醫學中心醫護人員手部衛生之認知、態度與意向之探討

The factors that influence hand hygiene motivation in health care workers

醫療照護相關感染是全球化的問題，也會增加醫療成本及死亡率，透過醫護人員的手有可能造成感染源的傳播。本研究在探討醫學中心醫護人員對手部衛生之認知、態度與行為意向，以作為醫院手部衛生推動策略與執行方針的重要參考。本研究採橫斷性研究，研究工具係參考醫策會及國內外文獻制定而成，問卷信度分析CVI值為0.9。問卷內容包含手部衛生認知、態度、意向三構面，採李克氏5點計分法。問卷有效回收166份，回收率為86.5%。結果發現醫護人員洗手態度得分低於洗手認知及行為意向，醫師手部衛生態度得分低於護理人員。醫院感控單位院內網站之內容被認是手部衛生知識最主要且最有幫助的訊息來源。「非侵入性治療前」和「照護同病人但不同部位前」要洗手是醫護人員需加強的洗手觀念。醫護人員認為透過院內資訊化宣導及獎勵員工的策略，可強化洗手意願及行為，建議醫院需更重視院內網頁之教育功能。此結果可作為醫院同仁之手部衛生意識促進與執行策略之參考，藉此降低院內感染發生之機會，進而提升醫院醫療照護品質。

World Health Organization has implemented hand hygiene program since 2005, but hand hygiene compliance rate observed worldwide are still between 40- 60%. This study want to find the factors that influence hand hygiene motivation in health care workers (HCWs) after 6 years hospital-wide hand hygiene program. There are 725 HCWs (71.6% of distributed) completed the questionnaire, using stratified sampling, contains satisfaction of hand hygiene products, factors that influence hand hygiene motivation, selection of hand hygiene products in hand hygiene moments. 27.5% HCWs were dissatisfied with alcohol-based handrub. The factors that reduce hand hygiene motivation were insufficient hand hygiene equipment (61.0%), inconvenient location (56.8%) and uncomfortableness (50%). In general medical practices, HCWs used alcohol-based handrub (53.7% to 75.0%) and liquid soap (39.3% to 48.8%) for hand hygiene. In some hand hygiene moments, such as after body fluid exposure risk, before aseptic procedure, and after touching patient under contact isolation, there were 71.4% to 93.8% HCWs used disinfectant liquid soap. The effective methods that may improve hand hygiene compliance include personal attention (84.9%), convenient hand hygiene equipment (83.7%), supplying of moisturizing skin care products (73.6%). After using different strategies to promote hand hygiene compliance, sufficient hand hygiene equipment and product satisfaction are still the factors that influence hand hygiene motivation in HCWs. There are also many hand hygiene opportunity that alcohol-based handrub can be used instead of disinfectant to reduce time consuming and also to protect the hands.