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Lack of Good Research into Hand Hygiene

霍桑效应对重症监护病房手卫生依从性的影响研究

目的 探索霍桑效应对重症监护病房（Intensive Care Unit，ICU）医护人员手卫生依从性的影响。 方法 2014 年 10 月—12 月科室根据世界卫生组织手卫生调查方法，采用现场直接观察法和隐蔽式观察法，分别对 ICU 122 名护士、12 名医生、4 名保洁、14 名工人的手卫生情况进行明访和暗访，并将明访和暗访监测到的手卫生时机的洗手执行情况进行对比分析；2015 年 1 月研究者对中国知网数据库中所报道的手卫生依从性调查的文章进行了文献回顾，检索关键词为“手卫生”“依从性”，对搜索获取到的文献进行分析。 结果 ICU 医护人员手卫生依从性明访、暗访结果分别为 70.05%（1 275/1 820）和 57.28%（1 023/1 786），差异有统计学意义（P<0.001）。对中国知网数据库中检索到的 62 篇核心期刊的研究方法采用明访的居多，其中明访 36 篇，暗访 24 篇，明暗访相结合的 2 篇；仅有 3 篇提及霍桑效应，其中 2 篇采取了避免霍桑效应的措施；手卫生依从性<50% 的文献占总文献的 25.8%，依从性在 50%～80% 的文献占总文献的 46.8%，依从性在 80%～90% 的文献占总文献的 12.9%，依从性>90% 的文献占总文献的 14.5%。 结论 ICU 医护人员手卫生依从性可能受霍桑效应影响，因此在进行手卫生依从性的调查时要避免霍桑效应，以取得真实的调查结果。

Practice of Quality Control Circle in Improving Hand Hygiene Compliance in Medical Staff

ObjectiveTo improve the hand hygiene compliance in medical staff via quality control circle (QCC) activities. MethodsFrom January to May 2014, QCC activities were actualized throgh selecting the theme, ensuring the plans, confirming the target, investigating the actuality, validating the true reasons, finding out the countermeasure, ensuring the effect. ResultsHand hygiene compliance, accuracy rate handwashing, and awareness rate before the QCC activities was 53.02%, 65.51% , and 45.56%, respectively; while after the activities was 79.91%, 87.39%, 95.44%, respectively; the differences were significant (P<0.001). ConclusionQCC activities may improve hand hygiene compliance in the medical staff; at the same time, it can fully mobilize the enthusiasm of the medical staff , cultivate the spirit of teamwork , and promote quality improvement .

Effects of plan-do-check-action cycle in improving hand hygiene compliance of medical staff

Objective To know the present situation of hand hygiene compliance in medical staff and analyze problems in the management of hand hygiene and related influencing factors, in order to take effective control measures and gradually improve hand hygiene compliance in medical staff. Methods Between January and October 2014 and between January and October 2015, 8-10 healthcare workers respectively from Department of Internal Medicine, Department of Surgery and Department of Rehabilitation were selected to be observed. The healthcare workers between January and October 2014 before the application of plan-do-check-action (PDCA) cycle were regarded as the control group, and hand hygiene observation was performed in October 2014; the healthcare workers between January and October 2015 were regarded as the observation group (after PDCA application), and hand hygiene observation was carried out in October 2015. Under the PDCA cycle, we set up hand hygiene management working group to investigate the hand hygiene work before PDCA cycle was applied. Hand hygiene knowledge survey was carried out. Fishbone diagram was used to find out the causes of poor hand hygiene compliance. Based on these factors, improvement plans of hand hygiene were regulated and implemented. Then, continuous improvement was promoted according to PDCA cycle management process. Results After PDCA implementation, healthcare workers’ hand hygiene compliance (79.67%), correct handwashing rate (94.97%), and hand hygiene compliance before contacting the patients (85.96%), before sterile operation (68.14%), after contacting the patients (78.02%), after contacting patients’ blood or body fluid (85.96%), and after contacting patients’ surroundings (79.14%) were all significantly higher than those before the PDCA implementation (46.39%, 69.62%, 38.42%, 23.20%, 49.14%, 53.78% and 48.39%) (P<0.05). After the implementation of PDCA cycle, the amount of disinfectants consumed per day and the amount of hand sanitizer was 10.13 mL, significantly more than that before PDCA implementation (2.8 mL). The hospital was equipped with full hygiene equipment. Conclusion Applying PDCA cycle for continuous improvement of hand hygiene work can promote the hand hygiene compliance for medical staff.

Effect of different interventions on the control of multidrug-resistant organisms in primary general hospitals

Objective To know the status quo of multidrug-resistant organism (MDRO) infection in primary general hospitals, analyze the differences among various intervention measures, and put forward guiding principles for MDRO infection control in primary general hospitals. Methods We investigated all patients (n=51 612) admitted into the hospital between January 2013 and December 2015, and found out 6 types of MDRO. Pre-interventional investigation was carried out between January 2013 and June 2014 (before intervention) during which no intervention measures were taken; Intervention was carried out between July 2014 and December 2015 (after intervention). All departments in the hospital (6 groups) were matched with intervention measures (6 groups) randomly. Then, we compared the MDRO detection rate, nosocomial infection case rate and intervention compliance rate among the groups. Results We detected altogether 611 MDRO cases (without duplication) out of the 51 612 cases. The total detection rate of MDRO was 1.18%. The detection rate of MDRO before and after intervention was 1.37% and 1.01%, respectively. The difference between the two was of statistical significance (P<0.05). After the intervention, the detection rate in groups 1, 5 and 6 was significantly lower than before (P<0.05); the differences in detection rate among groups 2, 3, and 4 were not significant (P> 0.05). Nosocomial infection rate decreased from 0.28% before intervention to 0.14% after intervention (P<0.05). After the intervention, MDRO nosocomial infection case rate of groups 1, 5 and 6 was significantly lower than before (P<0.05); the rate was lower in groups 3 and 4 than before without any significance (P>0.05); no MDRO cases were detected in group 2 and comparison was meaningless. The knowledge rates of medical workers and of nursing staff increased from 52.97% and 20.00% before intervention to 78.76% and 66.34% after intervention, respectively (χ2=30.670, 38.604;P<0.05). The compliance to all kinds of protection measures improved significantly (P<0.05) except compliances to equipment of hand antiseptic agent and patient transfer order (P> 0.05). Conclusion Promoting the compliance rate to hand hygiene and environmental cleaning and disinfection, primary general hospitals can decrease the detection rate and nosocomial infection case rate of MDRO.

