Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study
Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study
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DOI：
10.1186/s12879-016-1535-x
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发表时间：
2016-05-16
影响因子：
3.7
通讯作者：
Longtin, Yves
中科院分区：
文献类型：
--
作者：
Deyneko, Alexander;Cordeiro, Fernanda;Longtin, Yves
背景：人们对水槽位置对接触艰难梭菌感染 (CDI) 患者后洗手依从性的影响知之甚少。本研究的目的是确定护理 CDI 患者后医护人员 (HCW) 可以使用洗手池的位置，并评估对洗手依从性的影响。方法：我们在加拿大一家拥有 637 个床位的三级护理医院进行了一项横断面研究。通过直接、不引人注目的观察来测量医护人员与 CDI 患者接触后的手部卫生依从性。在诊断当天评估水槽与患者房间的位置。通过单变量和多变量逻辑回归评估依从性的预测因素。结果：观察到 CDI 患者护理后的 247 次手部卫生机会。手套使用依从性为 85.4% (211/247)，但 CDI 患者护理后洗手依从性仅为 14.2% (35/247)。 33.2% 的机会采用搓手代替洗手 (82/247)。 CDI 患者的患者区与最近水槽之间的中位距离为 13.1 m（四分位距，7.6-23.2）。只有 33.2 % (82/247) 的情况在离开患者房间时可以直接看到水槽。通过多变量分析，患者区域与最近水槽之间距离的增加与洗手依从性呈负相关（调整后 OR，0.90，95% CI，0.84-0.97；P = 0.008），而离开患者区域后正确脱掉手套的时间与洗手依从性直接相关（调整后 OR，14.87；95% CI，1.93-114.43；P = 0.01）。结论：与艰难梭菌感染患者接触后洗手依从性较低。难以接近水槽与洗手依从性降低有关。迫切需要改进策略。
Background: The impact of sink location on hand washing compliance after contact with patients with Clostridium difficile infection (CDI) is poorly understood. The aim of this study is to determine the location of hand wash sinks available to healthcare workers (HCWs) after caring for patients with CDI and to assess the impact on hand washing compliance.Methods: We performed a cross-sectional study in a 637-bed tertiary care hospital, Canada. HCW hand hygiene compliance after contact with CDI patients was measured through direct unobtrusive observations. Location of sinks in relation with the patients' rooms was assessed on the day of diagnosis. Predictors of compliance were assessed through univariate and multivariate logistic regression.Results: 247 hand hygiene opportunities following care of a CDI patient were observed. Glove use compliance was 85.4 % (211/247), but hand washing compliance after care of CDI patients was only 14.2 % (35/247). Hand rubbing was performed instead of hand washing in 33.2 % of opportunities (82/247). The median distance between the patient zone of CDI patients and the nearest sink was 13.1 m (interquartile range, 7.6-23.2). Sinks were directly visible upon exiting the patient's room on only 33.2 % (82/247) occasions. By multivariate analysis, an increasing distance between the patient zone and the nearest sink was inversely associated with hand washing compliance (adjusted OR, 0.90, 95 % CI, 0.84-0.97; P = 0.008), while proper timing of glove removal upon leaving the patient zone was directly associated with hand washing compliance (adjusted OR, 14.87; 95 % CI, 1.93-114.43; P = 0.01).Conclusions: Hand washing compliance following contact with patients with C. difficile infections was low. Poor access to sinks is associated with decreased hand washing compliance. Improvement strategies are urgently needed.