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Regulations and

Status of hand hygiene in hospitals in our country

Abstract With the improvement of our economy, the rapid social development, the improvement of people's living standard and education level, people's attention to medical and health care is getting higher and higher. Hospitals are places where people treat diseases. Therefore, many kinds of pathogens such as microorganisms, bacteria, viruses and chlamydia are found, and most of the patients who enter hospitals are sick, their immunity and immunity are weaker. If the control measures of hospital germs are not available, hospitals Internal infection can pose a safety threat to patients. At present, the infection in the hospital has become a public health problem, and medical staff hands is one of the main routes of transmission of germ infection. Without raising the concern of hand hygiene in the hospital, it causes severe infection in the hospital, which not only wastes the hospital resources but also helps the patients recover and the money will be caused Impact, serious cases have the possibility of death. This article starts from the current situation of hand hygiene in our country, and makes statistics and analysis on the hand hygiene facilities of the hospital, health care, support staff, health cognition of patients' opponents, knowledge level and hand hygiene compliance of medical staff in daily work. According to the actual problems, put forward corresponding monitoring and management measures to complete the hand hygiene facilities, improve the hand hygiene knowledge of medical staff, and strengthen the implementation of health hand hygiene staff.

Infection in hospitals has now become a public health concern of global concern, often resulting in the waste of resources, leading to the waste of time and money, and even worse, taking away their lives. Studies have shown that the main route of transmission leading to nosocomial infections is the medical staff's hands. According to the US CDC's estimates, about 30% of nosocomial infections can be controlled through proper hand hygiene practices. The higher the hand hygiene compliance of medical staff, the lower the hospital infection rate, especially the MRSA infection rate in hospitals is strictly and negatively related to the strict implementation of hand hygiene in the operation of medical personnel. This shows that hand hygiene has become an important means of controlling infections in hospitals. At present, the current status of hand hygiene in medical institutions in our country still has many shortcomings. In addition to describing the current status of hand hygiene for medical staff, this review includes hand hygiene status for hospital support staff and their families.

1. Hand hygiene related concepts

WHO Hand Hygiene Guidelines The definition of hand hygiene is a general term for any activity on hand hygiene. China's "hand hygiene standards for medical staff" for the definition of hand hygiene is a general term for medical staff to wash their hands, disinfect hand hygiene and surgical hand disinfection. Washing hands refers to medical staff washing hands with soap (soap) and mobile water to remove dirt, debris and some pathogenic bacteria from the hands. Sanitary hand disinfection refers to the medical staff rubbing his hands with a quick-drying disinfectant to reduce temporary hand bacteria. Surgical disinfection refers to pre-surgical medical staff with soap (soap) and mobile handwashing, and then hand disinfectant to remove or kill hand temporary resident bacteria and reduce the habitual bacteria. Hand hygiene indications include before touching the patient; before cleaning / aseptic manipulation; after touching the patient's body fluids; after touching the patient; after touching the patient's surroundings.

2. Hand hygiene evaluation and monitoring

At present, hand hygiene monitoring in most hospitals in China is embedded in the management of hospital infection and is carried out by hospital infection management personnel. The method adopted is the WHO direct observation method. The evaluation index is hand hygiene compliance rate, which is mainly the direct observation record of the number of hand hygiene performed on 5 hand hygiene indicators. The calculation method is: (hand hygiene actual times / hand hygiene timing) × 100%. However, the above evaluation and monitoring have not become the implementation of China's industry standards. China only stipulates that the total number of bacterial colonies with both hands after disinfection of sanitary hand should be ≤10cfu / ㎝², and the total number of bacterial colonies with two hands after surgical hand disinfection should be ≤5cfu / ㎝².

3 hand health status

3.1 hand hygiene facilities equipped with the situation

Hand hygiene facilities in China's "Hand hygiene regulations for medical staff" include hand-washing basins, running water, hand soap / hand sanitizer, dry hand products, and disposable dry-hand sanitizers. Convenient hand hygiene facilities are a prerequisite for hand hygiene. However, at present, there are still some hospitals that can not configure adequate adequate hand hygiene facilities according to the requirements of hand hygiene standards. Investigators in China found incomplete hand hygiene facilities as an important reason for restricting hand hygiene, including mobile water and dry tissue paper towels. A survey of 37 hospitals in one city showed that most of the handbasins are equipped with faucets, but 10.81% are still not equipped or can not be used. A hospital survey found that non-contact faucet equipped with only 18.84%, dry paper with only 1.09% equipment rate. In a remote area of the top three hospitals and other ICU clinical departments have no contact faucet, there is no disposable paper towels. As for the investigation of rapid hand disinfectants, it is found that the rate of hand disinfection agents is generally not high, and some health service units do not even have rapid hand disinfectants. This shows that many hospitals in our country hand hygiene facilities, especially hand disinfectants and hand dry products with inadequate. It is also possible to find out about the common use of hand hygiene facilities for patients and patients and on the other hand to indicate that the hand hygiene facilities used by the patients may still be blank at present. In addition, there are many problems such as the setting of the hand washing pool location is irrational and hand washing without hot water in winter. In short, due to the imbalance of regional economic development and the different emphasis on opponents' health, there are imbalanced hand hygiene facilities in various regions and between medical institutions.

