运用行为生态学模式管理手卫生的效果评价  

Evaluation the effect of the application of behavioural ecology model to hand hygiene management

作　　者：郭丽萍[1,2] 蒋艳 刘聪[1] 魏栋[1] 王卫华[1] 赵学军[1] 王颖[1] 张璟[1] 郎琳娜[1] 赵霞[1] 王春雷[3] 郑爱辉[1] 刘颖梅[3] 徐潜[1] 曹彬[1,3,4,5] GUO Li-ping;JIANG Yan;LIU Cong;WEI Dong;Wang Wei-hua;ZHAO Xue-jun;Wang Ying;ZHANG Jing;LANG Lin-na;Zhao Xia;WANG Chun-lei;ZHENG Ai-hui;LIU Ying-mei;XU Qian;CAO Bin(China Japan Friendship Hospital, Beijing.100029, Chin)

机构地区：[1]中日友好医院医院感染管理办公室,北京100029 [2]北京中医药大学管理学院,北京100029 [3]中日友好医院医院临床微生物与感染实验室,北京100029 [4]中日友好医院医院呼吸中心,北京100029 [5]首都医科大学呼吸病学部,北京100069

出　　处：《中华医院感染学杂志》2018年第6期957-960,共4页Chinese Journal of Nosocomiology

基　　金：中华医院感染控制研究基金资助项目(ZHYY2015-0003)

摘　　要：目的运用行为生态学模式管理手卫生。方法自2016年1月-6月,在某三级综合医院持续采取针对手卫生的多方面干预措施,此前、后各三个月分别为干预前期(2015年10月-2015年12月)和干预后期(2016年7月-2016年9月),本研究应用WHO推荐的"医疗机构手卫生自我评价系统",用于测量手卫生的系统性管理水平,通过记录比较干预前期、干预期和干预后期的数据,并参考其提示的系统性管理缺陷的线索,改善手卫生管理工作;分析手卫生的依从性、医院感染率及多药耐药菌检出率等医院感染管理指标的变化规律。结果 "医疗机构手卫生自我评价系统"平均值为379.5分,其中干预前期为367.5分,属于"尚可";干预期和干预后期的得分均属于"优秀";10名观察人员在2015年10月-2016年9月随机观察706名医务人员的手卫生执行情况,依从率为99.1%;手卫生依从率与医院感染率及6种多药耐药菌检出率间无相关性;按照回归方程中决定系数(coefficient of determination)的大小排序,手卫生依从率决定医院感染率的系数最大(0.55),决定耐碳青霉烯类铜绿假单胞菌(CRPA)检出率的系数为0.35、耐碳青霉烯类抗菌药物的肠杆菌科细菌(CRE)为0.29、其余均<0.1。结论教育和培训及多学科合作是改善手卫生管理的重要组成部分,但是陈旧的手卫生设施等客观因素阻碍了手卫生的管理效果。OBJECTIVE To study the application of behavioral ecology model in the management of hand hygiene.METHODS In a tertiary general hospital,we intervened in the hand hygiene management about multifaceted aspects during first six months in 2016.To compare the effect of hand hygiene management between pre-intervention,intervention and post-intervention,we first introduced the index of WHO recommended ＂ Hand Hygiene Self-Assessment Framework＂,according to records of the values from the index,corrected system defects;in the meanwhile,we analyzed the hand hygiene compliance,correctness of hand washing,hospital infection incidence（HAI）,and multi-drug-resistant-organism isolation rate.RESULTS The average system value is 379.5,the pre-intervention score was 367.5,which belonged to the ＂fair＂ level,scores of the intervention and post intervention were ＂outstanding＂ level.Ten medical staff have observed the implementation of hand hygiene of the 706 medical staff from October 2015 to September 2016.The total compliance rate of hand hygiene was 99.02%.The correctness of hand washing was 98.7%.The compliance rate between hospital infection rate and six kinds of multi-drugresistant-organism isolation rate had no correlation;in the regression equation,the coefficient of determination about HAI was 0.55,about the detection rate of CRPA（0.35）,and CRE（0.29）,any of the rest rate was less than 0.1.CONCLUSION Education,training and multi-disciplinary corporation were important factors to improve the compliance of hand hygiene,but the old hand hygiene facilities and other factors hinder the management of hand hygiene.

关 键 词：行为生态学 医疗机构手卫生自我评价系统 手卫生依从性 医院感染 多药耐药菌 

分 类 号：R16[医药卫生—公共卫生与预防医学]