| Objective1.To understand the current situation and problems of hand hygiene management in hospitals through literature review method,on-site observation method,questionnaire survey method and semi-structured interview method.2.To establish a SWOT analysis model and use the SWOT analysis method to systematically analyze the current situation of hand hygiene management in hospitals,and to develop countermeasures for hand hygiene management in hospitals based on the results of SWOT analysis.3.To evaluate the quantitative hand hygiene management countermeasures by expert rating method and select the optimal improvement countermeasures,so as to provide scientific basis and practical guidance for improving the hand hygiene management in hospitals.Methods1.Investigation of the current situation of hand hygiene management in hospitals(1)Literature review: summary analysis of hand hygiene management information and statements of a tertiary hospital in Linyi City in the past five years(2017-2021).(2)Field observation: from April 2019 to June 2019,the hand hygiene implementation of 55 clinical and medical-technical department staff in a tertiary hospital was observed by the field observation method.A hospital infection prevention and control officer from each department was selected as an observer for covert observation and retrospective video surveillance using the Hand Hygiene Observation Surveillance Form for Hospital Staff published by the World Health Organization(WHO).The study was conducted for a total of 54 days,with a cumulative observation time of 28530 minutes,18.7 ± 1.05 minutes per observation,and a total of 8859 hand hygiene moments were recorded.The observation data were statistically analyzed using SPSS 25.0.(3)Questionnaire survey: from July 2019 to September 2019,after the on-site observation study,the WHO’s Hand Hygiene Knowledge Questionnaire for Hospital Staff and Hand Hygiene Perception Questionnaire for Hospital Staff were used to conduct a questionnaire survey for staff in 55 departments of the hospital,and an electronic questionnaire was made,and the questionnaire QR code was pushed through We Chat,scanned and answered,and in accordance with the inclusion and exclusion criteria 220 staff members were included in the study,and 216 valid responses were received.The survey data were statistically analyzed using SPSS 25.0 and statistically described using percentages,mean ± standard deviation and chi-square test.(4)Semi-structured interviews: 15 people were selected to conduct semi-structured interviews with managers of administrative departments related to hospital infection management and staff of clinical departments,and the interview data were summarized and analyzed by the Colaizzi seven-step method.2.SWOT analysis of hand hygiene management in hospitalsBased on the results of the survey on the current situation of hand hygiene management in hospitals,the strengths,weaknesses,opportunities and threats of hand hygiene management in hospitals were summarized,and a SWOT analysis model was constructed to conduct a comprehensive analysis of the internal and external environmental factors of hand hygiene management,and countermeasures for hand hygiene management in hospitals were formulated based on the results of SWOT analysis.3.Construction of countermeasures for hand hygiene management in hospitalsA total of seven experts,including experts from the Center for Disease Control and Prevention,leaders of hospital authorities,leaders of administrative departments related to hospital infection management and heads of clinical departments,were selected to evaluate and score the hand hygiene management countermeasures in four dimensions:feasibility,effectiveness,necessity and economy,and then the optimal countermeasures were selected by using an additive evaluation-type calculation method.Results1.the current situation of hand hygiene management in hospitals(1)The results of the literature study: from 2017-2021,the trend of hand hygiene compliance and correct rate curves monitored in hospitals over a five-year period is basically the same,and is at a high level of 95.78%～100.00%;the use of hand-free sanitizer,in the last five years,shows an upward trend,and the use of soap is decreasing year by year,while the use of soap is increasing year by year,indicating that soap is slowly being soap replaced by soap;in the past five years,there were three peak periods of hand sanitizer consumption in hospitals,namely 2018,2020 and 2021,which were related to the 2018 accreditation of Grade 3 A hospitals,the 2020 novel coronavirus pneumonia epidemic and the rebound phenomenon of the novel coronavirus pneumonia epidemic in local areas within Shandong Province in 2021.(2)Quantitative study results: Through on-site observation,it was found that the average hand hygiene compliance was 75.35% and the average correct hand hygiene rate was 86.71%,and the overall implementation of hand hygiene in hospitals was not satisfactory.The hand hygiene compliance in different departments was the highest in the operating room(92.84%),followed by the ICU(82.18%),and the lowest in the imaging and laboratory departments(55.92%);in terms of different professions,the hand hygiene compliance of nurses was 80.90% and the correct rate was 91.12%,which was the highest among all study subjects,and the hand hygiene compliance of property and cleaning staff was the lowest(55.04%);the compliance of the five moments of hand hygiene,the highest was "after possible contact with the patient’s body fluids"(95.70%)and the lowest "after contact with the patient’s surroundings"(55.46%).The average knowledge rate of hand hygiene was 92.49%,and the knowledge rate of hand hygiene among hospital staff such as medical nurses and medical technicians was high,while the knowledge rate of hand hygiene among third-party managers such as property staff,cleaning staff and caregivers was relatively low.Respondents had a high overall score(10.76±1.34)for their attitude toward hand hygiene,affirmed the effectiveness of hand hygiene in preventing hospital infections,and cared most about the department heads’ perceptions of their own hand hygiene,while being less concerned about patients’ perceptions.Property and housekeeping staff had the highest self-rated hand hygiene implementation difficulty score(5.28±1.14)and the lowest self-rated hand hygiene compliance(75.00%)among foreign study staff.