3.2 hand hygiene awareness

Hand hygiene is a type of health behavior that requires the practitioner to have a proper understanding and understanding of the conduct of an activity. However, many surveys show that there is currently a wide range of differences in awareness, health care, support staff and patients with hand hygiene .

At a high level, medical staff generally have a high awareness of the basics of hand hygiene. A hand hygiene survey of 10 township hospitals showed that only 43.2% of medical staff knew the definition of hand hygiene and only 33.3% of medical staff knew about six-step hand washing and hand washing indications. From a tertiary hospital in Tianjin survey found that, for individual circumstances, such as contact with the patient's ambulance health awareness is low. Key departments such as ICU staff awareness is higher than the general department. However, the problems of low awareness rate and misunderstanding about the correct use of rapid hand disinfectants and gloves are not clear. Thus, the overall awareness of hand hygiene in primary health care institutions is still not high at present, and there is still much room for improvement in the awareness of basic hand hygiene knowledge such as hand hygiene indications. In addition, Of hospitals also have a low awareness of a certain aspect of the situation, especially for quick-drying disinfectant safety, economy, effectiveness of cognitive deficiencies. Correct use of gloves are misunderstood.

Hospital assistants generally lack awareness of the basic concepts of hand hygiene, while awareness of hand-washing indications is very low. Shanghai area CDC on the hospital staff hand hygiene survey showed that the cognitive rate was only 18.18%. A survey of hand hygiene status of support staff in a top three ward hospital showed that the awareness of hand washing before contact with patients and after contact with patients was only 27.08% and 43.89% respectively. A survey of carers shows that 85% of caregivers have unclear fingerprints on handwashing, 0 before compliance with sterile items, and 9.24% of pre-contact adherence rates. Another survey of hospital staff showed that only 24.32% of them took the six-step hand-washing method, and only 24.32% of them wash their hands after touching patients and departments. The hospital's cleaning staff and care workers and other supporting staff need daily access to the treatment environment, for this type of employee awareness of hand hygiene we can easily overlook. Patients are an important part of the hospital population and there is an increasing emphasis on the importance of monitoring by patients and their families for compliance by handlers in health care, and many people with chronic conditions need self-care, depending on whether the patient has the right Hand hygiene cognition. A survey of patients with hand hygiene status found that 48.61% of patients do not know how to regulate the hand washing method. A survey of family members shows that the correct rate of hand-washing is only 18.6% -45.2%. Overall, our patients awareness of hand hygiene is very low, for this group of patients hand hygiene education have a lot of room for improvement.

3.3 hand hygiene compliance and its influencing factors

China's medical institutions as a whole hand hygiene compliance rate is not high, but there are major differences at all levels. A review of 90 handicapped compliance rates among medical staff in a general hospital with 90 articles found that only 47.83% of hand health workers in our country are compliant. A blind survey of hand hygiene compliance among medical staff found that the average hand hygiene compliance rate was 48%. Hand hygiene survey of township hospitals found that medical staff hand hygiene implementation rate was 21.5%. However, the study on hand hygiene certification found that the hand hygiene compliance rate of medical staff after contact with patients was 54.33%, significantly higher than that of 20.21% before contact with patients. The above studies all show that medical staffs neglect the protection of patients and have a strong sense of self-protection. From the point of view of professional division of labor, nurses hand hygiene compliance is better than the doctor. Hand hygiene compliance by medical technicians is generally low in hospitals. Obviously low hand hygiene compliance among helpers in the hospital. A survey of county nursing workers hand hygiene compliance was 27.0%, cleaning staff only 14.3%. Hand hygiene compliance is also low for patients and their families and varies greatly in the timing of hand hygiene. For example, 95.7% of the patients' families actually assisted in hand-washing after they handled the toilet, but the actual hand-washing rate before and after feeding patients and changing clothes was 20.0% and 14.8% respectively. When nursing a child, 78.9% did not wash their hands after touching the body fluid of a child, 64% did not wash their hands after directly touching the surface of a hospital object, and 90.6% did not wash their hands directly before contacting a child.

