某醫學中心護理人員COVID-19疫情期間手部衛生及口罩遵從性調查

Survey on Hand Hygiene and Mask Compliance among Nursing Staff at a Medical Center During the COVID-19 Pandemic

2019年底於中國發現嚴重特殊傳染性肺炎COVID-19（CoronavirusDisease-2019）群聚，隨後迅速在世界各地大規模爆發，並證實可有效人傳人，世界衛生組織於2020年1月30日公布為公共衛生緊急事件。各國政府迅速採取之公共衛生緊急應變之感管措施中，手部衛生及佩戴口罩為最基本且有效之措施。本研究目的為比較中部某醫學中心COVID-19收治單位之護理人員於疫情前（2017年1月-2019年12月）及疫情期間（2020年1月-2022年12月）之基本屬性、手部衛生遵從率、手部衛生步驟正確率及口罩佩戴遵從率。研究結果顯示，急診及負壓病房護理人員在疫情期間的年齡和年資均顯著高於疫情前（p<0.05），但性別、教育程度、主管身分別及編制無統計上差異（p>0.05）；手部衛生遵從率方面，疫情期間急診及負壓病房均高於疫情前，但僅負壓病房的手部衛生遵從率呈顯著差異（p<0.05）；手部衛生步驟正確率在疫情期間，急診及負壓病房均顯著高於疫情前（p<0.05）；手部衛生五時機遵從率方面，僅負壓病房護理人員在時機四（接觸病人後）於疫情期間顯著高於疫情前（p<0.05），其餘手部衛生時機無顯著差異。口罩佩戴遵從率在急診及負壓病房於疫情期間均高於疫情前，但僅急診的口罩佩戴遵從率達顯著提升（p<0.05）。本院疫情期間的醫療照護相關感染密度低於疫情前，進一步分析發現負壓病房於疫情前和疫情期間的感染密度無顯著差異，急診因留觀時間皆小於24小時，故無感染率等相關數據。本院持續透過教育訓練、交叉稽核、即時反饋、管理階層支持及持續推動評比、獎勵活動等策略，增強醫療工作人員持續落實手部衛生及正確使用防護用具的動力。

At the end of 2019, a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, which subsequently gave rise to the coronavirus disease 2019 (COVID-19) pandemic, was discovered in China. Infections quickly spread throughout the world, confirming that the virus could be transmitted between humans. On January 30, 2020, the World Health Organization declared it a public health emergency. Governments around the world swiftly implemented public health emergency response measures, with hand hygiene being the most basic and effective method. This study aimed to compare the compliance rates of hand hygiene, correct handwashing steps, and mask-wearing during the pre-pandemic (January 2018 to December 2019) and pandemic periods (January 2020 to December 2021) in the COVID-19 treatment units of a medical center in central China. The results showed that the hand hygiene compliance rates in the emergency department, negativepressure wards, and general isolation wards were all higher during the pandemic period compared to the pre-pandemic period. However, only the hand hygiene compliance rate in the negative-pressure wards showed a significant improvement (p<0.05). Regarding the correct handwashing steps, all areas (emergency department, negative-pressure wards, and general isolation wards) showed significantly higher compliance rates during the pandemic period compared to the pre-pandemic period (p<0.05). Among the different times during which handwashing was practiced, the compliance rate for handwashing after patient contact in the negative-pressure wards and general isolation wards was significantly higher during the pandemic period (p<0.05), while there was no statistical difference in the other handwashing events (p>0.05). In terms of mask-wearing compliance, all areas showed higher rates during the pandemic period compared to the pre-pandemic period, but only the emergency department demonstrated a significant improvement (p<0.05). The hospital evaluated in this study was found to be implementing strategies with the aim of enhancing healthcare workers’compliance with hand hygiene practices and the correct use of personal protective equipment, including education and training, cross-auditing, real-time feedback, support from management, and ongoing evaluation and reward activities. In future, this and other hospitals should refer to recommendations from the literature to improve the auditing methods for hand hygiene in order to minimize the occurrence of the Hawthorne effect.