影響醫療人員手部衛生意願之因素探討

Factors Influencing Hand Hygiene Motivation among Health Care Workers

世界衛生組織自2005年推行醫療人員手部衛生運動，然而手部衛生遵從率大多仍介於40～60%，本醫學中心自2004年推動全院性手部衛生活動，希望藉此研究了解在連續6年推廣活動後仍影響手部衛生意願的原因。本研究採分層取樣之問卷調查法，有725位（71.6%）醫療人員完成對手部衛生產品滿意度、影響手部衛生意願原因及不同時機手部衛生方式之調查。研究結果，使用感覺不滿意比例最高為酒精性乾洗手液（27.5%）。降低手部衛生意願的原因為手部衛生設備不完備（61.0%）、地點不便（56.8%）、產品使用不適（50%）。常見一般醫療行為使用酒精性乾洗手液（53.7%至75.0%）和一般性洗手液（39.3%至48.8%）為主；如暴觸病人體液風險後、執行無菌技術前、接觸帶有特殊病菌之病人後等時機，則以使用消毒性洗手液為主（71.4%至93.8%）。認為有效提高手部衛生遵從率的方法主要為個人重視（84.9%）、有便利手部衛生設備（83.7%）、有護手設備（73.6%）。總結，在連續多年不同策略推動後，手部衛生設備的可近性和產品的使用滿意度仍為影響醫療人員手部衛生意願的原因，且相當多的手部衛生時機可以使用酒精性乾洗手液取代消毒劑使用，以達省時及避免手部傷害的目的。期望未來加強正確使用手部衛生產品和護手的觀念，加上持續營造院內手部衛生文化，以增強醫療人員的手部衛生動機，提高手部衛生遵從率。

The World Health Organization has implemented a hand hygiene program since 2005; however, the global hand hygiene compliance rate still ranges between 40% and 60%. This study was aimed at determining the factors that influence hand hygiene motivation among health care workers (HCWs) 6 years after a hospital-wide hand hygiene program was introduced. A stratified sampling was carried out on the HCWs using a questionnaire that comprised information on the satisfaction with hand hygiene products, factors that influence hand hygiene motivation, and selection of hand hygiene products during defined hand hygiene moments. The questionnaire was completed by 725 HCWs (71.6% of the total). Dissatisfaction with the alcohol-based handrub was observed among 27.5% of the HCWs. The factors that reduced hand hygiene motivation were insufficient hand hygiene equipment (61.0%), its inconvenient location (56.8%), and uncomfortableness (50%). During general medical practices, HCWs generally used an alcohol-based handrub (53.7% to 75.0%) and liquid soap (39.3% to 48.8%) for hand hygiene. Approximately 71.4% to 93.8% of HCWs used disinfectant liquid soap when presented with hand-hygiene moments such as risk of infection after body fluid exposure, before aseptic procedures, or after touching a patient placed under contact isolation. It was observed that personal attention (84.9%), convenient hand hygiene equipment (83.7%), and supply of moisturizing skin care products (73.6%) effectively improved hand hygiene compliance. Despite the initiation of different strategies that promote hand hygiene compliance, sufficient hand hygiene equipment and product satisfaction are still factors that influence hand hygiene motivation among HCWs. There are also many hand hygiene opportunities where alcohol-based handrubs can be used instead of disinfectant because they adequately protect the hands and are less time-consuming.