| BackgroudHospital-Acquired Infections(HAIs)are a maj or public health issue and can not let our guard down.The incidence of HAIs in developed countries is from 3.5%to 12%,that is lower than low and middle income countries where the incidence is 5.7%to 19.1%.HAIs can cause considerable economic damage to the patients,hospitals and the country,and prolongs the average hospital stay of patients by at least 2.61 days.Hand hygiene is the most important,simple,economic and effective way to prevent HAIs,especially those caused by contact transmission.Higher hand hygiene rate can reduce hospital infections rate by 30%.However,at present,the hand hygiene compliance rate of health care workers in China is still low.Various intervention measures have been adopted such as education and training,PDCA and comprehensive intervention,and hand hygiene compliance has been significantly improved during the intervention.However,these measures did not significantly improve hand hygiene compliance after intervention and can not be used as a long-term way to improve hand hygiene compliance.An important challenge for improving hand hygiene compliance is to find an accurate and reliable method to measure hand hygiene compliance.Although the direct observation method is the main measurement method that currently used,it also has many shortcomings.For example,hawthome effect obviously exists in the process of direct observation,and the measured value of hand hygiene compliance rate is nearly three times higher than the true value.In recent years,electronic hand hygiene monitoring systems have been used more and more widely in health care system at home and abroad,and are considered to be one of the potential effective alternatives for measuring hand hygiene compliance.However,due to the lack of research on the feasibility of system application,the effect of application and economic for the electronic hand hygiene monitoring system in China,it is not enough to draw a comprehensive and reliable conclusion at present.Therefore,this study analyzed the impact of the use of the electronic hand hygiene monitoring system on hand hygiene compliance rate for health care workers,the incidence of HAIs,as well as the cost-benefit for the system,and provided suggestions for further promoting the use of the hand hygiene electronic monitoring system widely.ObjectiveThis article evaluated the application effect of the electronic hand hygiene system by studying the changes in hand hygiene compliance of health care workers after using the system in a tertiary hospital in Shandong Province and the the changes in the incidence of HAIs.A cost-benefit analysis was conducted to evaluate the economic effects of the system and provide suggestions for promoting the use of the electronic health monitoring system widely.MethodsThe research data comes from a tertiary hospital in Shandong Province.We surveyed doctors and nurses in five ICU units and analyze the change of hand hygiene compliance rate from June 2018 to December 2019.In terms of application effect analysis,methods such as composition ratio and rate are used to descriptively analyze the general information of the survey ed medical staff,such as gender,department,and professional title.At the same time,the methods of rate and non-parametric tests(Mann-Whitney U test and Kruskal-Wallis test)are used to assess the overall changes in the hand hygiene compliance rate of the medical staff under investigation,between different departments,different occupational categories,and different professional titles.Descriptive analysis and comparative analysis of hand hygiene compliance rates between time and different time periods were carried out.Partial correlation analysis was used to analyze the relationship between changes in hospital infection rates and hand hygiene compliance.In terms of economic effect analysis,the spread dynamics model is used to simulate the spread of drug-resistant bacteria in the ICU department to establish the relationship between the hand hygiene compliance rate of medical staff and the change of hospital infection rate,and the cost-benefit ratio method is used to match the electronic health monitoring system Conduct a cost-benefit assessment.ResultsA total of 351 health care workers were surveyed in this study.Nurses account for 84.62%;women account 66.67%;82.62%of the health care workers had primary titles.The average hand hygiene compliance rate of health care workers is 68.18%.During the period of investigation,the hand hygiene compliance rate increased from 39.90%to 86.90%,rising in volatility.The hand hygiene compliance rate of nurses(70.30%)is higher than doctors(64.86%),and there was a significant differences(U=2123,P<0.05);There were significant differences in hand hygiene compliance among health care workers with different professional titles(H=5.683,0.05).The hand hygiene compliance rates of the primary,intermediate and senior professionals are 72.06%,68.58%,and 62.48%respectively;the hand hygiene compliance of health care workers did not show significant differences on different working days(H=0.917,P>0.05).The average compliance rates of health care workers from Monday to Friday were 69.47%,68.15%,and 69.57%,66.63%,68.21%,respectively.But the average compliance rate of health care workers in the morning and afternoon,different periods of each day(every 2 hours is a unit)showed significant differences(U=1683,H=22.7,P<0.05),the compliance rate in morning and afternoon were 77.32%and 59.79%respectively;the compliance rate of health care workers was 58.47%at 16-18 PM and the lowest compliance rate was 55.56%at 10-12 AM.There are still many problems in using the system such as inconvenience to wear the badge,induction failure of the system occasionally,long time for maintenance and inadequate supervision by the manager.The incidence of HAIs is relatively stable in this hosoital.From June 2018 to December 2019,the infection rate in the five departments varied between 4.51%and 9.59%.The overall fluctuation range was relatively small,and there was no obvious trend of increase or decrease which is no correlation with hand hygiene compliance rate(r=0.178,p>0.05).When the hand hygiene compliance rate increased to 50%and 60%,the net benefit of hospitals using the system was-50,900 RMB and 72,000 RMB.If the compliance rate can be increased to 90%,and the hospital has the largest net benefit of 244,000 RMB.ConclusionsAfter the application of the electronic hand hygiene monitoring system in this hospitals,the hand hygiene compliance of health care workers has improved.The hand hygiene compliance of senior professionals was lower than intermediate and junior professionals.Hand hygiene compliance rates are low during the peak hours.The study found that if the hand hygiene compliance rate is increased to more than 70%,the application of the system will be cost-benefit.However,There are still many problems in using the system which need to be further solved in the future,such as inconvenience to wear the badge,induction failure of the system occasionally,long time for maintenance and inadequate supervision by the manager.Based on these findings,we make the following recommendations:(1)Strengthen the management of the electronic hand hygiene monitoring system;(2)Strengthen the training and supervision of hand hygiene for target population;(3)Economically developed regions could be encouraged to take the lead in using the system;(4)Carry out more researches on the electronic monitoring system of hand hygiene. |
PDF Full Text Request