我非常赞同鬼才老师你的意见，可常常我感觉累得快趴下了，别人无所事事，科室制度有点虚设，反复同科长沟通见不到起色
阡陌 发表于 2012-6-15 09:08 static/image/common/back.gif
我非常赞同鬼才老师你的意见，可常常我感觉累得快趴下了，别人无所事事，科室制度有点虚设，反复同科长沟通 ...
其实要做好感控工作，不能仅用口去说话，要用我们自己的行动去说话，这样才有说服力。做感控工作不能搞教条主义，而要创造性地开展工作。
现在发现一种很不好的倾向，许多人说得多，做得少。
xmxxcx 发表于 2012-6-15 08:21 static/image/common/back.gif
非常赞同楼上各位老师的观点，脚踏实地，责任胜于能力！顶一下！！！！
“责任胜于能力！”说得太好了！
心灵的翅膀 发表于 2012-6-15 09:53 static/image/common/back.gif
“责任胜于能力！”说得太好了！
愚公移山，勤能补拙，只要功夫深铁杵磨成针!我们院感人做的就是别人眼里的傻事，自从换岗后身边的朋友都说我是傻了，放弃大好钱途，怎么会去做这些费力不讨好的工作，看见各位同行积极的回复，我很欣慰，世上有这么多的傻子愿意改变这个世界，路途遥远，一起努力吧！
老师说的非常好，道出了感控人的心声，我也时常提醒自己，在路最难走的时候，也一定要坚持走下去，总会好起来的。
xmxxcx 发表于 2012-6-15 08:21 static/image/common/back.gif
非常赞同楼上各位老师的观点，脚踏实地，责任胜于能力！顶一下！！！！
“责任胜于能力！”确实如此！不管做任何工作，你能力再强！但没有责任心！等于零！！何况我们做院感工作，是要实实在在的做！而不是弄虚作假！这就是我们肩上的责任！能力欠缺，我们可以通过努力学习，来提升能力！就象我们现在，没有机会外出学习，就上我们的“娘家”来充电！可以请教这么多的老师！还怕不能提升？所以“责任”这二个字太重要了！以前不知道有这么个家园！自从成了这个家里的一员后，几乎每天都想上来学习！当受到了“委曲”就到娘家来诉诉苦，心情就舒畅多了！这个“家”对我来说太重要了！在此感谢所有老师的付出！{:5_619:}
做一个感控人,首先做一个真实的人,还要做一个踏实的人,必须做一个慎独的人，说得多好,但做起来是多么难,遇到检查时,又有多少真实的,领导不重视时,又如何能做踏实和慎独,对于我这刚接手院感,且知识缺乏的人来说,更是难啊!路途遥远，一起努力吧！
本帖最后由 四叶草 于 2012-6-16 16:14 编辑
看到秋水斑斑和宋博士及各位老师的帖子，谈谈个人观点：
1、如果说团队建设和学科建设是经济基础，那么感控文化建设就像上层建筑，经济基础决定上层建筑。
2、秋水斑斑对我国感控文化先知先觉并有意推广，实属难得。可敬可佩！可能现在我国院感的发展，就国家的层面（顶层设计）和目前我国很多地方的院感发展现状，一时间恐难和美国等发达国家相提并论。
3、当然，我们也不能坐等顶层设计，任何致力于感控的院感人都有责任和义务来为中国的感控文化建设添砖加瓦。这其中就有感控先驱胡必杰教授，李六亿教授、吴安华教授、任南教授等。他们是我们的榜样。
4、随着我国院感的发展步入黄金时代，相信我们感控的团队建设、学科建设及文化建设均得到长足的发展。
欣赏了以上各位老师关于感控文化的精辟阐述，觉得感控文化就是一种慎独精神，其最高境界就是人人自觉执行。
本帖最后由 龙文鞭影 于 2012-6-16 17:05 编辑
美国的某些感控措施并不是强制标准，西方医学思想发展来源于（或融入于）宗教传承，其根本思维如我们今天之奉献。追求理想。当今国内医院在谋求效益，很大程度上的医生是为养家糊口，活的有“尊严”而已，所以虽强而不行！其人虽预而勉行之！（勉，非勉强，尽力而已）
对于感控文化，我们应该是以人为本，强调医务人员的道德观、价值观和行为规范在院感工作中的作用，这就要我们和临床相互理解、尊重，最终以保障病人的安全为目的，要有悲悯之心，关爱病人。注重的院感工作的实质，而不是为了应付检查，好多时候院感工作就是为了检查而做一些无用的监测数据，充其量真是在做一些数据垃圾！如散发的医院感病例，有的时候只是统计了数子，而并没有从深层次考虑为什么会发生感染，也不去和主管生交流讨论，不能正真起到解决问题的作用。我们应该改变这些观念，发现问题和主管医生探讨，踏踏实实的做些实事，惠及病人。
很赞同秋水老师的“感控是一门复杂的学科，不仅仅是技术，更有社会学、行为学、心理学及管理学等横向的东东。”
期待能有具体的“医生为什么不洗手”信息。
四叶草 发表于 2012-6-16 16:10 static/image/common/back.gif
看到秋水斑斑和宋博士及各位老师的帖子，谈谈个人观点：
1、如果说团队建设和学科建设是经济基础，那么感控 ...
