应用PDCA循环法提高手卫生依从性对医院感染的影响

Application of PDCA cycle in improving the effect of hand hygiene compliance on healthcare-associated infection

摘要:

目的 探讨应用PDCA循环法提高医务人员手卫生依从性的效果，以及对患者医院感染发病率的影响。 方法 2014年12月采用自制手卫生调查表对某三级医院医务人员开展问卷调查，根据调查结果及日常督导问题制定集束化干预措施，并于2015年1月起持续采取PDCA（计划-实施-检查-处理）循环管理模式落实措施，2015年1月—2020年12月为干预后阶段，比较2014年1—12月与干预后阶段手卫生相关指标及医院感染发病率。 结果 2014年12月共发放问卷2 513份，有效回收1 806份，其中调查医生507名，占28.07%，护士1 185名，占65.61%。PDCA循环持续改进后，2020年手卫生设施完善率、依从率、正确率、知晓率分别为99.36%、86.87%、86.55%、96.24%，高于2014年的41.19%、49.90%、13.46%、62.65%，差异均有统计学意义（均P < 0.001）。2014—2020年手卫生依从率（β=6.248，P < 0.001）、快速手消毒剂+洗手液（β=1.182，P=0.013）和擦手纸（β=0.508，P < 0.001）床日消耗量呈逐年上升趋势，医院感染例次发病率（β=-0.326，P < 0.001）则逐年下降；手卫生依从率、快速手消毒剂+洗手液、擦手纸床日消耗量分别与医院感染例次发病率呈负相关（r值分别为-0.977、-0.793、-0.951），差异均有统计学意义（均P < 0.05）。 结论 应用持续PDCA循环法落实集束化干预措施，可有效提高手卫生依从性，从而减少医院感染的发生。

Abstract:

Objective To explore the effect of application of plan-do-check-action (PDCA) cycle on improving health care workers' (HCWs) compliance to hand hygiene(HH) as well as the influence on incidence of healthcare-associated infection(HAI) in patients. Methods HH questionnaire was designed and used to survey HCWs in a tertiary hospital in December 2014, bundle intervention measures were formulated according to the survey results and routine supervision problems, measures were implemented by PDCA cycle management mode from January 2015. January 2015 to December 2020 was as a post-intervention period, HH-related indicators and incidence of HAI between January-December 2014 and post-intervention period were compared. Results In December 2014, 2 513 questionnaires were distributed and 1 806 were effectively recovered, 507 doctors (28.07%) and 1 185 nurses (65.61%) were surveyed. After the continuous improvement with PDCA cycle, facility completeness rate, compliance rate, correct rate and awareness rate of HH in 2020 were 99.36%, 86.87%, 86.55% and 96.24% respectively, which were higher than 41.19%, 49.90%, 13.46% and 62.65% respectively in 2014, difference were all significant (all P < 0.001). From 2014 to 2020, HH compliance rate (β=6.248, P < 0.001), bed-day consumption of alcohol-based hand rub + hand sanitizer (β=1.182, P=0.013) and paper towel(β=0.508, P < 0.001) increased year by year, case incidence of HAI (β=-0.326, P < 0.001) decreased year by year, HH compliance rate, bed-day consumption of salcohol-based hand rub + hand sanitizer and paper towel were negatively correlated with incidence of HAI (r=-0.977, -0.793, -0.951), difference were all significant (P < 0.05). Conclusion Application of continuous PDCA cycle to implement bundle intervention measures can effectively improve the compliance of HH and reduce the incidence of HAI.