重症监护室医务人员手卫生状况及干手措施对洗手效果的影响

Hand hygiene status and effect of handdrying measures on handwashing of health care workers in an intensive care unit

摘要:

目的了解重症监护室（ICU）医务人员手卫生状况及干手措施对洗手效果的影响。方法选择2013年2—4月某院ICU医务人员210人次，将其随机分为ABC三组，A组采用干手纸巾法、B组采用干手器法、C组采用个人小毛巾法干手，分别对其洗手前、洗手后和干手后进行手卫生现场采样检测。结果A、B、C 3组医务人员接触患者后洗手前手部菌落数分别为(29.10±15.08) CFU/cm2、(31.42±14.76)CFU/cm2和(30.36±15.52) CFU/cm2，3组比较，差异无统计学意义（F=0.048，P＞0.05）；按六步洗手法洗手后湿手采样，医务人员手部菌落数分别为(3.26±0.61) CFU/cm2、(2.98±0.59) CFU/cm2和(3.87±0.67) CFU/cm2，与洗手前比较，差异均有统计学意义（均P＜0.01）。采用不同的干手方式干手后，3组医务人员手部菌落数比较，差异有统计学意义（F=1.892，P＜0.05）；A组菌落数［(1.29±0.58) CFU/cm2］低于B、C组，B组［(9.51±0.73) CFU/cm2］低于C 组［(22.76±4.11) CFU/cm2］；A组合格率（90.00%）高于B、C组，B组合格率（68.57%）高于C 组（47.14%）。医务人员手分离病原菌居前5位的是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和凝固酶阴性葡萄球菌，与2013年度该院ICU分离居前5位的多重耐药菌高度一致。结论ICU医务人员进行各种诊疗护理操作后，手部污染严重；若干手方法不当，会导致手二次污染；其手分离的病原菌与患者分离的多重耐药菌高度一致。及时、正确地洗手和干手是保证手卫生质量的关键环节，对降低ICU患者多重耐药菌感染具有重要意义。

关键词:

重症监护室;洗手;手卫生;多重耐药菌;医院感染

Abstract:

ObjectiveTo realize hand hygiene status and effect of handdrying measures on handwashing of health care workers(HCWs) in an intensive care unit(ICU). MethodsFrom February to April 2013, 210 HCWs in an ICU were selected and randomly divided into three groups， group A dried hands with paper towel， group B with hand drier，and group C with personal towel，specimens from hands before handwashing, after handwashing, and after handdrying were taken and performed detection.ResultsHand microorganism count in group A,B and C before washing hands after contacting patients was (29.10±15.08)CFU/cm2,(31.42±14.76)CFU/cm2 and (30.36±15.52)CFU/cm2 respectively, the difference was not statistically different（F=0.048，P＞0.05）； After sixstep handwashing, hand microorganism count before hand drying in group A,B and C was (3.26±0.61)CFU/cm2, (2.98±0.59)CFU/cm2  and (3.87±0.67)CFU/cm2 respectively,compared with hand microorganism count before handwashing,  the difference was statistically different(all P<0.01）. After adopting different  handdrying methods, microorganism count in three groups was statistically different（F=1.892，P＜0.05）, group A (［1.29±0.58］CFU/cm2 )was significantly lower than group B and C, group B (［9.51±0.73］CFU/cm2 )was significantly lower than group C(［22.76±4.11］CFU/cm2); the qualified rate in group A （90.00%）was significantly higher than group B and C, group B （68.57%）was significantly higher than group C （47.14%）.The top 5 pathogens isolated from HCWs’ hands were Pseudomonas aeruginosa， Acinetobacter baumannii， Klebsiella pneumoniae，Escherichia coli，and  Coagulase negative Staphylococcus, these strains were highly consistent with the top 5 multidrugresistant organisms (MDROs) isolated from ICU patients in this hospital in 2013. ConclusionHCWs’ hands  are seriously contaminated after all kinds of medical performance; if hands are improperly dried，secondary contamination may occur; pathogens isolated from HCWs’ hands are highly consistent with MOROs from patients,timely and correct handwashing and  handdrying is the key link to ensure the quality of hand hygiene，and  is of great significance to reduce the occurrence of MDROs infection in ICU patients.

Key words:

intensive care unit; handwashing; hand hygiene; multidrugresistant organism; healthcareassociated infection