醫護人員手衛生對醫院感染發生率和成本效益的影響

陳俊艷　陳劍

摘要：目的 ?研究醫護人員手衛生對醫院感染發生率和成本效益的影響。方法 ?選取2018年10月～2019年10月我院64名醫護人員作為手衛生依從性研究對象，以2018年10月～2019年4月未實施手衛生管理為干預前期，2019年5月～2019年12月實施手衛生管理為干預后期，比較干預前后醫護人員手衛生（接觸患者前、無菌操作前、體液暴露后、接觸患者后、接觸周圍環境后）依從率、手衛生知識評分、正確洗手評分、患者醫院感染發生率、手衛生費用（手消毒劑、洗手液、一次性干紙巾、手衛生總費用及每例患者的手衛生成本）。結果 ?干預后，醫護人員接觸患者前、無菌操作前、體液暴露后、接觸患者后、接觸周圍環境后依從率均高于干預前，差異有統計學意義（P<0.05）;醫護人員手衛生知識評分、正確洗手評分均高于干預前[（41.90±5.12）分vs（28.44±4.65）分]、[（34.98±2.60）分vs（25.45±2.04）分]，差異有統計學意義（P<0.05）;醫護人員醫院感染發生率為1.51%（1/66），低于干預前的8.33%（5/60），差異有統計學意義（P<0.05）;醫護人員手消毒劑、洗手液、一次性干紙巾、手衛生總費用及每例患者的手衛生成本高于干預前，差異有統計學意義（P<0.05）。結論 ?醫務人員手衛生依從性提高，可預防醫院感染，降低醫院感染發生率，提高手衛生成本，但可預防醫院感染藥品消耗，促進經濟運行，增加醫療純收入，提高醫院社會效益和經濟效益，并且對促進醫院可持續發展具有重要的價值。

關鍵詞：醫護人員;手衛生;醫院感染;成本效益

中圖分類號：R197.323 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.18.034

文章編號：1006-1959（2020）18-0104-03

The Effect of Hand Hygiene of Medical Staff on the Incidence

and Cost-effectiveness of Hospital Infection

CHEN Jun-yan，CHEN Jian

（Infection Management Department，Nanjing Tongren Hospital，Southeast University School of Medicine，

Nanjing 211102，Jiangsu，China）

Abstract：Objective ?To study the impact of hand hygiene of medical staff on the incidence and cost-effectiveness of hospital infections.Methods ?64 medical staff in our hospital from October 2018 to October 2019 were selected as the subjects of hand hygiene compliance study. The non-implementation of hand hygiene management from October 2018 to April 2019 was taken as the pre-intervention period，The implementation of hand hygiene management from May 2019 to December 2019 is the post-intervention period. Compare the compliance rate of medical staff before and after the intervention （before contact with the patient， before aseptic operation， after exposure to body fluids， after contact with the patient， and after contact with the surrounding environment），hand hygiene knowledge score， correct hand washing score， incidence of nosocomial infections in patients， hand hygiene costs （hand disinfectants， hand sanitizers， disposable dry tissues， total hand hygiene costs and hand hygiene costs per patient）.Results ?After the intervention， the compliance rate of medical staff before contact with the patient， before aseptic operation， after exposure to body fluids， after contact with the patient， and after contact with the surrounding environment were all higher than before the intervention， the difference was statistically significant （P<0.05）; knowledge of hand hygiene of medical staff score and the correct hand washing score were higher than before the intervention [（41.90±5.12） points vs （28.44±4.65） points]， [（34.98±2.60） points vs （25.45±2.04） points]， the difference was statistically significant （P< 0.05）; the incidence of nosocomial infection among medical staff was 1.51% （1/66）， which was lower than 8.33% （5/60） before the intervention，the difference was statistically significant （P<0.05）; hand disinfectants and hand sanitizers for medical staff The total cost of disposable dry paper towels， hand hygiene and the cost of hand hygiene per patient were higher than before the intervention，the difference was statistically significant （P<0.05）.Conclusion ?The improvement of medical staff's hand hygiene compliance could prevent hospital infections， reduce the incidence of hospital infections， and increase the cost of hand hygiene， but it can prevent hospital infection drug consumption， promote economic operations， increase medical net income， and improve hospital social and economic benefits and it had important value to promote the sustainable development of hospitals.

Key words：Medical staff;Hand hygiene;Hospital infection;Cost-effective

臨床診療、護理操作都需要通過醫護人員的手來完成，手衛生狀況直接影響病原菌的傳播[1]。據相關調查顯示[2]，因醫護人員手衛生造成醫院感染約占所有原因的30%。故手衛生是預防和控制醫院感染最簡單、最經濟的方法，也是保障患者和醫務人員安全的重要途徑。但由于醫護人員工作繁忙或部分醫護人員對手衛生認知不全，或并未將手衛生的意識貫徹到行動中，造成手衛生執行存在偏差，發生手衛生不良問題[3，4]。本研究結合2018年10月～2019年10月我院64名醫護人員為研究對象，旨在探討醫護人員手衛生對醫院感染發生率和成本效益的影響，現報道如下。……