对感控文化的先知先觉实不敢当，仅是一些浅显的思考而已。
很赞同第3点“我们也不能坐等顶层设计，任何致力于感控的院感人都有责任和义务来为中国的感控文化建设添砖加瓦。”，感控工作的专业理论与技术快速发展的同时，感控文化也必须同步发展，所以坐等顶层设计的“成熟”时机是不可取的，而是需要每个感控人都积极在感控文化方面倾注一些思考及精力，在多个层面上推动感控文化的建设及发展。
发展感控文化关键在于人们的“悟”性。感控工作的重要性其实每个人都知道，但因其受各种客观因素的制约，导致一些正确的理念无法坚持下去，往往发生许多亡羊补牢的教训，但教训过后，又是原地踏步，如何从根本上改变这一现状，需要各方面的努力，但感控人员的“悟”性很重要，大家的觉悟还有待于提高。做正确的事，不要被其他因素所左右，才是我们真正要做的。期待感控文化的大繁荣、大发展。
若谷 发表于 2012-6-17 22:04 static/image/common/back.gif
很赞同秋水老师的“感控是一门复杂的学科，不仅仅是技术，更有社会学、行为学、心理学及管理学等横向的东东 ...
“医生为什么不洗手”在办公室电脑上，明天找时间发上来。
本帖最后由 月朦胧 于 2012-6-20 06:51 编辑
有了版主的先知先觉，有了大家的探讨和反思，有了我们和国外差距的寻找，有了我们追逐感控文化的热情，有了我们这些论坛感控布衣的积极参与，我们有理由相信，在大家的共同努力下，我们的感控理念、感控文化都会稳步提升！宛若秋水老师，鬼才老师，相信你们的努力不会白费!无论是顶层设计还是实际实施，只要我们春风化雨，坚持在做，我们就一定会有收获！
婉若秋水 发表于 2012-6-19 22:52 static/image/common/back.gif
“医生为什么不洗手”在办公室电脑上，明天找时间发上来。
Why Healthcare Workers Don’t Wash Their Hands: A Behavioral ExplanationMichael Whitby, MD; Mary‐Louise McLaws, PhD; Michael W. Ross, PhD From the Centre for Healthcare Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Brisbane (M.W.), and School of Public Health and Community Medicine, University of New South Wales, Sydney (M.‐L.M.), Australia; and World Health Organization Center for Health Promotion Research and Development, School of Public Health, University of Texas, Houston (M.W.R.).Address reprint requests to Michael Whitby, MD, Centre for Healthcare Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Ipswich Road, Brisbane QLD 4102, Australia (whitbym@health.qld.gov.au). Objective.To elucidate behavioral determinants of handwashing among nurses. Design.Statistical modeling using the Theory of Planned Behavior and relevant components to handwashing behavior by nurses that were derived from focus‐group discussions and literature review. Setting.The community and 3 tertiary care hospitals. Participants.Children aged 9‐10 years, mothers, and nurses. Results.Responses from 754 nurses were analyzed using backward linear regression for handwashing intention. We reasoned that handwashing results in 2 distinct behavioral practices—inherent handwashing and elective handwashing—with our model explaining 64% and 76%, respectively, of the variance in behavioral intention. Translation of community handwashing behavior to healthcare settings is the predominant driver of all handwashing, both inherent (weighted ) and elective (weighted ). Intended elective in‐hospital handwashing behavior is further significantly predicted by nurses’ beliefs in the benefits of the activity (weighted ), peer pressure of senior physicians (weighted ) and administrators (weighted ), and role modeling (weighted ) but only to a minimal extent by reduction in effort (weighted ). Inherent community behavior (weighted ), attitudes (weighted ), and peer behavior (weighted ) were strongly predictive of inherent handwashing intent.Conclusions.A small increase in handwashing adherence may be seen after implementing the use of alcoholic hand rubs, to decrease the effort required to wash hands. However, the facilitation of compliance is not simply related to effort but is highly dependent on altering behavioral perceptions. Thus, introduction of hand rub alone without an associated behavioral modification program is unlikely to induce a sustained increase in hand hygiene compliance. Although healthcare worker (HCW) compliance with handwashing guidelines is a cornerstone of ideal infection control practice, the rate of such compliance has proved to be abysmal.1 A variety of interventions have been investigated with the intent of improving knowledge of and compliance with handwashing guidelines and then reinforcing these practices2‐6; however, until recently, none have engendered evidence of sustained improvement during a protracted period.7,8In 2000, two groups published findings that provided hope to those concerned about improving handwashing practice. Pittet et al.7 demonstrated that handwashing compliance among nurses at the University of Geneva hospitals increased to a maximum of 66% during a 48‐month period. This improvement was associated with concomitant decreases in healthcare‐acquired infection rates and cross‐transmission of methicillin‐resistant Staphylococcus