将手卫生进行到底，Pittet博士又出大作
在最新的柳叶刀（10月）感染疾病杂志，Dr. Pittet发表文章：全球化推行多模式持续促进提高手卫生：类实验。
Lancet Infect Dis. 2013 Oct;13(10):843-51. doi: 10.1016/S1473-3099(13)70163-4. Epub 2013 Aug 23.
Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimentalstudy.Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, Memish Z, Urroz O, Richet H, Storr J, Donaldson L, Pittet D.
SourceFirst Global Patient Safety Challenge, WHO Patient Safety Programme, WHO, Geneva, Switzerland.
AbstractBACKGROUND:Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO'sstrategy for improvement of hand hygiene in five countries.METHODS:We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygieneprinciples. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010.
实验的设计是类实验（前后对照，或自身对照），时间在于2006年12月~2008年12月。在6个点，43个医院。囊括了意大利、马里、巴基斯坦、萨特阿拉伯等国家（为神马没有中国？？？！！！）。{:1_5:}{:1_4:}FINDINGS:We noted 21 884 hand-hygiene opportunities during 1423 sessions before the intervention and 23 746 opportunities during 1784 sessions after. Overall compliance increased from 51·0% before the intervention (95% CI 45·1-56·9) to 67·2% after (61·8-72·2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio 4·67, 95% CI 3·16-6·89; p<0·0001) than in high-income countries (2·19, 2·03-2·37; p<0·0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2·15, 1·99-2·32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18·7 (95% CI 17·8-19·7) to 24·7 (23·7-25·6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up.
手卫生依从性从51.0提高到67.2，（大家自问，敢问我国咋样呢？？这些似乎都是中低收入国家）在中低收入国家手卫生提高效果优于高收入国家，在所有的地方，“手卫生评分”均有显著提高。手卫生评分是个什么玩意？欢迎大家去看一个翻译贴——手卫生促进策略指南。以前我发过的。这个内容主要由紫陌红尘会员翻译，在此在此表示感谢。发现使用了一个非常有趣的度量——国家毛收入每人头。这点在当今的手卫生文章中少见。INTERPRETATION:Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide.FUNDING:WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.
老师能翻译详细点吗？看不懂呢 真的要学外文的，一点也看不懂 老师，看不懂英文呀！{:1_4:}能否翻译一下？ 请提供全文，谢谢了。 看不懂。。。。。。。。。。。。。。。。。。。 老师能否翻译成中文再发表， 想了解内容，但是{:1_4:}看不懂，需要翻译！ http://www.ncbi.nlm.nih.gov/pubmed/23972825
下载不到全文哦，蓝鱼大咖能分享全文吗？{:1_7:} 婉若秋水 发表于 2013-10-7 20:29 static/image/common/back.gif
http://www.ncbi.nlm.nih.gov/pubmed/23972825
下载不到全文哦，蓝鱼大咖能分享全文吗？
这看了摘要，还没有去研究全文。看来大家都想要，我去DOWNLOAD一下 要随时仔细查看后续全文翻译！ 不认识英文啊手依从性51-62% 好像和我们医院差不多{:1_12:} 红衣主教章鱼 发表于 2013-10-8 21:37 static/image/common/back.gif
不认识英文啊手依从性51-62% 好像和我们医院差不多
想想全天候的手卫生依从性，我们还会有那么高吗？ 这是当年他在日内瓦大学的促进。
Geneva, Switzerland, 7 hospital-wide
1994.12~1997.12.2次/年 （ before and during implementation of a hand-hygiene campaign）
测量方法（outcome measures） ：依从性、感染率、MRSA感染率、手消毒剂的消耗量（overall compliance、 nosocomial infection rates, attack rates of meticillin-resistant Staphylococcus aureus (MRSA) and consumption of handrubdisinfectant
手卫生协作组：多学科、各科室高级医生护士、行政管理人员、服务供应部门
宣传资料： 选择海报70种每个阶段3~5种 医院250处
会议：6~8次/年
含酒精手消毒剂院内各处安装
人力资源、主管表示支持，提供资金用于感染控制
实际观察法
结果每年3月、6月反馈：医院通讯、教育新从业人员、1994年开始做MRSA主动筛查和去定植
观察了20 000 手卫生时机，依从性48%（1994）增加到66%（1997）
洗手液和水的消耗量，洗手率稳定（30% ），手消毒剂的使用量持续增加 (p<0·001）
护士和护士助理的手卫生明显改善，医生依从性仍然很低
医院感染率从16.9% （1994）降至 9.9% （1998） ，MRSA感染率下降 (2.16 to 0.93 episodes per 10 000 patient-days）
手消毒剂的消耗量增加：increased from 3.5 to 15.4 L per 1000 patient-daysbetween 1993 and 1998 (p<0·001)
safihu 发表于 2013-10-8 23:05 static/image/common/back.gif
想想全天候的手卫生依从性，我们还会有那么高吗？
忙的时候顾不着，闲的时候不想做。恐怕就是我们手卫生的概括。ICU略好些，但要是保持在60%，也非常不容易了。我觉得这里面比较可行，也可取的是，手卫生不是一蹴而就 。而是分阶段的来完成提高，从K-A-P三个方面来逐步完善，先提高知识，提高认识，再端正态度，愿意去执行，最后内化为自我自觉的行为。 safihu 发表于 2013-10-8 23:05 static/image/common/back.gif
想想全天候的手卫生依从性，我们还会有那么高吗？
老师说的对 从全天综合观察的话手卫生依从性真的很不乐观，做调查时工作人员可能是一种应对心理，结果会稍微好一点，检查时就做不检查就不好好做，这种现象普遍存在 ，下一步我们将努力的从思想上提高认识。 红衣主教章鱼 发表于 2013-10-9 20:39 static/image/common/back.gif
老师说的对 从全天综合观察的话手卫生依从性真的很不乐观，做调查时工作人员可能是一种应对心理，结果会稍 ...
现在在临床在我们观察时普遍达到我们考核值的基础上，继续提高很重要，另外是如何能够尽可能观察到非高峰时段及全员如护工交接运送病人等等各类人员工作情况中的手卫生依从性还要花很大工夫啊。
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