临床护理和实践杂志

ISSN:2639-9911

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今天在医疗保健中洗手：为什么我们没有变得更好？

Nicholas S Carte*

Graduate Faculty Lead, Department of Nursing & Health Professions, Manchester, NH, 03101, USA

*Address for Correspondence:尼古拉斯（Nicholas）的Carte博士，AGNP-C，APRN，护理与健康专业系研究生教职员工，美国新罕布什尔州曼彻斯特市商业街33号，美国03101，美国，电话：（910）617-2516;电子邮件：nickphd@hotmail.com;n.carte@snhu.edu

Dates:Submitted:2019年4月1日；得到正式认可的：2019年4月24日；发布：2019年4月25日

如何引用本文：carte ns。今天在医疗保健中洗手：为什么我们没有变得更好？临床护理练习。2019;3：014-016。doi：10.29328/journal.cjncp.1001011

版权许可证：©2019 Carte NS等。这是根据Creativ金博宝app体育e Commons归因许可分发行的开放访问文章，该文章允许在任何媒介中不受限制地使用，分发和复制，前提是适当地引用了原始作品。

2010年，一项研究表明，只有约40％的医生和其他医疗保健提供者遵守医院和其他医疗机构中适当的手动卫生技术。这些统计数据令人震惊，因为医疗保健专业人员是为卫生和不育设定金标准的人，但是他们仍然发现在每种实践中都很难证明这一标准[1]。即使联合委员会支持手动卫生是预防医疗相关感染（HCAI）的最关键干预措施（HCAIS），手卫生的合规率尚未大大改善[2]。本文摘要的目的是回答一个问题，为什么即使有证据支持适当的手卫生会减少HCAIS，为什么不进行洗手？

我们几代人都知道用肥皂和水洗手是适当的个人卫生的一部分[3]。实际上，通过法国药剂师的示威游行，这种用某种形式的防腐剂清洁的概念出现了。在1822年，这位药剂师希望使用氯化物或肥皂溶液来消除人类尸体的恶臭，发现这种溶液也可以用作消毒和防腐剂[4]。直到1975年，疾病控制与预防中心（CDC）才首先提出了医院的正式洗手指南[5]。

一些进展

作为预防感染的基础，医疗保健环境中适当的手卫生有助于减少患有HCAI的患者的机会。随着这些严重的感染，有时还会威胁生命的并发症。疾病控制与预防中心（CDC）确定，在这些医疗机构中，近31例住院患者中有近1人患有一种感染[6]。从以前的每天25分中的1个结果中提高了这些数字，已经取得了一些进展，但需要做更多的事情[7]。

The culprit

Surprising, the hands that offer the much-needed healthcare services to patients are the ones that are often to blame for the spend of healthcare-associated infections [2,3,5,8]. As the most common vehicle for the transmission of HCAIs, the healthcare professional is the one who can prevent the spread of the resistance organisms leading to HCAIs and thus, decrease the cost of healthcare [8,9]. Of course, major organizations including the CDC and the World Health Organization (WHO) continue to launch patient safety campaigns in an attempt to improve hand hygiene compliance among healthcare professionals [10]. The findings of several studies have determined that it is a combination of many factors that is leading to the lack of a 100% compliance in hand-hygiene among healthcare professionals [8].

合理化数字

人们通常可以试图将责任归咎于也许没有进行适当的手卫生的人。但是，在全国范围内适当的手工卫生方案中，持续数量较低的问题（平均）仍然是40％的医生和其他医疗保健提供者。有几个问题导致这些较少的数字和解决方案可以改善它们[8,10]。

Problem One: We think we are in compliance

如果医疗机构的个人（这意味着每个人）不知道手工卫生的合规率，那么这将是任何医疗机构改善手工卫生中的第一个也是最大的障碍。解决方案是“向他们展示数字”。如果合规团队使用某种形式的客观监控系统，则事实证明，这可以提高对手动卫生指南的合规性[8,10]。

问题第二：谁有时间这样做？

This is another common reason for many health care professionals to identify for the low adherence to hand hygiene. Many facilities do attempt to offer reminders through posters, signs, and so on. In fact, this method of attempting to increasing compliance rates in this area in healthcare has been going on for decade. The issue is that the techniques have little proven success. The staff know they need to practice proper hand hygiene. The solution could be eliminating the steps to process and increase efficiency. One example could include: a lean technique for organizing work-flow such as the 5S methodology (sort, straighten, shine, standardize, and sustain) [11]. This method focuses on addressing the system issue and potentially frees up the individuals time. Another solution is incentive based compliance rate hand hygiene goals. A good way to improve patient-safety and meet these goals [8,10].

问题三：供需问题

If you supply the material, someone may use it. However, you must have enough of the supply available for the individual to use the resource. However, this is not often enough as the sanitizer, soap dispenser, and sink can often be located in an inconvenient location. The best-intention to comply if the barriers are limiting the healthcare profession. The solution is simply asking the assigned staff to establish a process for restocking the soap dispensers and sanitizers. In addition, consider reviewing the location of each for convenience of healthcare professionals [8,10].

One interesting alternative

一些医疗机构已经实施了所谓的无握手区域。这种方法从传统的手工摇晃变为其他向某人打招呼的方法，包括温暖的微笑，纳马斯特或拳头撞击[9]。但是，这些替代性交流手段仅在HCAIS问题上提供了创可贴。他们并不反映需要解决医疗保健提供者缺乏感染和控制的关注。通过行为改变，如何改善手动卫生的依从性。当然，改变人类习惯在全球范围内仍然是一个持续的挑战。

我们为什么不改善？

There is not a simple answer to this question concerning the lack of improved hand hygiene to prevent HAIs among healthcare professional. Through many studies, research has proven that a single intervention doesn’t work in addressing the low compliance rate for hand hygiene. Instead, the best approach appears to be combination of support from leadership. These approaches include the following: appropriate access to supplies, frequent educating of staff and professionals, observation and training, and remainders [9]. In addition, there is evidence to support that surveillance and performance feedback have improved the percentage of hand hygiene among healthcare professional [8,10]. If we wish to move the needle forward on the compliance hand hygiene front, a concerted team effort will be needed among all involved who in healthcare facilities.

即使到21世纪，医疗保健职业之间的手工依从性仍然是一个挑战。在全球范围内，该人群适当的手卫生的合规率持续下降到50％以下[1,8,10]。许多出版物提供了解决此问题的解决方案，包括这篇简短的文章。在本文中，首先概述了从19世纪初期到当前CDC的建议的简要历史。然后，审查了几十年来继续成为问题的潜在原因。此外，解决了三个问题。当然，可以讨论有关医疗保健中适当手动卫生技术的主题的更多内容。在将来的文章中，应探讨对手动卫生和多模式的多学科方法的探索。考虑技术在进一步支持手动卫生方面的作用的考虑是要考虑未来研究的另一个领域。