Investigation On Hand Hygiene Compliance Of Medical Staff In Some Inpatient Departments In A Municipal Comprehensive Hospital

Objectives:This survey is designed to understand the current situation of hand hygiene compliance of medical staffs in some inpatient departments in a municipal comprehensive hospital.The objectives of this survey are to understand the implementation of hand hygiene of medical staffs,to explore their knowledge and perception of hand hygiene,as well as to analysis the availability of hand hygiene supplies and hand hygiene related management mechanism.The results from this study will provide reference for improving hand hygiene compliance of medical staffs in the future.Methods:According to the level of hospital infection rate in inpatient departments,15 departments are selected from 30 inpatient departments by stratified sampling method.The method of observation are applied to understand the implementation of hand hygiene of medical staffs,the availability of hand hygiene supplies and the management mechanism of hand hygiene.A questionnaire survey is used for 268 medical staffs in the 15 in-patient departments to explore their knowledge and perception of hand hygiene.Purposive sampling is applied to select some hospital managers,department managers and general medical staffs for in-depth interviews.Excel and Epidata3.1 are used for data entry and SPSS 17.0 is used for data analysis.Results:1 In total,3271 hand hygiene opportunities are observed in the 15 inpatient departments.The observed hand hygiene compliance is 15.77%.The hand hygiene compliance of doctors and nurses are,respectively,15.16%and 16.38%.Their difference is not statistically significant(p>0.05).Comparison of the hand hygiene of medical staffs from different departments,it is showed that medical staffs from department of internal medicine have the highest hand hygiene compliance which is 17.83%,whereas the hand hygiene compliance is lowest at department of E.N.T and ophthalmology,only 11.11%,the surgery department is in between,reaching 15.34%.There is no significant difference of hand hygiene compliance between medical staffs from surgical and internal medical departments(p>0.05).However,the hand hygiene compliance of E.N.T and ophthalmology is significantly lower than that of surgical and internal medical staffs(p<0.05).In comparison of the hand hygiene at "five moments",it is indicated that the hand hygiene compliance of "After body fluid exposure risk" is up to 72.41%,and the hand hygiene compliance of "Before touching a patient" is lowest,only reaching 1.63%.But there is no statistically significant difference in the compliance of doctors and nurses at each moment(p>0.05).In terms of the choice of hand hygiene methods,57.95%of the medical staffs choose hands washing,42.05%of them choose hand-rub.Both doctors and nurses are more likely to choose hands washing as a way of hand hygien and there is no significant difference in the choice of hand hygiene methods between doctors and nurses(p>0.05).2 The equipped rate of washing pool is observed highest in the ward,up to 100%,followed by the treatment room of 71.43%.Washing pool equipped rate is lowest in the office generally,only 62.50%,where as the washing pool is not available at nurse station,99.56%washing pool is equipped with clean water.However,only 14.41%washing pool is equipped with hand soap,15.72%washing pool is equipped with hand hygiene reminder poster and only one washing pool is equipped with dry toilet paper(0.44%).89.80%therapeutic vehicle is equipped with hand-rub,but the hand-rub is only 59.79%available in the ward.The hand-rub equipped rate at diagnostic room and surgical dressing room are,respectively,66.67%and 60%.The availability of hand-rub is lowest at nurse station which is only 6.67%.In addition,only 48.80%hand-rub is with hand hygiene reminders posters.3 The total score of hand hygiene knowledge is 28.The results shows that the average knowledge score is 18.59±2.39(12-27)for medical staffs from the 15 inpatient departments with the correct rate of 66.39%.The medical staffs' knowledge of gloves usingis highest of up to 97.39%,followed by the other knowledge of hand hygiene(84.7%),"5 Moments" knowledge of hand hygiene(65.49%),knowledge of health-care-associated infections(62.13%).Their knowledge about alcohol-based hand-rub and hand hygiene options is relatively lower,which are 55.60%and 50.31%respectively.There is significant differences in the knowledge of hand hygiene among medical staffs with different educational levels(p<0.05).The investigated medical staffs generally believe that hand hygiene is a effective way to prevent health-care-associated infections.With regard to the ways to improve the hand hygiene,the respondents think training is the most effective way.Improve the availability of hand hygiene supplies is also important.However,they think the impact of management mechanism and interpersonal factors is relatively lower.In terms of the impact of the surrounding interpersonal relationship on personnel hand hygiene,the respondents think that the department manager plays an very important role,followed by colleagues and the impact from patients is smallest.The reported self-evaluation of and other-evaluation of the hand hygiene compliance rate are generally high.The self-evaluation hand hygiene compliance is positively associated to attitude of hand hygiene,but negatively correlated with age,education and the difficulty of performing hand hygiene(p<0.05).4 The studied hospital does not have policy to support and develop hand hygiene,The current policy is more about hand hygiene operation and supplies.There is no sytematic hand hygiene management policy.The expenditure of hand hygiene products are borne by each departments.Conclusions:1 The hand hygiene compliance of medical staffs in these inpatient departments is pretty low with a rate of reaching 15.77%.Both doctors and nurses have lower hand hygiene compliance and there is no difference between the two groups.The hand hygiene compliance for medical staffs from E.N.T and ophthalmology department is the lowest.With regard to the hand hygiene at "five moments",the hand hygiene compliance of "After body fluid exposure risk" is highest and compliance of "Before touching a patient" is the lowest.In terms of the choice of hand hygiene approach,most medical staffs are more likely to choose hands washing.2 Hand hygiene supplies are not available at nurse station and some treatment rooms at this hospital.The supplies of the dry hand papers vacancies and supplies of hand soap is not enough.In addition,hand-rub is also not adequate.3 Medical staffs' knowledge of hand hygiene knowledge is not high especially on the hand-rub and hand hygiene options.The majority of interviewed medical staffs pay less attention on hand hygiene.In addition,the training efficiency of the hand hygiene is low at this hospital.It is required to strengthen the training of the hand-rub knowledge and improve the awareness of the importance of hand hygiene ·4 There is no formal hand hygiene management policy in this hospital which can not guarantee the implementation of hand hygiene.All hand hygiene costs are budgeting from the department income,which will lead to the lack of hand hygiene supplies.