北京市8所综合性医院手卫生隐蔽式调查分析

Concealed investigation on hand hygiene in 8 general hospitals in Beijing

摘要:

目的尝试在直接观察法的基础上设计隐蔽式调查方案控制偏倚，以真实地评估医院医务人员手卫生依从性。方法2016年6月对北京市8所综合性医院医务人员手卫生依从性进行隐蔽式调查，获取手卫生依从性及正确性的数据，对数据进行统计、直接标化，并与2015年通过直接观察法所获得的手卫生监测数据进行比较。结果2016年医院医务人员手卫生依从率为58.04%，正确率为88.68%。经直接标化后，ICU手卫生依从率最高（81.29%），急诊科手卫生正确率最高（93.29%），神经内科手卫生依从率及正确率均最低（42.97%和82.35%）；护士手卫生依从率及正确率均最高（69.02%和92.84%），保洁员手卫生依从率及正确率均最低（37.25%和71.59%）；接触患者后手卫生依从率最高（71.79%）、正确率最低（88.76%），清洁/无菌操作前手卫生依从率最低（43.08%）、正确率最高（93.50%）。隐蔽式调查法所获得医务人员手卫生依从率均低于直接观察法（均P＜0.05），正确率的差异程度不同。结论手卫生依从性在科室、人员、指征的分布中存在差异，需加强对手卫生重点环节的干预。采用普通直接观察法对手卫生依从性的调查结果存在一定的偏倚，手卫生调查方法有待完善。

Abstract:

ObjectiveTo design a concealed investigation scheme to control bias based on direct observation method, evaluate actual hand hygiene(HH) compliance among health care workers(HCWs).MethodsHH compliance among HCWs in 8 general hospitals in Beijing was performed concealed investigation in June 2016, data of HH compliance and correctness were obtained and conducted statistical analysis as well as direct standardization, then compared with HH surveillance data obtained by direct observation method in 2015.ResultsIn 2016, HCWs’ HH compliance rate and correct rate were 58.04% and 88.68% respectively. After direct standardization, ICU had the highest HH compliance rate (81.29%), emergency department had the highest HH correct rate (93.29%), neurology department had the lowest compliance rate and correct rate of HH (42.97% and 82.35% respectively); nurses had the highest compliance rate and correct rate of HH (69.02% and 92.84% respectively), cleaners had the lowest compliance rate and correct rate of HH (37.25% and 71.59% respectively); compliance rate of HH after contacting patients was the highest (71.79%) but correct rate was the lowest (88.76%), compliance rate of HH before cleaning/aseptic procedure was the lowest (43.08%) but the correct rate was the highest (93.50%). HH compliance rate of HCWs investigated by concealed method was lower than that by direct observation(P<0.05), and the extent of discrepancy in correctness was different.ConclusionHH compliance is different in the distribution of departments, personnel, and indication, it is necessary to strengthen intervention in key aspects of HH. There is a certain bias in results of direct observation on HH compliance, HH investigation methods need to be improved.