In addition to hand hygiene compliance and hand hygiene awareness, hand hygiene compliance also includes inadequate hand hygiene management systems, inadequate enforcement capacity, inadequate compliance monitoring systems and methods, inadequate funding and support. Another heavy workload, no time or too busy and too much hand hygiene on the skin will cause irritation is also an influencing factor. As far as medical personnel are concerned, the development of hand hygiene in different regions and between different medical institutions is unbalanced. This may be caused by differences in regional economy and hospital management. Different departments, due to the different nature of the work, the workload of different work pressure differences and different levels of awareness of the department manager caused a difference. The higher compliance of nurses with hand hygiene than doctors may be due to their management methods and the nurses in our country are generally closely linked with the work of hospital infection. Hospital support workers in our country are generally poorly educated and less health-conscious people, and due to the lack of emphasis on the training of workers on the part of hospitals, hospitals are poorly compliant. For patients and their families, there is no systematic and systematic hand hygiene education activities for the patients and their families in our country's hospitals. Of course, due to the entire social nosocomial infection and hand hygiene publicity, patients and their families are more concerned about the knowledge about their diseases. Nosocomial infections and hand hygiene did not pay much attention.

4. Discuss and suggest

4.1 Monitoring and Management

In fact, there are still many hospitals in our country more than the sense of management work by the Department of Nursing or the Ministry of Medical staff part-time, and the number of people specializing in the nurse work is also very small. Insufficient and unprofessional staff can affect hand hygiene monitoring and management. In addition, most of our hand hygiene practices are biologically focused on hand hygiene outcomes, however there is no complete specification of compliance monitoring. Therefore, it is recommended that medical institutions should, as far as possible, formulate a systematic long-term monitoring plan according to the actual situation. Rich monitoring content, in addition to hand hygiene and hand hygiene indications, as well as the composition of hand hygiene products and related issues, mastery hand hygiene knowledge, awareness and attitude toward hand hygiene and satisfaction. Implementation can be integrated into the daily hospital monitoring work, at the end of the monitoring will be fed back to the various departments, hand sanitation assessment into the hospital assessment, and hospital assessment directly affect the performance appraisal, for a good department to give a certain economy reward. Finally, it is also worth exploring how patients can be involved in hand hygiene supervision under the current circumstances.

4.2 Hand hygiene facilities and supplies availability

Hand hygiene work is based on complete hand hygiene facilities. However, there are still many hospitals in our country that do not have adequate hand hygiene facilities. The main reason is that managers may be too concerned about the cost of expenditure, all the costs of hospital infection management will be classified as hospitals and departments of the cost accounting, while ignoring the nosy work of the economic and social benefits. Therefore, under the current circumstances, we should increase the nosocomial infection in health economics research, including the cost of hospital infection management estimates, benefit estimates, cost-effectiveness analysis, cost-benefit analysis, and thus be more objective data support. In addition, studies have shown that the cost of hand hygiene using instant dry disinfectants is only 73% of the cost of handwashing with soap, saving nearly 30% of the cost. Therefore, promoting the use of alcohol-based hand disinfectants is one of the best options for ensuring hand hygiene. Finally, providing the most rational hand-care products for healthcare workers is also an important part of hand hygiene. A study comparing various hand measures found that dry paper with good effect, time-consuming, low cost, pollution-free environment, etc., it is recommended to use dry hand-washing after the best choice.

4.3 hand hygiene awareness

Some studies have shown that the correct rate of response of health care workers to hand hygiene knowledge is generally raised by hand hygiene training, which shows that systematic training and mission education can improve the mastery of health knowledge of hand hygiene by medical staff. However, at present, the training and promotion of many hospitals in our country is too monotonous. Therefore, enriching training and publicity forms will make hand hygiene more vivid and impactful. For example, we can arrange dance, songs and songs, and use the internet to try. In the training more comprehensive, in addition to hand-washing methods, but also should emphasize the timing of hand hygiene and promotion of quick-drying disinfectant use. In addition to medical workers, hospital leaders, workers, patients and their families can also be included in the training target. Such as the use of one or two hospital weeks will be on the leadership of a brief training; the same with the medical staff attendance training 2 to 4 times a year, usually the assessment results and its economic assessment linked to the patient and their families can be a month Departments to explain it, you can also use some departments or hospitals in the health class training.

 

 

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