|
|
检索丨刘金淑（濮阳市油田总医院）
翻译丨孔晓明（溧阳市人民医院）
审核丨周超群、陈志锦
根据《美国感染控制杂志》8月刊发布的一项新研究，通过新工具，患者和家属感到有权提醒医护人员进行手卫生，能成功提高手卫生依从率，但只有一半以上的医生认为患者应提醒医务人员进行手卫生。
医疗保健相关感染（HAIs）会增加疾病发生率和死亡率，据估计，美国急诊医院入院患者5%至10%会发生HAI。大多数HAI是可预防的，减少HAI的唯一最有效的措施是手卫生。
西维吉尼亚大学（WVU）医学院的艾里逊·辛格林博士（MD）领导了一个多学科研究团队，对西维吉尼亚大学（WVU）医学院Ruby纪念医院住院儿童的家长、成人患者和初级保健医生进行了横断面调查，该医院是位于瓦尔多摩摩根镇设有645张床位的三级保健教学医院。多学科研究团队，包括WVU公共卫生学院的Kayeromi Gomez博士、WVU心理学系的Ellen Manegold 学士和WVU医学院的Rashida Khakoo医学博士，使用匿名自填问卷调查了他们对医院新的患者授权工具（PET）的态度。家长和病人调查表分发于2015年12月至2016年6月；医生调查于2015年11月进行。
APIC总裁，FAPIC、CIC、MPS中心的Linda Greene说:“患者参与日益成为手卫生改进策略的重要组成部分。医疗机构必须认识到患者和家属是医疗团队的重要组成部分，应鼓励他们参与手卫生活动。”
包括108名成年患者和114名家长，共有222人完成了调查。大多数成年患者（64％）和家长（70％）表示，PET使他们感觉在治疗方面能更多地控制。大多数家长和成年患者认为能舒适地使用PET来提醒医护人员进行手卫生。然而，研究人员指出，如果医生没有执行手卫生，家长更有可能提出来的比例比成年患者高20%。在Ruby纪念医院，由于医院多方面提倡医务人员手卫生，手卫生率从2015年的48％上升到2016年的约75％。领衔研究的作者Lastinger说：“手卫生率达到48%是很正常的，所以75％就很惊人了！”
在包括29名住院医师和60名主治医师的89个医务人员答卷中，只有54.9％的受访者认为患者应参与提醒医务人员进行手卫生。总的来说，医生表示，他们更喜欢患者口头提出请求，而不是使用PET提醒他们进行手卫生。
在不支持患者参与的医生当中，37％的受访者认为提醒医生执行手卫生并不是患者的责任；16％的受访者认为医生会感到尴尬；13％的受访者认为会对医患关系产生负面影响。
虽然一些研究已经研究了患者参与在医护人员手卫生中的作用，但很少有人研究患者家属提醒医务人员进行手卫生的作用。然而，研究指出，如果患者参与取得成功，医务人员必须将其视为有益的而不是威胁，这点已被证明是患者参与取得成功的其中一个障碍。
Lastinger总结道：“根据本项研究的结果，患者授权似乎是促进医护人员执行手卫生的有效策略，但是医务人员对PET的接受仍然是一个挑战。”
来源:：APIC
参考文献：Reference: Lastinger A, et al. Use of patient empowerment tool for hand hygiene. American Journal of Infection Control, Volume 45, Issue 8 (August 2017).
原文：
Empowering Patients Effectively Improves Physician Hand Hygiene
Armed with new tools, patients and parents felt empowered to remind healthcare providers to perform hand hygiene, successfully improving compliance rates, but just over half of physicians felt that patients should be reminding providers, according to a new study published in the August issue of the American Journal of Infection Control.
Healthcare-associated infections (HAIs) contribute to significant rates of illness and mortality, with an estimated five to ten percent of patients admitted to acute care hospitals in theUnited Statesacquiring an HAI. Most HAIs are preventable, and the single most effective measure to reduce HAIs is hand hygiene.
Allison Lastinger, MD, of the West Virginia University (WVU) School of Medicine, led a multidisciplinary research team that performed a cross-sectional survey of parents of hospitalized children, adult patients and primary care physicians at the WVU Medicine J.W. Ruby Memorial Hospital, a 645-bed tertiary care teaching hospital in Morgantown, W.Va. Using an anonymous, self-administered questionnaire, the multidisciplinary research team—which included Kayeromi Gomez, PhD, of the WVU School of Public Health, Ellen Manegold, BA, of the WVU Department of Psychology, and Rashida Khakoo, MD, of the WVU School of Medicine—examined their attitudes toward a new patient empowerment tool (PET) at the hospital. The parent and patient surveys were distributed from December 2015 to June 2016; the physician survey was distributed in November 2015.
“Patient involvement is increasingly recognized as an important component of hand hygiene improvement strategies,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. “Organizations must realize that patients and families are an important part of the healthcare team, and their involvement in hand hygiene campaigns should be encouraged.”
A total of 222 adult patients and parents completed the survey (108 adult patients and 114 parents). Most adult patients (64 percent) and parents (70 percent) said the PET made them feel more in control of their care. Most parents (77 percent for physicians and 81.4 percent for nurses) and adult patients (64.8 percent for physicians and 71.2 percent for nurses) felt comfortable using the PET to remind healthcare workers to perform hand hygiene. Researchers noted, however, that parents were nearly 20 percent more likely than adult patients to speak up if a physician did not perform hand hygiene. In Ruby Memorial Hospital, hand hygiene rates increased from 48 percent in 2015 to approximately 75 percent in 2016 as a result of the hospital’s multipronged initiative to increase handwashing rates among its healthcare providers. “Forty-eight percent is pretty standard,” said lead study author Lastinger, “so 75 percent is phenomenal.”
Among 89 healthcare provider responses (29 residents and 60 attending physicians), only 54.9 percent felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient make the request verbally, rather than using the PET to remind them to perform hand hygiene.
Of the physicians who did not support patient involvement, 37 percent felt that it was not the patient’s responsibility to remind physicians to perform hand hygiene; 16 percent felt that it was embarrassing to the doctor; and 13 percent felt that it would have a negative impact on the patient-physician relationship.
While a number of studies have examined the role of patient involvement in healthcare worker hand hygiene, few have examined the role of family members in reminding healthcare providers to perform hand hygiene. However, the study notes that if patient involvement is to be successful, healthcare workers must accept it as helpful and not as a threat, which proved to be somewhat of an obstacle in this instance.
“Based on the results of this study, patient empowerment appears to be an effective strategy to facilitate healthcare workers’ adherence to hand hygiene, but acceptance of the PET by providers remains a challenge,” said Lastinger. “Barriers to hand hygiene adherence among healthcare providers should be identified and addressed.”
Reference: Lastinger A, et al. Use of patient empowerment tool for hand hygiene. American Journal of Infection Control, Volume 45, Issue 8 (August 2017).
Source: APIC
[本文图片来源于互联网，如有侵权请告知]
图文编辑：独白
审稿：赵静 孙庆芬
|
|
发表于 2017-9-6 21:02:08