洗手——一个简单有效安全的解决方案
Hand washing: A simple, but effective safety solutionJune 19th, 2012
by Frank D. Byrne
You wouldn't think that we'd have to devote a lot of time, attention and effort to getting people to wash their hands, would you? It's pretty straight forward. Efficient hand washing is probably the least expensive and certainly one of the most effective patient safety interventions to prevent hospital-acquired infections.
Yet, hand-washing results across hospitals and other healthcare organizations are routinely dismal. At St. Mary's Hospital in Madison, Wisc., we were right there. A few years ago, our compliance of staff and physicians using accepted hand-washing protocol before and after patient contact was only 76 percent, ranking us near the bottom of all hospitals in our SSM Health Care system.
Needless to say, when these results were shared we were distressed, as these numbers were significantly out of line with our other patient safety indicators. So we utilized our SSM Health Care culture of continuous improvement to get better.
We first did our research. We looked at organizations that had achieved success in hand washing, not just in SSM Health Care but outside. For example, Novant Health, headquartered in North Carolina, achieved 99 percent hand-hygiene compliance and 63 percent reduced methicillin-resistant Staphylococcus aureus (MRSA) infections through a creative, comprehensive campaign. Novant generously made its campaign materials downloadable for free at WashingHandsSavesLives.org to any organization.
All departments at St. Mary's Hospital designated hand-washing champions who met monthly at first, and less often as the process progressed. I personally became the Administration champion. Through our SSMHC planning process, each department established hand-washing goals aligned with our organizational goals. Monthly progress based on agreed-upon measures was recorded on prominently displayed departmental goal posters. Lastly, each individual employee at St. Mary's was required to have a personal hand-washing goal documented on his/her Passport, the personalized goals tool we provide to each staff member.
One of the biggest barriers we faced was our "Midwestern politeness," where we were reluctant to correct each other if we observed less-than-optimal hand washing. This was particularly true with physicians. An unsuccessful attempt to address this was to have people submit names of those who needed reminders; each would then receive a letter signed by me. That proved completely ineffective at doing anything but angering the recipients, one of whom commented, "I wish someone would have told me when they saw me rather than me getting this letter from you six weeks later."
It's too early to declare victory but our results have improved dramatically. We went from 76 percent compliance to more than 90 percent for the last twelve months, and as high as 97 percent for two months. Simultaneously, we experienced a statistically significant reduction in healthcare onset-MRSA, from 0.362 per 1000 patient days to 0.194 per 1000 patient days (p=0.003).
Given these great results, we also took care to celebrate our successes and the hard work of those who brought us to this point. For example, we provided each of our department champions with logowear embroidered with "St. Mary's Hand Hygiene Champion."
All of our efforts continue, plus we're adding more all the time--the latest of which is a contest encouraging staff to develop videos and/or posters on hand washing. We are not letting up.
Hand washing--it's a simple but important act. Yet we believe that it has dramatically contributed to helping us fulfill our commitment of providing a safe environment for those we are privileged to serve.
Frank D. Byrne, M.D., is the president of St. Mary's Hospital in Madison, Wisc. 下面是一些评论：
Showing 18 comments
Barbara Wright
This article gives me hope for the future!Tis not only sloppy handwashing that's the real problem, but, GLOVES!I think that the wearers of gloves are protecting themselves and not the patients.I refused to be treated by a 'carer' whose gloves touched everything in her sight, eg., telephone, door handles, case notes, flicking back her hair; you name it, she touched it while wearing the same pair of gloves before returning to attend to me! Ugh!
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1 week ago 12 Likes
Sandra Phillips Sperry
Or the person who goes room to room with the same pair of gloves on!
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6 days ago in reply to Barbara Wright 1 Like
Jeannie
EWWW...now that's nasty!
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6 days ago in reply to Sandra Phillips Sperry
Countrychimp
thia happened to me..I got MRSA from an intern entering my room and using the same gloves she already was wearing..
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6 days ago in reply to Sandra Phillips Sperry
Vsalmon
I absolutely agree that the GlOVES is the real problem among care takers and they need to be taught about this because they are not aware of what they are cross taminating germs from other surfaces to the patient.I often thought that way about food handlers in deli's and restaurants -- that they are only protecting themselves and not the consumer.The same pair of gloves that is worn while doing other chores in back of the counter is the same gloves that is used used to prepare your sandwich.Good thinking Barbara!
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6 days ago in reply to Barbara Wright
Michelle van der Merwe
I agree with Babara here, glove wearers will also go on to wear the same gloves to do everything besides the patient and sometimes the next patient and when you as the patient comment they take offence.Hand washing which seems a simple thing is such a hard thing to train people to do correctly.Which is strange as it protects both the hand washer and the patients.