aureus. The Geneva program was multilevel and multifactorial, with a number of interventions likely to affect HCW behavior. However, the particular focus of this program was the provision of an alcohol‐based hand rub designed to reduce the time taken and the inconvenience associated with handwashing. Subsequently, Larson et al.8 described a significant increase in handwashing compliance that was sustained for a 14‐month period in a Washington, DC, teaching hospital. Their program attempted to induce organizational cultural change toward optimal hand hygiene, with senior administrative and clinical staff overtly supporting and promoting the handwashing program.After publication of the Geneva study,7 commercially produced alcohol‐based hand rubs became widely marketed and introduced into hospitals, with the expectation that a sustained increase in compliance with handwashing guidelines would follow. The usefulness of such products has been reinforced on the basis of recommendations in internationally well‐respected guidelines.9 Some reports of short‐term improvements in compliance that occurred after the introduction of alcohol‐based hand rubs, often recorded from overt observation, have been published.10‐13Although the benefits of the interventions reported by Pittet et al.7 and Larson et al.8 are undoubted and the cost‐effectiveness of the programs has been justified,14 we must now identify why these interventions were successful. Handwashing as a practice is a globally recognized phenomenon; however, the inability to motivate HCW compliance with handwashing guidelines suggests that handwashing behavior is complex. Human behavior is the result of multiple influences from our biological characteristics, environment, education, and culture. Although these influences (hereafter referred to as “components”) are usually interdependent, some have more force than others.Many theories have been developed to define the nature and relationship of multiple factors that affect a range of health‐related behaviors. Use of these theoretical behavior models has widely occurred in a number of areas of health education and health promotion, sometimes with considerable success.15 The Theory of Planned Behavior (TPB)16 is appropriately used when examining behaviors considered to be determined by a person’s intention. With regard to handwashing, the model is predicated on a person's acceptance that the immediate cause of handwashing is their antecedent intention to wash their hands. The intention to perform a given behavior is predicted directly, although to differing degrees, by 3 intermediate variables: attitude (a feeling that the behavior is associated with certain attributes or outcomes that may or may not be beneficial to the individual), subjective norms (a person’s perception of pressure from peers and other social groups), and perceived behavioral control (a person’s perception of the ease or difficulty in performing the behavior). These intermediate variables are predicted by the strength of the person's beliefs about the outcomes of the behavior, normative beliefs (which are based on a person's evaluation of the expectations of peers and other social groups), and control beliefs (which are based on a person's perception of their ability to overcome obstacles or to enhance resources that facilitate or obstruct their undertaking of the behavior). For each behavior, qualitative assessments, which usually take the form of focus‐group discussions, are initially used to best determine the content of each influencing component. This often means that predictive components described by other behavioral models can also be included in the final paradigm to best explain the behavior of interest. Our investigations focus on elucidating and determining the origin of the behavioral determinants of handwashing in nurses in the healthcare setting.
谢谢秋水老师！已经当下来了！
若谷 发表于 2012-6-20 15:11 static/image/common/back.gif
谢谢秋水老师！已经当下来了！
刚刚找到完整的文章，“医生护士为什么不洗手？”现发上来，期待读后分享。
本帖最后由 婉若秋水 于 2012-7-4 17:15 编辑
http://bbs.sific.com.cn/thread-81928-1-1.html
这是否应该成为我们下一步感控文化的建设方向呢？呼吁感控文化的顶层设计中制定医院感染伦理守则，填补医院感染核心制度及感控核心文化的空白？目前，医改大洗牌的时机是否是感控理念创新塑造的契机呢？