多元策略可否提升護理人員洗手完整率Can multiple strategy improve the completeness of hand washing of nursing staff

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2020-10-05 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

陳家貞*

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

其他 other

科別

  • 肺/胸腔護理 Pulmonary Nursing

中文關鍵詞

洗手、手部衛生、多元策略、完整率

英文關鍵詞

Handwashing、hand hygiene、multiple strategy、completeness

機構名稱

長庚醫療財團法人高雄長庚紀念醫院

申請單位

12A 胸腔內科病房

中文摘要

形成臨床提問:
新型冠狀病毒肺炎(COVID-19)疫情盛行,洗手是杜絕肺炎傳染重要途徑,亦是感染管制基本之策略。人員雖了解洗手重要性,但實際查核完整執行率並未達到標準,或在直接觀察監控洗手行為容易引起霍桑效應導致對於完整率的高估,因應病人安全重視及醫療照護行為零容忍之政策觀念的推展,有哪些策略能有效提升洗手完整率,達到有效洗手以維持健康生活,預防感染。
文獻搜尋的方法與分析:
將臨床問題進行分析並提出PICO,Population:護理師(Nurs*),Intervention:多元策略(Multi* Strateg*),Outcomes:洗手完整率(Hand Hygiene Compliance、Handwashing Compliance)。運用布林邏輯、控制詞彙MeSH terms、切截字truncation檢索技巧,搜尋資料庫:Cochrane library、PubMed、Embase、中文電子期刊資料庫Airiti Library等,運用limit及filters檢索功能,此問題類型為治療型,搜尋主要以SR與RCT文章為主,最後納入三篇文獻以評讀。
文獻的品質評讀:
依據Oxford CEBM (2011)研究證據等級分類,此三篇文獻證據力等級評定皆為Level 1。運用GRADE working group證據品質表評分,三篇文獻評定為無升級因素,降級因素為具有偏差風險,故證據品質降為「中」,洗手策略無風險問題,且可有效提升護理人員洗手完整率,故為明確顯示介入措施成效,建議強度為「強」。
證據之臨床應用:
依文獻結果擬定具體可行洗手多元策略為:一、洗手教育:拍攝洗手影片;二、提醒機制:包括1.洗手秒數提醒歌曲、2.洗手五時機提醒小卡、3.藥盒提醒小物,並擬定評核機制,採隨機、定期但不定時方式進行監測洗手完整率,以防霍桑效應。
成效評值:
洗手多元策略共介入13週,進行第6次監測,收案25人,洗手完整率由介入前71.7%提升至94.2%,感染率相較於去年同期比較下降0.13%,並以手部螢光檢測儀再進行檢測,25人共出現18點(5.14%),於螢光檢測儀檢測手部衛生清潔率為94.9%;人員對於多元洗手策略整體滿意度為98%。
結論與建議:
依據實證文獻整合結果與本專案實證應用結果顯示,多元洗手策略視為可行之策略,此項策略安全且經濟實惠,對人員無傷害性及安全之問題,洗手是預防院內感染最有效方法,除可保持人員健康,亦可防止病人感染之疑慮,是極為可行之策略,有效洗手可減少細菌繁殖,降低感染風險及縮短病人住院時間,減少醫療成本,達到護病安全與健康之雙贏成果。

英文摘要

Ask an answerable question (PICO):
With the prevalence of the new coronavirus pneumonia (COVID-19) outbreak, hand washing is an important means of eliminating the transmission of pneumonia and basic strategy for infection control. Although staff understand the importance of hand-washing, the rate of complete hand-washing implementation is not qualification, or the Hawthorne effect was overestimated due to direct observation and monitoring of hand-washing behavior. What are the strategies to promote the concept of patient safety and zero-tolerance policy in health care to increase hand-washing completeness, to maintain healthy lifestyle and to prevent infection?
The Method and Analysis of Literature Review:
The clinical questions were analyzed and put with PICO, Population: Nurs*, Intervention: Multi* Strateg*, Outcomes: Hand Hygiene Compliance, Handwashing. (Compliance), Search databases: Cochrane library, PubMed, Embase and Aririti Library, etc., and use the limit and filers search function. This question type is treatment. The search was mainly based on SR and RCT articles, and finally three papers were included for review.
Critical Appraisal:
According to the Oxford CEBM (2011), all three papers were graded as Level 1. Using the GRADE working group evidence quality scale scoring, three papers are rated as having no upgrade factor, and the downgrading factor is the risk of bias, so the quality of evidence is reduced to "medium", the hand washing strategy was harmless, and can effectively improve the complete rate of hand washing by nursing staff. Therefore, it is clearly show the effectiveness of intervention measures, the recommended strength is "strong".
Clinical Application of Evidence:
Based on the results of the literature, we set some specific and feasible hand-washing strategies : 1) hand-washing education: film a video on hand-washing; 2) reminder mechanism: include 1) hand-washing seconds reminder song, 2) hand-washing 5-moment reminder card, 3) medicine container reminder small objects, and an evaluation mechanism to monitor the hand-washing completeness rate randomly, regularly and irregularly to prevent the Hawthorne effect.
Evaluation of Effectiveness:
The hand washing multivariate strategy intervention was conducted for 13 weeks, and the 6th surveillance was conducted. 25 nurses were collected, the hand washing completeness rate increased from 71.7% to 94.2%, and the infection rate decreased by 0.13% compared to the same period last year. The overall satisfaction rate of the hand washing strategy was 98%.
Conclusions and Recommendations:
According to the results of the empirical literature and the results of the application in this project, multiple hand-washing strategies are regarded as feasible, safe, cost-effective, non-harmful and safe for staff.