(3)Qualitative study results: The qualitative study finally summarized three themes,namely,Theme 1 was positive feelings about hand hygiene management: hand hygiene management is standardized,the system is perfect,the organization is sound,and hand hygiene management is effective;Theme 2 was negative feelings about hand hygiene management: the implementation of hand hygiene is not optimistic,and hand hygiene monitoring and supervision are problematic;Theme 3 was method for hand hygiene management improvement: establishing a mature hand hygiene culture,develop longterm plans and milestones,continuously improve hand hygiene management,and strengthen hand hygiene monitoring and supervision.2.SWOT analysis of hand hygiene management in hospitals(1)Strengths: hospital hand hygiene management system is perfect,management organization is sound,medical staff hand hygiene training and assessment mechanism is perfect,clinical departments have strong compliance with hand hygiene management,medical staff pay attention to the prevention and control of hospital infection.(2)Weaknesses: non-medical staff is the weak link of hand hygiene management,unreasonable allocation of human resources,single form of hand hygiene training,unsound hand hygiene culture,lack of effective supervision and incentive mechanism,hand hygiene economic expenditure related to departmental performance accounting,quality of hand hygiene supplies and unreasonable use of gloves affect hand hygiene motivation.(3)Opportunities: Health administrative departments have strict requirements for hospital infection control,hospital grade evaluation plays a role in promoting hand hygiene management,the occurrence of public health events plays a warning role for hand hygiene management in hospitals,hand hygiene supplies and hand hygiene monitoring means keep advancing with the development of science and technology.(4)Threats: Patients have high expectations of hospital medical standards and the medical environment,the new coronavirus pneumonia epidemic poses challenges for hospital infection management,and the actual level of hand hygiene implementation in hospitals does not meet the requirements of the tertiary hospital grade review.(5)Develop countermeasures for hand hygiene management in hospitals:(1)Carry out various publicity activities with the theme of hand hygiene;(2)Take the hospital grade review as an opportunity to promote continuous improvement in the quality of hand hygiene management;(3)Deepen the connotation of hand hygiene,strengthen the concept of hand hygiene and cultivate the spirit of prudence;(4)Cluster behavioral interventions;(5)Use the knowledge,belief and action model to improve hand hygiene compliance;(6)Set up role models and exemplary effects;(7)Strengthen the hand hygiene management of non(8)Optimize human resources and workflow;(9)Take the prevention and control of the novel coronavirus pneumonia epidemic as an opportunity to create a hand hygiene culture;(10)Strengthen administrative supervision with leadership participation and make full use of the Hawthorne effect;(11)Enrich the form of hand hygiene training;(12)Hand hygiene costs are covered by the hospital and increase performance incentives;(13)Upgrade hand hygiene facilities and supplies and standardize the use of gloves;(14)Formulate a long-term plan and set phased goals;(15)Draw on the management experience of other hospitals;(16)Continuously upgrade hand hygiene monitoring and supervision methods.3.Research on countermeasures of hand hygiene management in hospitalsSixteen hand hygiene management countermeasures in hospitals were rated by the expert scoring method,and six optimal countermeasures were finally selected by calculating the score ranking,which were(1)To take the hospital grade review as an opportunity to promote continuous improvement of hand hygiene management quality;(2)To strengthen hand hygiene management for non-hospital staff;(3)To strengthen administrative supervision with leadership participation and make full use of the Hawthorne effect;(4)To take the prevention and control of the novel coronavirus pneumonia epidemic as an opportunity to create a hand hygiene culture;(5)To use the knowledge,trust and action model to improve hand hygiene compliance;(6)To develop long-term plans and set phased goals.Conclusions1.The factors affecting hand hygiene management in hospitals are multifaceted,including the influence of people,materials,systems,policies and other external factors.The literature review method,on-site observation method,questionnaire survey method and semi-structured interview method can provide a true and comprehensive picture of the current situation of hand hygiene management.2.Using SWOT analysis,we conduct a comprehensive,systematic and accurate study of the current situation of hand hygiene management in hospitals,analyze and summarize the various internal strengths and weaknesses and external opportunities and threats related to hand hygiene management,and arrange them in the form of a matrix,then match the various factors with each other and analyze them,so as to formulate corresponding management countermeasures according to the analysis results and make the formulation of hand hygiene management countermeasures in hospitals more The analysis will be based on the results of the analysis.3.The quantitative evaluation of hospital hand hygiene management countermeasures in four aspects of feasibility,effectiveness,necessity and economy by expert rating method can objectively select countermeasures that are in line with the current situation of the hospital and are practical and feasible,which is conducive to the improvement of hospital hand hygiene management. |
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