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1 week ago 1 Like
Sandra Phillips Sperry
Dr. Byrne,
To what do you attribute your success?Handwashing is an embarrassing problem whichoften falls into the "personal accountability" category.I have seen some of my clients who have had tremendous success but only with continuous reinforcement and monitoring.Others continue to struggle with poor performance from surgeons to patient care technicians......
Sandra
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6 days ago
Puttycat1
Although hand washing is so very important and definitely reduces the transmission of "bad stuff", don't forget about the stethoscope covers that are so popular amongst RN's and MD's ... they go from room to room, patient to patient day after day for who knows how long without being washed or disinfected ... acrylic nails are also a hazard as all kinds of things collect under them especially if the acrylic nail is not glued well ...
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6 days ago
Bev
Yikes, we are surrounded by microorganisms (we live in microorganism soup); so why not the easiest and cheapest protection for both the patient and the caregiver---wash your hands! Seems pretty easy to remind people with all those sinks and towels available. Signs may not work as well as just saying something.
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6 days ago
yahoo-FCCX4RZZBY2GBOXBYURKLQQ5DY
The Doctors and Nurses at the Mayo clinic here in Mankato MN think that the hand sanitizer is the way to go.I have not seen any of them wash their hands with soap & water.This distresses me but I do not feel comfortable asking them to wash their hands.
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6 days ago
Leo
Dr. Byrne,
Were staff using an alcohol based hand disinfectant, like Purell, instead of hand washing before gloving up?I see that "alternative" a lot in hospitals.How is that compared to hand washing?
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6 days ago
Marevg
I am a 50 year graduate of a hospital nursing school program and proper hand washing was a mantra then and constantly stressed in my nursing home home career as a nursing supervisor; nurse educator; and licensed nursing home administrator in my state.Yes it is simple, but I heard so many complaints about the rashes from the soaps, the lack of paper towels to dry hands, etc., that I knew compliance was always going to be an issue.I am happy to report that I taught my grandchildren to wash their hands with soap as they sing "Happy Birthday" twice. However, I do not know if they continue to do so when I am not there. I only know that I have given my husband strict orders to have every person who approaches me in a hospital to wash their hands.I probably will have nobody come into my room and will be labeled an "uncooperative patient"!!!
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6 days ago 1 Like
Nurmiati Amir
I commit to do hand washing because it is not only protect my patiens but also my self.
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6 days ago
aroonkamath
I sincerely believe that no amount of reminders, warnings or penalties are likely to work in ensuring compliance. Every individual caregiver must respect hand washing as part of personal commitment to service. This is true both for the hygienic handwash and the surgical scrub. Surgical scub also suffers a similar fate. Most scrubbing areas in the Ors have clocks. Sadly, not many even know they are there or why they have been installed. But I must admit (after being a surgeon for 35 years) that the 3-5 minutes of mandatory surgical scrub seems to last for 3-5 hours, if not more!
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6 days ago
Felekemeseret
Hand washing is a good idea to protect the patient from hospital acquired infection, but inappropriate use of gloves are the major cause of hospital acquired infection.In addition to hand washing, use of one glove for one patient and prevention ofcontamination to the surrounding is mandatory to protect the patient and our self too.
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5 days ago
Sandragulian
I wish I had bought stock in the glove industry years ago!It mostly started to protect workers from AIDS. but has become an obsession to many medical staff.The rediculous uses of them today defy common sense.Yes, hand washing could prevent much waste and abuse..Thank you Florence Nightingale....
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5 days ago
Jmnic Lund2021
Yes, I can believe that we still have to remind people to wash their hands. You would not believe how many times I have been in a public restroom and witnessed people use the facilities and then walk out WITHOUT washing their hands. UUGh! It makes me want to ask them where they left their upbringing!
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5 days ago
Csteed
Collapse
Here’s some
positive news forboth patients and care givers when it comes to hand
hygiene compliance - electronic monitoring can help.There is a solution that we’ve implemented it at
Greenville Health System, taking hand hygiene to the next level. We are using
the DebMed Group Monitoring System for automated real-time monitoring and
reporting of hand hygiene compliance.Already, the system has captured
and reported on eight million hand hygiene events and we have increased hand
hygiene compliance by five to 12 percent – in less than one month. We are
very happy with the results to date. 手卫生一直是院感强调的重点，但临床科室依从性不高！{:1_2:} 樵夫版主能否好人做到底，帮忙译成国语，与大家共享否？先谢啦！{:1_1:} 白衣飘飘 发表于 2012-6-28 19:47 static/image/common/back.gif
樵夫版主能否好人做到底，帮忙译成国语，与大家共享否？先谢啦！
同意四楼的建议：最好翻成中文的，这样比较好接受哦！ 我等英语不好的人难受了
看不懂{:1_4:}{:1_10:}{:1_248:} 有些句子还是看不明白，等待樵夫版主翻译后的文章。
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