某醫學中心2004-2007年全院醫療區手部衛生運動的推行方法及成果評估

Promotion and Achievement of a Hospital-wide Hand Hygiene Program Implemented during 2004-2007 at a Teaching Hospital in Taiwan

林慧姬(Hui-Chi Lin) ； 田貴蓮(Kuei-Lien Tien) ； 孫春轉(Chun-Chuan Sun) ； 王秀華(Shiou-Hwa Wang) ； 張上淳(Yee-Chun Chen) ； 陳宜君(Shan-Chwen Chang)

《感染控制雜誌》 20卷3期 (2010/06) Pp. 146-162

https://doi.org/10.6526/ICJ.201006_20(3).0002

摘要

Infection control is a vital issue for both patient safety and occupational health. The most feasible and fundamental component of infection control measures is hand hygiene. However, behavioral change in the target population remains a formidable obstacle, and the average Level of compliance is low. After the outbreak of the severe acute respiratory syndrome (SARS) epidemic in 2003, we reviewed the strengths and weaknesses of infection control strategies for combating this disease, which had a very high morbidity and mortality in Taiwan. Our review highlighted the importance of hand hygiene. We also conducted an unannounced inspection of the hospital floors in December 2003. The results of tests revealed that compliance was only 16.6%. Hence, a hospital-wide hand hygiene program was implemented. With the strong support of the hospital administrators, we designed a multidisciplinary approach revolving 4 components (cognition, equipment, and behavior) based on the literature review, pilot study, and the concept of the total quality management. This program included promotion of the use of alcohol-based handrubs at the points of patient care; education through lectures, online selflearning materials, and resources for self-assessment; posters and reminders at various points of care; active participation for education and monitoring at unit levels; overt observation and verbal reminders by infection control nurses; periodic audit and performance feedback; and competitions and incentives at department, unit, and individual levels. The program was reviewed, revised, and promoted annually in accordance with the plan-do-check-action cycle. The overall compliance of hand hygiene increased gradually from 43.3% in 2004 to 95.6% in 2007, which was highly correlated with the reduction of the nosocomial infection rate (r=0.9l, p=0.0128). In 2007, the departments with quality-improvement plans showed higher compliance rate of hand hygiene (96.5 ± 6.2 vs. 86.5 ± 5.9, p=0.0075) and overall competition score (85.7 ± 3.2 vs. 75.9 ± 2.4, p＜0.0001) than those without. Active participation of the medical staff and strong support of administrators at the department/unit level were associated with better and sustained effect for overall achievement of infection control.

關鍵字

手部衛生 ； 多元策略 ； 行爲改變 ； 全面品質管理

並列摘要

Infection control is a vital issue for both patient safety and occupational health. The most feasible and fundamental component of infection control measures is hand hygiene. However, behavioral change in the target population remains a formidable obstacle, and the average Level of compliance is low. After the outbreak of the severe acute respiratory syndrome (SARS) epidemic in 2003, we reviewed the strengths and weaknesses of infection control strategies for combating this disease, which had a very high morbidity and mortality in Taiwan. Our review highlighted the importance of hand hygiene. We also conducted an unannounced inspection of the hospital floors in December 2003. The results of tests revealed that compliance was only 16.6%. Hence, a hospital-wide hand hygiene program was implemented. With the strong support of the hospital administrators, we designed a multidisciplinary approach revolving 4 components (cognition, equipment, and behavior) based on the literature review, pilot study, and the concept of the total quality management. This program included promotion of the use of alcohol-based handrubs at the points of patient care; education through lectures, online selflearning materials, and resources for self-assessment; posters and reminders at various points of care; active participation for education and monitoring at unit levels; overt observation and verbal reminders by infection control nurses; periodic audit and performance feedback; and competitions and incentives at department, unit, and individual levels. The program was reviewed, revised, and promoted annually in accordance with the plan-do-check-action cycle. The overall compliance of hand hygiene increased gradually from 43.3% in 2004 to 95.6% in 2007, which was highly correlated with the reduction of the nosocomial infection rate (r=0.9l, p=0.0128). In 2007, the departments with quality-improvement plans showed higher compliance rate of hand hygiene (96.5 ± 6.2 vs. 86.5 ± 5.9, p=0.0075) and overall competition score (85.7 ± 3.2 vs. 75.9 ± 2.4, p＜0.0001) than those without. Active participation of the medical staff and strong support of administrators at the department/unit level were associated with better and sustained effect for overall achievement of infection control.

並列關鍵字

Hand hygiene ； multidisciplinary approach ； infection control ； total quality management