世界卫生组织 (WHO) 手部卫生运动获得成功

阳光

http://www.ncbi.nlm.nih.gov/pubmed/23972825

英文原标题： Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study.

作者：Benedetta Allegranzi ,Angèle Gayet-Ageron ,Nizam Damani ,Loséni Bengaly ,Mary-Louise McLaws ,Maria-Luisa Moro

期刊名称：Lancet Infect Dis  影响因子：16.144(SCI)

【出版日期】2013

【卷 号】Vol.13

【期 号】No.10

中文摘要来源：医纬达

中文摘要

背景

医疗保健相关感染是全球患者安全的重大威胁。 感染主要通过医务人员的手传播，但他们对建议的依从性通常较低，需要有效地改善策略。 我们评估了 WHO 关于改善手部卫生的策略在五个国家中的效果。

方法

我们在 2006 年 12 月至 2008 年 12 月之间，在哥斯达黎加、意大利、马里、巴基斯坦和沙特阿拉伯的六个试点地区（43 家医院中的 55 个科室）中进行了一项准实验性研究。 我们在四个为期 3—6 个月的阶段中使用分步进行的方法实施了 WHO 的策略，并通过问卷评估了医务人员对手部卫生的依从性及其关于微生物传播和手部卫生原则的知识。 我们以手部卫生行动（即，洗手或手部擦洗）符合预定义机会的比例来表示依从性。 我们在 2010 年 4 月评估了核心策略活动的长期可持续性。

结果

我们发现，在干预前的 1423 次调查中存在 21 884 次手部卫生机会，在干预后的 1784 次调查中存在 23 746 次机会。 总体依从性从干预前的 51·0% (95% CI 45·1—56·9) 上升至干预后的 67·2% (61·8—72·2)。 依从性与人均国民收入总值独立相关，且干预在中低收入国家中的效果（比值比 [OR] 4·67，95% CI 3·16—6·89；p<0·0001）大于高收入国家 (2·19, 2·03—2·37; p<0·0001)。 经过对主要混杂因素进行校正后，在所有地点中干预的实施均对医护人员的依从性产生了重大效果。 在所有地点，医护人员的知识均有所改善，其平均评分从 18·7 (95% CI 17·8—19·7) 上升至教育课程后的 24·7 (23·7—25·6)。 干预 2 年后，所有地点都报告手部卫生行动持续进行，且持续或进一步地有所改进，包括在全国进行推广等。

结果解读

在不同国家中的不同环境中，实施 WHO 的手部卫生策略具有可行性和可持续性，并可在医护人员中引起显著的依从性和知识改善，该结果支持建议将其在全世界推广使用。



英文摘要

BACKGROUND
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's strategy 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-hygiene principles. 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.

FINDINGS
We noted 21&#8200;884 hand-hygiene opportunities during 1423 sessions before the intervention and 23&#8200;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 [OR] 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.

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.

樱木

手卫生知识的普及在国内恐怕是任重而道远的。