感應式語言機增進重症醫護人員洗手率之成效探討

Efficacy of a Talking Machine to Increase Handwashing Rate of Workers in ICU

本研究欲探討使用感應式語言機，對增加重症醫護人員洗手率及間接降低院內感染的成效。研究採單盲類實驗性設計，研究對象為北部某醫學中心入加護病房48小時內無院內感染者，共169位參與。對照組收案時維持現行洗手告示，實驗組接受語言機介入措施。研究工具包括語言機，感染危險因子表。資料收集包括：接觸病人洗手次數，院內感染情形。洗手次數於收案日及使用語言機滿24小時後分別於1,3,5,7日隨機抽取任一小時採參與式及非參與式觀察，院內感染情形於病人轉出時收集。以描述性統計及邏輯式迴歸分析資料。主要結果包括(1)總觀察次數4800次，洗手率實驗組80.5%，高於控制組40.1%。(2)醫生接觸病人前洗手率增加最多達56.7%。(3)護理人員接觸後洗手率最高為87.0%。(4)院內感染實驗組較對照組為低。以上兩組變項達統計上差異，以邏輯式迴歸分析於控制共變項後，未使用語言機發生院內感染的風險比是使用語言機的9.47倍(95%C.I.=2.92-30.74,p=.00)，顯示藉由語言機提示人員洗手，對病人發生院內感染具有間接保護作用。本研究工具及研究結果可作為國內、外增加洗手率之實證根據。

The objective of this study was to determine whether a talking machine can improve handhygiene and decrease nosocomial infection. Method: This study was a single blind experimentaldesign in a medical center intensive care unit.Atotal of 169 patients were randomly assigned in twogroups. The control group was given ordinary protocol, the experimental group was reminded towash hands by a new talking machine. We closely observed health care workers and all visitorshandwash rate at day 1, day 3, day 5, and day 7. Data were also collected regarding patientsinfection rate before transfering to the wards. Statistics: The data were put under statistics analysisby ki-sqare, paired t-test, independent t-test and logisic regression. Result: A total of 5525 timeswas observed over six months. The hand washing rate was improved 35%. The physicians handhygiene washing rate increased 57% and nurses' also had 33% improvement. The nosocomialinfection rate significantly increased in the control group, the odds ratio was 9.47 (95% C.I.= 2.92-30.74; p=.00 ). Conclusion: A talking machine provided effective hand hygiene compliance anddecreased the nosocomial infection rate, suggesting its ongoing prevalence use in wards forlong-term effects.