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The Lancet Infectious Diseases:澳大利亚国家手卫生倡议8年后对感染控制措施、卫生保健工作者教育和临床结果的影响:一项纵向研究

发布日期:2018-10-29来源:The Lancet Infectious Diseases发布人:感控雏鹰


摘要

背景

国家手卫生倡议(NHHI)是一项基于世界卫生组织五大手卫生时刻的标准手卫生文化变革计划,旨在提高澳大利亚卫生保健工作者的手卫生依从性,并降低与卫生保健相关的感染风险。我们分析了它的有效性

方法

在这项纵向研究中,我们评估了国家手卫生倡议(NHHI)实施8年后(2009年1月1日至2017年6月30日)的结果,包括医院参与,手卫生依从性(以观察到的时刻比例衡量)三次年,教育参与,成本和与卫生保健相关的金黄色葡萄球菌菌血症(HA-SAB)的发生率的关联 。

结果

2009年至2017年期间,国家卫生保健机构的参与率增加(2009年有105家医院[103家公立和2家私营],而2017 年 为 937家医院[598家公立和339家私营])和整体手卫生依从性在2009年为63.6%(56978个手卫生时刻中执行了36 213 [95%CI 63.2-63.9] ,到2017年依从性提高至84.3%(586 559个手卫生时刻中执行了494 673) [984.2-84.4]; p < 0.0001)。每一个手卫生时刻以及每一个卫生保健工作人员观察组手卫生依从性也都增高了,包括医务人员在2009年依从性为50.5%(8669个手卫生时刻执行了4377)[95%CI 49.4-51.5]而到2017年为71.7%(74 788个手卫生时刻执行了53 620)[71.4-72.0]; P <0.0001)。1 989 713 NHHI在线学习证书课程已经完成。2016年NHHI预算相当于全国每个住院病人的0.06澳元。在澳大利亚的主要公立医院(n = 132)中,改善的手卫生依从性与HA-SAB的发生率的下降相关(RR为0.85; 95%CI 0.79-0.93;p≤0.0001):手卫生依从性每增加10%,HA-SAB的发生率下降15%。

结论

国家手卫生倡议项目(NHHI)证实手卫生依从性的显着持续改善和HA-SAB发病率的下降有关。主要作用包括采用标准化方法的持续中央协调以及医院纳入认证标准。国家手卫生倡议项目可以在其他国家文化变革计划中得到效仿。

资金

澳大利亚卫生保健安全和质量委员会。

Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study

Summary

Background

The National Hand Hygiene Initiative (NHHI) is a standardised culture-change programme based on the WHO My 5 Moments for Hand Hygiene approach to improve hand hygiene compliance among Australian health-care workers and reduce the risk of health-care-associated infections. We analysed its effectiveness.

Methods

In this longitudinal study, we assessed outcomes of the NHHI for the 8 years after implementation (between Jan 1, 2009, and June 30, 2017), including hospital participation, hand hygiene compliance (measured as the proportion of observed Moments) three times per year, educational engagement, cost, and association with the incidence of health-care-associated Staphylococcus aureus bacteraemia (HA-SAB).

Findings

Between 2009 and 2017, increases were observed in national health-care facility participation (105 hospitals [103 public and two private] in 2009 vs 937 hospitals [598 public and 339 private] in 2017) and overall hand hygiene compliance (36213 [63.6%] of 56978 Moments [95% CI 63.2–63.9] in 2009 vs 494673 [84.3%] of 586?559 Moments [84.2–84.4] in 2017; p<0.0001). Compliance also increased for each Moment type and for each health-care worker occupational group, including for medical staff (4377 [50.5%] of 8669 Moments [95% CI 49.4–51.5] in 2009 vs 53?620 [71.7%] of 74788 Moments [71.4–72.0]; p<0.0001). 1989713 NHHI online learning credential programmes were completed. The 2016 NHHI budget was equivalent to AUD$0?06 per inpatient admission nationally. Among Australia's major public hospitals (n=132), improved hand hygiene compliance was associated with declines in the incidence of HA-SAB (incidence rate ratio 0?85; 95% CI 0.79–0.93; p≤0?0001): for every 10% increase in hand hygiene compliance, the incidence of HA-SAB decreased by 15%.

Interpretation

The NHHI has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of HA-SAB. Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes.

Funding

Australian Commission on Safety and Quality in Health Care.

原文链接:https://www.thelancet.com/journals/laninf/issue/vol18no11/PIIS1473-3099(18)X0011-5

简译人:感控雏鹰