CAJ | 학술논문

目的：探索大型医院提高医务人员手卫生依从性和正确性的策略和措施。方法2012年7月开始某院医院感染管理科运用世界卫生组织（WHO）“多模式手卫生促进策略”，从系统改变、教育培训、评价和反馈、提醒、建立手卫生文化5个方面采取措施；由经过统一培训的医院感染管理专职人员深入临床进行手卫生依从性和正确性观察，将2012年1—6月（干预前）和2014年1—6月（干预后）的手卫生依从率和正确率进行比较，观察和评价干预措施效果。结果干预后，手卫生依从率和正确率分别为75．92％（8369／11023）、94．11％（7782／8269），均高于干预前[分别为53．67％（5127／9553）、83．88％（3642／4342）]，差异均具有统计学意义（均 P ＜0．001）。不同岗位中，医生和护士干预前后手卫生依从率比较，差异均具有统计学意义（均 P ＜0．001）；工人和其他人员干预前后手卫生依从率比较，差异均无统计学意义（均 P ＞0．05）。除“接触体液后”，其余4个手卫生指征干预前后依从率比较，差异均具有统计学意义（均 P ＜0．001）。结论通过运用“多模式手卫生促进策略”，采取系统改变、教育培训、评价和反馈、提醒，以及建立手卫生文化的综合措施能有效提高医务人员手卫生依从性和正确性。
목적：탐색대형의원제고의무인원수위생의종성화정학성적책략화조시。방법2012년7월개시모원의원감염관이과운용세계위생조직（WHO）“다모식수위생촉진책략”，종계통개변、교육배훈、평개화반궤、제성、건립수위생문화5개방면채취조시；유경과통일배훈적의원감염관리전직인원심입림상진행수위생의종성화정학성관찰，장2012년1—6월（간예전）화2014년1—6월（간예후）적수위생의종솔화정학솔진행비교，관찰화평개간예조시효과。결과간예후，수위생의종솔화정학솔분별위75．92％（8369／11023）、94．11％（7782／8269），균고우간예전[분별위53．67％（5127／9553）、83．88％（3642／4342）]，차이균구유통계학의의（균 P ＜0．001）。불동강위중，의생화호사간예전후수위생의종솔비교，차이균구유통계학의의（균 P ＜0．001）；공인화기타인원간예전후수위생의종솔비교，차이균무통계학의의（균 P ＞0．05）。제“접촉체액후”，기여4개수위생지정간예전후의종솔비교，차이균구유통계학의의（균 P ＜0．001）。결론통과운용“다모식수위생촉진책략”，채취계통개변、교육배훈、평개화반궤、제성，이급건립수위생문화적종합조시능유효제고의무인원수위생의종성화정학성。
Objective To explore strategies and measures to improve hand hygiene (HH)compliance and correctness of health care workers (HCWs)in a large hospital.Methods The WHO multimodal hand hygiene improvement strategy was adopted by healthcare-associated infection(HAI)management department of a hospital,measures consisted of five key com-ponents,including:system change,education and training,evaluation and feedback,reminders in the workplace,and insti-tutional safety climate.HH compliance and correctness of HCWs were observed by infection control practitioners,HH compliance and correctness in January-June of 2012 (pre-intervention)and January-June of 2014 (post-intervention)were compared,effectiveness of intervention strategies were evaluated.Results HH compliance rate and correctness rate of post-intervention were both higher than pre-intervention (75.92% [8 369/11 023]vs 53.67% [5 127/9 553],P <0.001;94.11%[7 782/8 269]vs 83.88%[3 642/4 342],P <0.001).Of different occupations,HH compliance rates of doctors and nurses were significantly different before and after intervention (both P <0.001),while workers and staff of other oc-cupations before and after intervention were not significantly different(both P >0.05).Except ‘after body fluid exposure’, HH compliance rates of the other four indications for HH before and after intervention were significantly different(all P <0.001).Conclusion HH compliance and correctness of HCWs can be improved after adopting WHO multimodal hand hy-giene improvement strategy.