"First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool
"First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool
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DOI：
10.1186/s13756-017-0267-z
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发表时间：
2017-10-30
影响因子：
5.5
通讯作者：
Sax, Hugo
中科院分区：
文献类型：
--
作者：
Clack, Lauren;Scotoni, Manuela;Sax, Hugo
背景：医护人员的手是医疗保健中病原体传播的最重要途径，但迄今为止详细的手轨迹研究还不够。我们开发并应用了一种新方法来系统地记录手接触表面接触 (HSE)，以描绘现实生活中医疗保健环境中真实的手部传播途径。方法：使用头戴式摄像头和商业编码软件捕获 8 名护士和 2 名医生的 10 次主动护理事件，并使用分层编码方案对 HSE 类型和持续时间进行编码。我们根据世界卫生组织的“手部卫生五个时刻”确定了与患者感染风险特别相关的 HSE 序列。该研究在瑞士一所拥有 900 个床位的大学医院的创伤重症监护室进行。结果：总体而言，这 10 个视频总长 296.5 分钟，有 8 名护士和 2 名医生。总共识别出 4222 个 HSE（每 4.2 秒 1 个 HSE），其中涉及裸手（79%）和戴手套（21%）的手。患者区域内的 HSE（n = 1775；42%）包括移动物体（33%）、不动表面（5%）和患者完整皮肤（4%），而患者区域外的 HSE（n = 1953；46%）包括医护人员自己的身体（10%）、移动物体（28%）和不动表面（8%）。另外 494 起 (12%) 事件涉及患者关键部位。序贯分析揭示了 291 个 HSE 从患者区域外部到内部的转变，即“定植事件”，以及 217 个从任何表面到关键部位的转变，即“感染事件”。手部卫生发生了 97 次，其中 14 次（5% 依从性）发生在定植事件中，3 次（1% 依从性）发生在感染事件中。平均而言，搓手持续 13 +/- 9 秒。结论：HSE 的丰富性强调了手在潜在病原体传播中的核心作用，而在潜在定植和感染事件中很少进行手卫生。我们的方法产生了有效的视频和编码工具，用于在主动患者护理期间深入分析手部轨迹，这可能有助于设计更有效的预防方案。
Background: Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings.Methods: A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland.Results: Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone (n = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone (n = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 +/- 9 s.Conclusions: The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.