護理人員戴手套與手部衛生遵從率之探討

A Survey of Compliance with Hand Hygiene and Glove Use among Nurses

本研究的目的為探討護理人員在手套的配戴及手部衛生的遵從率，採前瞻、觀察性調查，自2012年7月至12月，以中部某醫學中心8個含成人及兒科單位的護理人員為研究對象。在330個應戴手套的時機，實際戴手套有242個時機，戴手套的遵從率為73.3%，其中無菌手套配戴遵從率顯著高於清潔手套。在644個應執行手部衛生的時機，有278個時機確實執行手部衛生，整體手部衛生遵從率為43.2%。統計顯示戴手套者的手部衛生遵從率顯著低於未戴者（38.3%VS.62.1%，P＜0.01），另外可能因為戴手套者認為手套有隔離污染手部的作用或提供完整的保護，可以取代洗手，因此在執行照護前的手部衛生遵從率顯著低於未戴手套者所致（13.3%VS.50%，P＜0.01）。建議加強護理人員對手部衛生五時機的認知、戴手套的時機及有關病人安全的觀念、定期稽核和回饋各單位手部衛生的遵從率。另外，清楚規範清潔技術標準、需戴手套的時機、運用計畫性行為理論架構，探討影響護理人員執行手部衛生信念的因素，由長官或同儕帶頭培養遵從的工作規範，以及在人力及資源方面做良好的規劃，以提升整體手部衛生遵從率。

The purpose of this study was to investigate compliance with hand hygiene and glove use among nurses using convenience sampling. A prospective, observational study was conducted across 8 wards of a medical center - both adult and pediatric-from July to December 2012. Glove use was rated as “reasonable” in most cases (88.3%). The total compliance with glove use was 73.3%, while compliance with hand hygiene in cases of glove use was 43.2% - respectively 18.5% before healthcare activities and 66.7% after healthcare activities (p = 0.00). When gloves were used correctly, compliance with hand hygiene was 13.3% before healthcare activities and 66.1% after healthcare activities. When gloves were used incorrectly, compliance with hand hygiene was 50.0% before healthcare activities and 68.2% after healthcare activities. Glove use was strongly associated with lower hand-hygiene compliance before healthcare activities (p = 0.00). In conclusion, we recommend that infection control practitioners apply an educational program, conduct regular monitoring, and provide feedback in order to improve compliance with glove use and hand hygiene. In addition, we suggest introducing social cognitive models to evaluate predictors of health behavior.