【作者】 张莉；

【导师】 刘纯艳；

【作者基本信息】 天津医科大学 ， 护理学， 2008， 硕士

【摘要】 目的通过对护理人员执行手卫生情况及手部微生物污染状况的调查研究,了解护理人员的手部卫生现状和手卫生知识的掌握情况以及手卫生依从性的影响因素,旨在强化护理人员执行手卫生及控制医院感染意识;探讨干预措施对改善护理人员手卫生状况、提高洗手依从性和降低医院感染率的功效,为医院感染的预防、控制、管理提供科学依据。对象方法采用定性和定量调查相结合的方法,首先在天津市某所三级甲等综合性医院包括内科、外科、重症监护病房、门急诊等临床科室随机选取了150名护理人员作为研究对象进行基线调查,采用观察法和问卷法收集了解研究对象的洗手行为、执行手卫生依从性的影响因素和手卫生知识的掌握情况并对护理人员洗手后进行手部采样,对采样标本做细菌培养及细菌鉴定。针对护理人员的手部卫生现状和影响手卫生依从性的因素,制定干预措施,选择两个基本条件相同病区的护理人员各22名作为研究对象进行对照实验,评价干预前后的效果。结果1.手部微生物污染检测结果:被抽查的150名护理人员洗手后手部采样全部有细菌污染,占被检测数的100%;其中有54例超标,占36%。在150例手部采样标本中,检出的细菌主要有凝固酶阴性葡萄球菌(CNS)、革兰阳性芽胞杆菌、霉菌、酵母菌、棒状杆菌、嗜麦芽窄食单胞菌、不动杆菌等,并检出致病菌其中包括金黄色葡萄球菌、大肠埃希菌等,药敏鉴定显示存在耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)及超广谱β-内酰胺酶菌(ESBL_s)。护理人员手部携带的细菌及构成比与该院近年医院感染的主要菌株相一致。2.护士手卫生执行情况:被调查150名护士的洗手合格率为64%;手卫生依从率平均为30.79%±28.03%。不同年龄、学历、职称护士的手卫生依从率没有显著性差异(P＞0.05),危重症病房护士的手卫生依从率高于内科、外科普通病房及门急诊的护士(P＜0.05)。各项洗手指征出现后,手卫生依从率较高的依次是处理污物后、去卫生间前、接触患者后分别为75.87%±28.97%、68.45%±35.49%、57.86%±32.64%。在影响护士执行手卫生的20项因素中,认为最重要的前三位因素是:①工作太忙;②清洁剂、消毒剂引起皮肤干燥;③未对洗手或擦手的效果进行有效地监控。3.护士手卫生知识掌握情况:150名护士手卫生知识总分平均为19.02±2.09,其中手卫生指征平均得分为14.06±1.25,手卫生相关知识的平均得分为4.97±1.18。不同年龄、学历、职称护士手卫生知识没有显著性差异(P＞0.05),危重症病房护士的手卫生知识高于内科、外科普通病房及门急诊护士(P＜0.05)。护士手卫生知识得分与手卫生依从率经统计学检验无相关性(P＞0.05)。4.针对护理人员洗手认知行为现状与主要影响因素采取干预措施进行对照实验:行为教育后实验组的洗手合格率由干预前的63.64%提高为90.91%,洗手率由28.41%上升为55.27%,对照组的洗手合格率为68.18%,洗手率为27.59%,干预后自身对照及与对照组相比二者均有显著性差异(P＜0.05);为实验组提供快速手消毒剂,用手消毒剂擦手与洗手液流动水洗手效果进行比较,洗手合格率无统计学意义(P＞0.05);细菌清除率使用手消毒剂为89.59±3.14%,洗手液流动水为86.59±3.38%,二者有显著性差异(P＜0.05);执行手卫生所用时间使用手消毒剂为19.00±2.33s,洗手液流动水为163.55±44.49s,二者有显著性差异(P＜0.05);实验组在干预前、行为教育后、提供快速手消毒剂后的洗手率对比均有显著性差异(P＜0.05);在干预期间实验组的医院感染率与对照组相比有显著性差异(P＜0.05)。结论护理人员不规范洗手行为后手部携带的微生物有致病菌及耐药菌株的存在与近年该院医院感染的主要菌株相一致。护理人员手部卫生状况亟待提高,执行手卫生及控制医院感染意识有待强化;通过采取有针对性的干预措施,可有效提高护理人员的手卫生状况和执行手卫生的依从性,使医院感染率有所下降。更多还原

