【Cochrane简语概要】改善医护人员手部卫生以减少患者护理中出现感染的方法

本综述的目的是什么？ 

找出能够增强医护人员对手部卫生建议依从性的策略，无论是用肥皂和水洗手，还是使用速干手消毒剂（ABHR），或二者兼而有之。本系统综述是对先前发表的Cochrane综述研究的更新。

主要信息 

许多基于世界卫生组织（WHO）目前建议的单一干预策略及策略组合，使大多数研究中的手部卫生依从性增加，无论其研究的设置如何。然而，不同策略的证据确定性从非常低到中等不等。目前尚不清楚在特定环境中，哪种策略或策略组合最有效。

我们在本综述中研究了什么？ 

一般认为传统的手部卫生是减少医疗护理相关感染的最重要的方式，这些感染许多通过直接接触传播，特别是经由医护人员的手。在世界各地推广手部卫生耗费了许多时间和精力。尽管已经尝试了许多不同的策略来改善手部卫生的依从性，但最有效的方法仍不清楚。

（图片来源于网络）

本综述的主要结果是什么？ 

本综述共纳入26项研究。其中十四项研究评估了WHO建议的不同策略组合对提高手部卫生的依从性是否成功。这些策略包括：增加酒精类手卫生用品的供应量，为工作人员提供不同类型的教育，提醒（书面及口头），不同类型的绩效反馈，行政支持和工作人员参与。六项研究评估不同类型的绩效反馈，两项研究评估教育，三项研究评估线索，如体征或气味，一项研究评估 ABHR 的放置位置。

包括 WHO 推荐策略的多策略（策略组合）也许能够略微改善手部卫生依从性，并略微降低感染率（低确定性证据）。包括 WHO 推荐的所有策略的多策略干预很少，或几乎不导致耐甲氧西林金黄色葡萄球菌（MRSA）感染率（低确定性证据），但尚不确定这是因为 WHO 推荐的这些方法提高了手部卫生依从性，还是因为降低了细菌定殖率，因为证据的质量很低。包含所有推荐策略和附加策略的多策略干预，可能会略微提高手部卫生依从性（低质量证据）。目前尚不清楚这种 WHO 增强型干预措施是否会降低感染率，因为这一证据的质量很低。

绩效反馈可以提高手部卫生依从性（低质量证据），并可能略微减少感染及定殖率（中等质量证据）。教育能够提高手部卫生依从性（低质量证据）。一些线索提示，如体征或气味，可能会略改善手部卫生依从性（低质量证据）。将 ABHR 放置在接近使用点的位置，可能会略微改善手卫部生依从性（中等质量证据）。

本综述的最新进展如何？ 

本综述作者检索了截至2016年10月发表的研究。

结论: 

鉴于证据、干预措施和方法确定性的变异性，仍然迫切需要进行方法学上强有力的研究，来探究多策略干预与简单干预的效果，以增加手部卫生依从性，并确定多策略干预或策略组合的哪部分在特定的情况下最有效。

译者：张志莹，北京中医药大学志愿者；审校：鲁春丽，北京中医药大学循证医学中心；编辑排版：张晓雯，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Methods to improve healthcare worker hand hygiene to decrease infection in patient care

What is the aim of this review? 

To find out what strategies can improve healthcare workers' compliance with recommendations for hand hygiene, either handwashing with soap and water or using alcohol-based hand rub (ABHR), or both. This is an update of a previously published review.

Key messages 

A variety of single intervention strategies and combinations of strategies, many based on current recommendations from the World Health Organization (WHO), led to increased hand hygiene compliance in most studies, regardless of setting. However, the certainty of the evidence varied from very low to moderate, depending on the strategy. What remains unclear is which strategy or combination of strategies is most effective in a given context.

What did we study in the review? 

Traditionally hand hygiene has been considered the single most important way of reducing health care-associated infections, many of which are spread by direct contact, especially by the hands of healthcare workers. Much time and effort is spent worldwide promoting hand hygiene. Many different strategies have been tried to improve hand hygiene compliance but the most effective methods remain unclear.

What are the main results of the review? 

We included 26 studies in the review. Fourteen studies assessed the success of different combinations of strategies recommended by WHO to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of alcohol-based hand hygiene products, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR.

Multimodal (combinations of) strategies that include some but not all strategies recommended by WHO may slightly improve hand hygiene compliance and slightly reduce infection rates (low certainty of evidence). Multimodal interventions that include all strategies recommended by WHO may lead to little or no difference in methicillin-resistant Staphylococcus aureus (MRSA) infection rates (low certainty of evidence), but it is uncertain whether such WHO-based approaches improve hand hygiene compliance or reduce colonisation rates because the certainty of this evidence is very low. Multimodal interventions that contain all recommended strategies plus additional strategies may slightly improve hand hygiene compliance (low certainty of evidence). It is unclear whether such WHO-enhanced interventions reduce infection rates because the certainty of this evidence is very low.

Performance feedback may improve hand hygiene compliance (low certainty of evidence) and probably slightly reduces infection and colonisation rates (moderate certainty of evidence). Education may improve hand hygiene compliance (low certainty of evidence). Cues, such as signs or scent, may slightly improve hand hygiene compliance (low certainty of evidence). Placement of ABHR close to the point of use probably slightly improves hand hygiene compliance (moderate certainty of evidence).

How up-to-date is this review? 

The review authors searched for studies that had been published up to October 2016.

Authors' conclusions: 

With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.

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