提升加護病房護理人員於照護過程之手部衛生遵從率

落實手部衛生是加護病房最有效的感管措施，也是照護品質的重要指標。本單位由於院內感染件數增加，初步查核發現護理人員在照護連續過程中，常於多項活動完成後才洗手，手部衛生遵從率低，故引發動機，期望藉由專案介入加以改善。經現況分析發現加護病房護理人員手部衛生遵從率低的主要導因：手部衛生認知不足、不熟悉洗手時機操作、缺乏提醒標示、頻繁洗手導致手部傷害。專案成員結合單位特性與文獻，腦力激盪，設計情境模擬影片及one by one實作演練，同時增設提醒標示與護手產品，促成工作流程中的行為改變，有效將手部衛生遵從率由43.1%提升92%，手部衛生認知正確率由54.5%提升92.8%，達專案目標，期望此專案經驗作為相關照護單位之參考。

關鍵字

手部衛生；加護病房；照護過程

並列摘要

Implementing hand hygiene is the most effective infection control intervention in intensive care units. It is also an important indicator of quality care. Because of an increased number of infection cases, we initiated a clinical checkup and found hand hygiene compliance of our unit was low. In the continuum of the critical care process, nursing staff often wash hands after a series of care activities. We were motivated to do the project to enhance hand hygiene compliance of the clinical care process among ICU nurses. The situation analysis found that the main causes for low hand hygiene compliance were: incorrect knowledge of hand hygiene, unfamiliarity with indications of hand hygiene in critical care practice, lack of reminders, and skin irritation resulting from frequent hand-washing. The team members combined unit characteristics, literature reviews, and brainstorming to design multiple training courses. Video simulation of clinical scenarios and one-on-one group practice successfully made changes in hand hygiene behavior. Concurrently, we added reminders on bedside devices and hand creams. The compliance of hand hygiene in patient care activities improved from 43.1% to 92%, while the accuracy of recognition on hand hygiene increased from 54.5% to 92.8%. Consequently the goal of this project was reached and it is expected that the result can serve as a reference for the relevant care units.

並列關鍵字

hand hygiene ； intensive care unit ； care process

參考文獻

王綾憶、李文生、林春梅、許巧蕙、謝麗質、歐聰億（2015）．神秘客在推廣手部衛生扮演之角色．感染控制雜誌，25(3)，105-114。https://doi.org/10.6526/ICJ.2015.301

Alshehari, A. A., Park, S., & Rashid, H. (2018). Strategies to improve hand hygiene compliance among healthcare workers in adult intensive care units: A mini systematic review. The Journal of Hospital Infection, 100(2), 152-158. https://doi.org/10.1016/j.jhin.2018.03.013

Derde, L. P. G., Cooper, B. S., Goossens, H., Malhotra-Kumar, S., Willems, R. J. L., Gniadkowski, M., Hryniewicz, W., Empel, J., Dautzenberg, M. J. D., Annane, D., Aragão, I., Chalfine, A., Dumpis, U., Esteves, F., Giamarellou, H., Muzlovic, I., Nardi, G., Petrikkos, G. L., & Bonten, M. J. M. (2014). Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: An interrupted time series study and cluster randomised trial. The Lancet Infectious Diseases, 14(1), 31-39. https://doi.org/10.1016/S1473-3099(13)70295-0

Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database Systematic Reviews, 9, Cd005186. https://doi.org/10.1002/14651858.CD005186.pub4

Iordanou, S., Middleton, N., Papathanassoglou, E., & Raftopoulos, V. (2017). Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infectious Diseases, 17(1), 607. https://doi.org/10.1186/s12879-017-2704-2

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提升加護病房護理人員於照護過程之手部衛生遵從率

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