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BMJ:洗手是最经济、最有效、最方便控制病原菌传播的措施  

2012-05-18 07:12:55|  分类: 文化知识长廊海洋 |  标签: |举报 |字号 订阅

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根据2012年5月4日发表于BMJ的一项最新研究显示,全英性洗手运动的评价第一次表明,手部卫生能够成功地减少一些卫生保健相关性感染。

从2005年1月开始的全英性洗手运动,是通过指导床边酒精擦手液的使用方法,粘贴海报鼓励卫生保健人员洗手和一系列患者准许的材料的方法面向英国国家医疗服务体系(NHS)信托机构进行开展的。这只是一系列全英倡议活动中的一项,旨在减少英格兰和威尔士医院内耐甲氧西林金黄色葡萄球菌(MRSA)、甲氧西林敏感的金黄色葡萄球菌(MSSA)和艰难梭菌(C. difficile)的感染水平。

洗手运动的评价是由伦敦大学医学院(UCL's Medical School)和健康保护局(HPA)的研究人员进行的。他们记录了2004年7月到2008年间医院每季度购买的酒精擦手液(AHR)和肥皂数量。在调整许多影响因素之后(包括床位占用率的影响、医院类型和其他的全国性干预的时机),他们发现在购买水平和感染率间存在明显的联系。

根据研究显示,在过去的4年里,肥皂和AHR总的采购量增长近3倍,从每名患者每床的21.8mls增长到59.8mls。MRSA菌血症每1000床每天感染率从1.88下降到0.91,而艰难梭菌的感染率从16.75下降到9.49。MASA菌血症感染水平未下降。

研究同时显示,肥皂购买的增加始终与艰难梭菌感染的减少独立相关,然而增加酒精擦手液的采购与MRSA的感染的独立关联性只在研究的最后一年。这些稳定的、独立的关联性在考虑其他干扰因素之后依然存在。

“直到现在,我们依然不能够说发动这样的全国性运动是否对患者带来实实在在的好处,”伦敦大学医学院主要调查员Sheldon Stone博士说。“这项研究可表明的是,洗手运动(主要在于协调和资助策略)可使医院购买酒精擦手液和肥皂的数量上持续增加,而这又反过来有助于减少感染和改善健康结果。”

Stone博士继续说道,“洗手运动在英国已经取得极大的成功,它改变了NHS职员内部文化。虽然现在这个运动停止了,但许多感染控制团体希望看到继续保持前进,并且形成一个新的全国性手部卫生政策或是开展更新过的运动。”

英国健康保护局(HPA)卫生保健相关感染实验室主任Barry Cookson教授说:“研究报告显示,在健康保健机构,洗手和酒精擦手这样相对简单的措施可极其有效防止有害菌的传播。不需要依赖于其他的措施,我们就可以看到购买的肥皂和酒精擦手液越多,MRSA和艰难梭菌的感染水平下降程度就越大。我们应该继续推行这些抗击细菌传播最前线的措施。”

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.

BMJ 2012;344:e3005

Stone SP Fuller C Savage J Cookson B Hayward A Cooper B Duckworth G Michie S Murray M Jeanes A Roberts J Teare L Charlett A

Royal Free Campus, University College London Medical School, London NW3 2PF, UK.

Abstract
To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. 187 acute trusts in England and Wales. Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10?000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P<0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P<0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P=0.02) and C difficile infection (0.75, 0.67 to 0.84; P<0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit. The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections.

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