Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina
Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina
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DOI：
10.1016/j.ajic.2004.08.009
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发表时间：
2005-09-01
影响因子：
4.9
通讯作者：
Safdar, N
中科院分区：
文献类型：
--
作者：
Rosenthal, VD;Guzman, S;Safdar, N
手卫生是控制医院感染的根本措施。然而，卫生保健工作者对手部卫生的持续遵守情况很差。我们试图通过实施教育、培训和绩效反馈来提高对手部卫生的依从性。我们同时测量了医院感染。方法：对重症监护病房（icu）患者常规护理过程中手部卫生的总体依从性进行监测；阿根廷布宜诺斯艾利斯1家医院的1个外科重症监护室和1个冠状动脉重症监护室，在实施手卫生教育、培训和绩效反馈计划之前和期间。2000年9月至2002年5月，每周进行两次观察性调查。使用国家医院感染监测（NNIS）标准确定icu的医院感染，并进行前瞻性监测。结果：我们在两个icu中观察到4347个手部卫生机会。依从性逐渐改善(洗手依从性，23.1%（268/1160）至64.5% (2056/3187)（RR, 2.79; 95% CI: 2.46-3.17; P < 0.0001）。在同一时期，两个icu的总体医院感染从47.55 / 1000患者日（104/2187）降至27.93 / 1000患者日（207/7409），RR为0.59；95% ci: 0.46-0.74, p < 0.0001)。结论：一个由重点教育和频繁的表现反馈组成的项目在遵守手部卫生方面产生了持续的改善，同时降低了icu的医院感染率。
Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel.Methods: We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance.Results: We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001).Conclusion: A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.