【Abstract】 Objective Through the study and investigation for current situation of microbial contamination on the nurses’ hands,to enhance the nurses’ concept of handwashing and control the hospital infection.Research the effective intervention to improve the handwashing state;increase the handwashing compliance and decrease the nosocomial infection rate.To provide the scientific evidence for the prevention,control and management of nosocomial infections.Object and Methods Use the investigative method of qualitation and quantitation conjuncted,the study take 150 nurses randomly from the medical and surgery department and intensive care unit(ICU)and clinic service and emergency of a grade-A comprehensiveness hospital of Tianjin as the observation objects.Observe the nurses’ handwashing rate as handwashing indicated appearancing and sampled the hands of nurses after handwashing,to progress bacterial culture and identification. Use observation method and questionnaire to collect and understand the informations of handwashing behavioral and basic knowledge of hand hygiene,to analyses the influential factor for compliance of hand hygiene.To aim at error handwashing behavioral,formulate management and intervention measure,choose two division whose basic condition are identical as the objects of confrontation test,evaluate the effect after the intervention test.Results 1.The detection results of microbial contamination on the nurses’ hands and handwashing installations:after handwashing 150 nurses’ hands samples that all contaminated,account 100%;among the total 54 samples over-standard,account 36%. There are 7564 strains are cultured of 150 samples of nurses’ hands and the capital bacteriums are coagulase negative staphylococcus(CNS),Gram positive Spore-Forming,mould,budding fungus,microbacterium,stato-bacillus,et al.The samples of nurses’ hands are detected pathogenic bacteria,including:Staphyl- ococcus aureus(SA),Bacillus coli,drug sensitive test to show that there are meticillin-resistant Staphylococcus aureus(MRSA),meticillin-resistant coagulase negative staphylococcus (MRCNS),and superspectrumβ-lactamase bacterium(ESBL_S)on the samples.The microbion on the the nurses’ hands are coincidence with the capital germs of nosocomial infections in this hospital at recent years.2.The performed condition of hand hygiene:the average rate of compliance of hand hygiene of 150 nurses are 30.79±28.03%.After each handwashing indicated appearancing,the higher rates of compliance of hand hygiene are after handle filth, before go to toilet,and after touch patients,the rates are 75.87±28.97%, 68.45±35.49%,and 57.86±32.64%respectively.Among the 20 factors to influence performance of hand hygiene,the most important factors are:①the work too busy,②cleanser,antiseptics cause asteatosis cutis,③the effectually monitoring not establish for the effect of handwashing.3.The prehension of knowledge of hand hygiene:the average mark of knowledge of hand hygiene is 19.02±2.09,among the total the average mark of knowledge of hand hygiene indicated is 14.06±1.25,and the average mark of correlated knowledge of hand hygiene is 4.97±1.18.The nurses with different age,educational background and professional title whose marks of knowledge of hand hygiene havn’t significant difference(P＞0.05),but nurses of ICU whose marks higher than nurses of the medical and surgery department and clinic service and emergency(P＜0.05).After statistically analysis the score of the health information of hand hygiene and the compliance of hand hygiene are not correlation(P＞0.05).4.Aim at the current state of handwashing cognitive behavior and contaminate of handwashing installations,take intervention measure and run the controlled trial. Own control the samples of nurses’ hands after handwashing have significant difference;after intervention the qualified rate of handwashing from 63.64%to 90.91%,and the rate of handwashing from 28.41%to 55.27%,incontrol group the qualified rate of handwashing is 68.18%,and the rate of handwashing is 27.59%.After intervention test group own control and compared with control group have significant difference also(P＜0.05).To provide test group with antiseptic hand-rubproduct for handwashing and contrast using flow water,the qualified rate of handwashing have not statistically significant(P＞0.05),the clearance rate of germs of the group using antiseptic hand-rub product is 89.59±3.14%,and the clearance rate of germs of the group using flow water is 86.59±3.38%,the two groups have significant difference(P＜0.05);the time consuming of the group using antiseptic hand-rub product is 19.00±2.33s,and the time consuming of the group using flow water is 163.55±44.49s,the two groups have significant difference(P＜0.05);before intervention,after behavior education and after providing antiseptic hand-rub product the rate of handwashing have significant difference(P＜0.05);the nosocomial infection rate have significant difference between test group and control group in period of intervention time(P＜0.05).Conclusion There are pathogenic bacterias and drug resistant strains on the hands of nurses after the error handwashing behavior,the pathogenic bacterias and drug resistant strains are coincidence with the capital germs of nosocomial infections in this hospital at recent years.The state of hand hygiene of nurses must need improvement urgently;handwashing installations should be consummate;take the direct intervention to enhance infection control,effectively increase the handwashing compliance and decrease the nosocomial infection rate.更多还原