提升醫護人員洗手遵從率-以北部某區域級醫院為例

Improvement in the Hand-washing Compliance Rate of Staff in a Regional Hospital in Taipei

醫療品質是現今各醫療院所均面臨的重要課題，而院內感染為醫療照護品質重要指標之一。美國疾病管制中心明確指出洗手是預防院內感染最簡單與重要的方法。本研究之主要目的在於利用品管圈手法以提升醫院醫護入員洗手遵從率。2007年醫院醫護入員洗手遵從率僅為44.9%。個案醫院透過感染管制室成員與院內相關單位醫護入員組成之品管圈，進行改善醫護人員洗手專案。活動期間為期六個月並分為：計畫期（改善前）為2007年8-10月、執行期（改善中）為2007年11-12月及評值期（改善後）為2008年1月。以品管圈手法確認覺得自己的手不髒、沒有洗手的習慣、忘記洗手、不認為洗手很重要、宣導不足和缺乏獎懲制度六項原因，並擬定對策執行。改善後之醫護人員洗手遵從率大幅提升至92.7%，顯示醫護人員之洗手習慣可透過適切之教育活動改變。

Maintaining the quality of medical care in hospitals is now a challenge in modern medicine. The occurrence rate of health care-associated infections is an important indicator of the quality of medical care. The Centers for Disease Control (CDC) recommends hand washing as the simplest, most effective method to prevent health care-associated infections. The purpose of this study was to understand the efficacy of quality control circle (QCC) methods developed by the department of infection control in increasing the hand-washing compliance rate of hospital staff. The hospital under study was a regional hospital in Taipei where the hand-washing compliance rate of the staff was 44.9% in 2007. A quality control group was formed comprising members from the infection control department and staff from the hospital. Timing of action procedure was 6 months, which included planning from August to October 2007, implementation from November to December 2007, and evaluation in January 2008. The hospital under study targeted the most common causes of poor hand-washing compliance: assuming that one’s hands are clean, not being accustomed to hand washing, forgetting to wash one’s hands, not considering hand washing to be important, poor advertising, and a poor system of rewards and penalties; these were considered to be the 6 major problems that required urgent attention. We reviewed the problems and designed strategies to improve the situation. This resulted in an improvement in the hand-washing compliance rate of the staff to 92.7% in 2008. This study demonstrated that hand-washing habits could be altered by way of education and feedback.