Analysis on influencing factors and improving measures of hand hygiene implementation among healthcare workers based on the Grounded Theory

Objective To explore the influencing factors and improving measures of hand hygiene among healthcare workers. Methods From June to August 2016, several healthcare workers from clinical departments and nosocomial infection control department in Chengdu were selected by purposive sampling method. Data was collected by individual in-depth interviews, and was three-rank coded by Nvivo 8 software based on Grounded Theory. Results After three-rank coding, 6 important influencing factors were generalized which were re-categorized into 3 levels: personal cognition, behavior capacity and social support. At the last, the whole framework of the theory was constructed through core coding. Conclusion In clinical practice, we should take reasonable measures to strengthen the training of hand hygiene, improve the hand hygiene facilities, strengthen supervision and management, and effectively improve the implementation rate of hand hygiene.

肿瘤医院护理人员手卫生认知及执行状况调查

目的了解肿瘤医院护理人员手卫生认知及执行状况，为控制医院感染、制订预防措施提供有效依据。 方法2011年5月-7月，采用横断面调查法，对肿瘤医院的23个科室中528名护理人员进行问卷调查，调查护理人员手卫生认知及执行情况。 结果绝大多数护理人员对手卫生指征具有正确的认识，问卷的正确回答率（正答率）较高。护理人员手卫生知识认知情况正答率不足90%的项目有8项。47.85%的护理人员日消毒或洗手次数为10～20次。“工作太忙”为手卫生执行效果不佳的主要原因。 结论肿瘤医院护理工作人员手卫生知识认知和手卫生执行率还有待加强。

Analysis of intervention measures and effects on hand hygiene compliance of nursing staff

ObjectiveTo investigate the problems in the use of quick-drying hand disinfectants and formulate intervention measures to improve the hand hygiene compliance of nursing staff.MethodsFrom February 2014 to June 2016, the hand hygiene compliance of nursing staff was continuously observed according to the hand hygiene observation table recommended by the World Health Organization. The questionnaire on the use of quick-drying hand disinfectants, which passed the reliability and validity test, was used to find out the reasons leading to the low compliance rate of hand hygiene among nurses, and pertinent interventions were formulated. From November 2016 to December 2017, intervention measures were gradually implemented throughout the hospital, and the hand hygiene compliance of nursing staff was continuously observed again. Then we compared the compliance rate of hand hygiene and the compliance rate of hygienic hand disinfection among nurses in the second quarter of 2016 (before intervention) with those in the last quarter of 2017 (after intervention).ResultsThe compliance rates of hand hygiene and hygienic hand disinfection among nurses before intervention were 62.15% and 49.77%, respectively, and those after intervention were 91.64% and 90.80%, respectively. The differences were statistically significant (P<0.05).ConclusionThe factors affecting the hand hygiene compliance of nursing staff are identified through questionnaires and targeted intervention measures have effectively improved the hand hygiene compliance rate of nursing staff.

干预措施对医务人员手卫生依从性的影响研究

【摘要】 目的 探讨能有效提高全科病房医务人员手卫生依从性的干预措施。 方法 2009年5月-6月，采用现场隐蔽观察法记录全科病房医务人员手卫生情况，分析其影响因素。并采取针对性干预措施，比较干预措施前后手卫生依从性变化，研究干预措施的效果。 结果 干预前医务人员手卫生总执行率为44.73%，干预后医务人员手卫生总执行率为78.25%，干预措施后洗手卫生总执行率显著高于未干预前的手卫生总执行率。 结论 采取积极的全方位的干预措施，可显著提高全科病房医务人员的手卫生依从性。

Application of Quality Control Circle in the Management of Hand Hygiene for Nurses in Hemodialysis Center

ObjectiveTo investigate the application and effect of quality control circle (QCC) in the management of hand hygiene for nurses in hemodialysis center. MethodsQCC was applied in the management of hand hygiene in hemodialysis center from March 2013 to February 2014. Factors affecting the compliance and correctness of hand hygiene in hemodialysis nurses were analyzed, and counter measurements were established and applied. Moreover, effect of QCC management was also assessed. ResultsAfter the application of QCC, the compliance and correctness of hand hygiene in hemodialysis nurses increased significantly from 41.02% to 88.46% (P<0.05) and 46.88% to 91.30% (P<0.05), respectively. Moreover, maneuver application, team spirit, professional knowledge, communication and cooperation among nurses were also increased by QCC management. ConclusionThe application of QCC can not only increase the compliance and correctness of hand hygiene in hemodialysis nurses but also improve team cohesiveness, which is worth recommendation and promotion.