An Investigation And Intervention About Hand Hygiene Of Ward Nurses

Objectives To investigate the present situation of ward nurses’ knowledge, perception and practice about hand hygiene in a general3A-level teaching hospital in a capital city, thus to understand hospital nurses’ hand hygiene situation and formulate corresponding measures. To explore the effective strategies, improve the hand hygiene compliance of ward nurses, decrease HCAI, ensure patient and medical staff safety and enhance healthcare quality continuously.Methods Convenience sampling method was used. A general3A-level teaching hospital which had41wards in a capital city was selected. Of which14wards were selected using a completely random sampling method. All clinical teachers of the14wards and the nurses on duty on the same day who were in charge of patients were investigated. Field observation and questionnaire survey were carried out. In the first stage, two trained observers using the standard Observation Form, publicized by the World Health Organization carried out field observation to record the practice of hand hygiene in wards. A questionnaire survey was implemented subsequently. The self-reported questionnaires included three parts:basic personal information sheet, Hand Hygiene Knowledge Questionnaire for Health-Care Workers and Perception Survey for Health-Care Workers. In the second stage, head nurses and clinical teachers from the selected wards were trained with targeted interventions according to the results of the first stage. In the third stage, follow-up data was collected by using the same method after1month. Descriptive analysis, parametric analyses (independent-sample t-test, x2test) and Pearson correlation analysis were performed to analyze the basic information, knowledge, perception and performance of subjects, as well as to evaluate effects before and after intervention.Results A total of47,44nurses were observed and the response rate for the questionnaire was100%(47/47,44/44) before and after intervention respectively. Reason of failed follow-up was production, vacations, etc. Detailed information was as follows:1、The total observation time in baseline survey was12,514minutes, an average of31.21±1.98minutes/person. One month later, the total observation time was12,586minutes after intervention, mean31±1.37minutes/person. Hand hygiene compliance of ward nurses before and after intervention increased significantly from11.7%(47/401) to29%(118/406). Especially the hand hygiene compliance of clinical teachers significantly increased from12.32%(17/138)(baseline survey) to28%(40/143)(after intervention), there was a statistically significant (p<0.05). The improvement of hand hygiene compliance, which wasn’t significant difference in before clean/aseptic procedures and were significant difference in the other4indications (before touching patients, after body fluids exposure risk, after touching patients and after touching patients’ surroundings),p<0.01.2、HCW-HH knowledge questionnaire:Baseline survey showed that the rate of using alcohol-based handrub for hand disinfection was100%. One month later after intervention, the result was89.4%. The total score was15.58±2.54(10-21) on average in baseline survey and16.09±2.48(12～22) on average after intervention. An independent-sample t-test was performed to analyze the total score in baseline survey and after intervention, which was not significant difference (a=0.05, p=0.61). Comparing with baseline and after intervention, the score of clinical teachers was significant difference (t test p<0.05).3、HCW-HH perception questionnaire:There was no significant change in the overall level of nurses’score before and after intervention, but the average score of clinical teachers in the difficulty of performing hand hygiene increased from3.15to5.54and was significant difference (p<0.05)Conclusion Although ward nurses’hand hygiene compliance is still not optimistic, but most have realized the importance of hand hygiene. So the next step, the intervention to improve hand hygiene compliance is based on scientific allocation of human resources and reducing working intensity, to equip with hand hygiene facilities reasonably, strengthen management, optimize operation process, improve awareness and ability of clinical teachers to guide other clinical ordinary nurses as well as uphold and strengthen hand hygiene training and supervision together. It will be the most effective way to improve hand hygiene compliance.