生依从率，同时收集该部门医院感染相关指标；干预阶段：布设基于射频识别技术研发的手卫生智能提醒管理系统，自动采集该部门医务人员遵从接触患者前、后的手卫生行为，计算依从率，同时收集该部门医院感染相关指标。比较干预前后医务人员手卫生依从率、医院感染率、多药耐药菌检出率及每床日速干手消毒剂消耗量等。结果干预后医务人员手卫生依从率为69．52％，较干预前的38．27％显著提高，且差异有统计学意义（P＜0.05）；干预后不同岗位医务人员手卫生依从率均显著高于干预前（P＜0．05），且干预后手卫生依从率呈逐月上升的趋势，并一直稳定保持在较高的水平；干预后医院感染率下降（7.81％vs 35.56％，P＜0．05），多药耐药菌检出率下降（20.0％ vs 40.63％），而速干手消毒剂消耗量显著上升（189.33 vs 36.69 ml／床日）。结论手卫生智能提醒管理系统不仅实现了对医务人员手卫生行为的智能提醒和有效管理，同时使医院感染的相关指标也得到相应改善。Objective To determine the effect of an intelligent alert and management system introduced into intensive care units （ICU） on the management efficiency of hand hygiene compliance （HHC） for health care workers （HCWs） and on the indicators of nosocomial infection.Methods Surgical general ICUs from an upper first-class hospital was chosen and the study was implemented in two stages.Baseline stage：the HHC rates of ICU HCWs were investigated in secret by trained observers and the nosocomial infection indicators were also collected and analyzed.Intervention stage： the intelligent hand hygiene alert and management systems, which based on radiofrequency identification technology, have been deployed to collect ICU HCWs’ hand hygiene behaviors before or after patient contact and analyze the HHC rates automatically.The nosocomial infection indicators were also collected and analyzed.The HHC rates of ICU HCWs, nosocomial infection rate, the detection rate of multi-drug resistant bacteria and the consumption of alcohol-based hand rub were compared before and after the intervention.Results Compared with before intervention, total HCC rate increased significantly after intervention （69.52%vs 38.27%,P〈0.05）, and the HHC rates of HCWs in different positions were all significantly higher than before intervention （P 〈0.05）.The HHC rates have been rising month by month and remained at high levels since intervention.The nosocomial infection rate （ 7.81% vs 35.56%, P 〈0.05 ） and the detection rate of multi-drug resistant bacteria （20.0% vs 40.63%） decreased, and the consumption of alcohol-based hand rub increased significantly [ 189.33 vs 36.69% ml/（ bed＆#183; day） ] .Conclusion The hand hygiene intelligent alert and management system not only realizes the intelligent reminds and effective management of HCWs’ hand hygiene behaviors, but also improves the hospital infection indicators.

关 键 词：手卫生 依从率 智能提醒系统 医院感染 

分 类 号：R197.324[医药卫生—卫生事业管理]