The impact of gown-use requirement on hand hygiene compliance
The impact of gown-use requirement on hand hygiene compliance
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DOI：
10.1086/498906
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发表时间：
2006-02-01
影响因子：
11.8
通讯作者：
Snydman, DR
中科院分区：
文献类型：
--
作者：
Golan, Y;Doron, S;Snydman, DR
背景资料。手卫生依从性仍然很低，尽管它在预防感染方面有效。长袍通常被用来减少细菌在医院内的传播。使用长袍既耗时又昂贵，与单纯的手部卫生相比，它们的有效性还存在争议。在支持使用长袍要求的论点中，可能会提高感染控制的意识，导致改善手卫生依从性。手部卫生依从性记录在14个月的交叉试验中，比较了2个重症监护病房在有和没有长袍使用要求期间的遵从性。在170小时的观察中，记录了1619次手卫生机会。护理前依从性为10%，护理后依从性为36%。对手套和睡袍的依从性分别为62%和63%。护士、医生和治疗师的术后手部卫生依从性分别为40%、38%和22%。患者接触、体液接触和其他室内活动后的依从性分别为42%、48%和22%。在有和没有长袍使用要求的时期，总体的护理后遵从性(37%对34%)以及按人员和活动类型划分的比率相似。在接触预防措施的患者亚组中，在接受护理前，有穿睡袍要求的患者与没有穿睡袍要求的患者相比，手部卫生依从性分别为11%和10%(P=.85)，护理后的手卫生遵从性分别为45%和39%(P=0.09)。在这个亚组中，在调整了室内活动类型、医务人员、重症监护病房和观察者后，预计在有和没有使用长袍要求期间的术后手部卫生依从性分别为48%和41%(P=0.02)。使用长袍的要求可能会改善重症监护病房的手部卫生依从性的假设无法得到证实。在接触预防的患者亚组中，与使用长袍要求相关的手部卫生依从性的改善很小，并且不影响预托保率。
Background. Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance.Methods. Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement.Results. During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P = .85) before care was given and 45% versus 39% (P = .09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P = .02).Conclusions. The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown- use requirement was small and did not affect precare rates.