医务人员手卫生依从性干预效果研究
|
摘要
医务人员的手卫生与医院感染密切相关,提高医务人员手卫生的依从性有助于医院感染的控制和预防。国内外对手卫生科学的研究有着较长的历史,并提出了许多有应有前景并有效的手卫生依从性促进方法。本研究,对某三甲医院的手卫生现状进行了调查分析,并应用培训、教育、监督、等一系列措施对医务人员手卫生进行干预,并评价其效果。本研究首先对医院进行全面的手卫生现状的基线调查取得基础数据,再对医院全体医务人员进行手卫生知识培训,对样本科室进行经常的行政监督,通过对比分析,探讨这些干预措施对提高医务人员手卫生依从性的作用。
There is closely relationship between health care workers’hand hygiene and hospital infection. Large number epidemiology investigations show that the kinds and number of bacteria on health care worker’s hands are more than others, and hospital infection occurs usually direct or indirect by hand to hand. This way is more dangerous than air borne spread. Washing hands and disinfecting hands can effective reduce the bacteria on health care workers’hands. It is basal and simple way to prevent and control pathogenic spread.
At present, the status of hand hygiene of health care workers is not optimistic. Health care workers usually not care hand hygiene. More than half health care workers are not given knowledge about hand hygiene. Although many health care workers can realize principia of hand hygiene, but persevere in correct washing hand way are few. The compliance with hand hygiene is very low. Improve behave of hand hygiene with health care workers is one important problem of hospital infection research.
Method:
Baseline survey was made by collect the status and compliance with hand hygiene of health care workers in hospital. Then health care workers were given intervention by hand hygiene train, education, and intendance. The effect was appraised. Last all health care workers in hospital were given hand hygiene train, supervise the experimental departments, discuss the effect of intervention for improving compliance with hand hygiene of health care workers by contrast research.
Result:
1. Hand carrier rate of health care workers: Before and after medical operating the hand carrier rate was 100%.The qualified rate of hand carrier rate was 10.9% before medical operating, and it was 0 after. The qualified rate was 61% by using soap and flow water, and it was 100% by using alcoholic hand antiseptic.
2. Hand hygiene disposition in hospital: The disposition rate of hand washing pool was 85.1% in outpatient department, and it was 87.3% in inpatient department. The disposition rate of alcoholic hand antiseptic was 37.2% in outpatient department, and it was 13.1% in inpatient department.
3. Hand hygiene knowledge of health care workers: The health care workers were improved on the knowledge of hand hygiene, hand washing process, hand drying, indication of hand washing and hand disinfecting and alcoholic hand antiseptic.
4. Hand hygiene behaves of health care workers:
(1)Compliance with hand hygiene: After intervention, compared with baseline, the compliance rate with hand hygiene obvious improved from 59.1% to 73.8%. It was obvious difference byχ2 test. There were eight indications of compliance rate with hand hygiene improved. It was showed that compliance with hand hygiene of health care workers were obvious improved after hand hygiene train.
(2)Hand hygiene way: Baseline survey showed that health care workers washed hands mostly by soap and flow water, only 7.3% by alcoholic hand antiseptic. After intervention, health care workers were 41% using alcoholic hand antiseptic difference comparing with baseline.
(3)Dry hands way: Baseline survey showed that health care workers dry hands ways mostly include using clothing, paper towel and natural drying. After intervention, health care workers were mostly using paper towel, one-off towel and fan blower.
(4)Qualified rate of washing:The qualified rate of washing hand was obvious difference between baseline (57.3%) and after intervention (71.3%).
Conclusion:The result proved that the experimental group compliance with hand hygiene was obvious improved after intervention of hand hygiene promotion measures. Hand washing way was mostly using alcoholic hand antiseptic. The intervention was also improved health care workers’wrong dry hands way. They begin to use paper towel, fan blower and one-off towel to decrease hand washing secondary pollution and improve hand washing qualified rate. It also showed that given hand hygiene knowledge and administrative supervision could improve compliance with hand hygiene of health care workers.
There is closely relationship between health care workers’hand hygiene and hospital infection. Large number epidemiology investigations show that the kinds and number of bacteria on health care worker’s hands are more than others, and hospital infection occurs usually direct or indirect by hand to hand. This way is more dangerous than air borne spread. Washing hands and disinfecting hands can effective reduce the bacteria on health care workers’hands. It is basal and simple way to prevent and control pathogenic spread.
At present, the status of hand hygiene of health care workers is not optimistic. Health care workers usually not care hand hygiene. More than half health care workers are not given knowledge about hand hygiene. Although many health care workers can realize principia of hand hygiene, but persevere in correct washing hand way are few. The compliance with hand hygiene is very low. Improve behave of hand hygiene with health care workers is one important problem of hospital infection research.
Method:
Baseline survey was made by collect the status and compliance with hand hygiene of health care workers in hospital. Then health care workers were given intervention by hand hygiene train, education, and intendance. The effect was appraised. Last all health care workers in hospital were given hand hygiene train, supervise the experimental departments, discuss the effect of intervention for improving compliance with hand hygiene of health care workers by contrast research.
Result:
1. Hand carrier rate of health care workers: Before and after medical operating the hand carrier rate was 100%.The qualified rate of hand carrier rate was 10.9% before medical operating, and it was 0 after. The qualified rate was 61% by using soap and flow water, and it was 100% by using alcoholic hand antiseptic.
2. Hand hygiene disposition in hospital: The disposition rate of hand washing pool was 85.1% in outpatient department, and it was 87.3% in inpatient department. The disposition rate of alcoholic hand antiseptic was 37.2% in outpatient department, and it was 13.1% in inpatient department.
3. Hand hygiene knowledge of health care workers: The health care workers were improved on the knowledge of hand hygiene, hand washing process, hand drying, indication of hand washing and hand disinfecting and alcoholic hand antiseptic.
4. Hand hygiene behaves of health care workers:
(1)Compliance with hand hygiene: After intervention, compared with baseline, the compliance rate with hand hygiene obvious improved from 59.1% to 73.8%. It was obvious difference byχ2 test. There were eight indications of compliance rate with hand hygiene improved. It was showed that compliance with hand hygiene of health care workers were obvious improved after hand hygiene train.
(2)Hand hygiene way: Baseline survey showed that health care workers washed hands mostly by soap and flow water, only 7.3% by alcoholic hand antiseptic. After intervention, health care workers were 41% using alcoholic hand antiseptic difference comparing with baseline.
(3)Dry hands way: Baseline survey showed that health care workers dry hands ways mostly include using clothing, paper towel and natural drying. After intervention, health care workers were mostly using paper towel, one-off towel and fan blower.
(4)Qualified rate of washing:The qualified rate of washing hand was obvious difference between baseline (57.3%) and after intervention (71.3%).
Conclusion:The result proved that the experimental group compliance with hand hygiene was obvious improved after intervention of hand hygiene promotion measures. Hand washing way was mostly using alcoholic hand antiseptic. The intervention was also improved health care workers’wrong dry hands way. They begin to use paper towel, fan blower and one-off towel to decrease hand washing secondary pollution and improve hand washing qualified rate. It also showed that given hand hygiene knowledge and administrative supervision could improve compliance with hand hygiene of health care workers.
引文
1.Rotter ML.Hygienic hand disinfection[J]. Infection Control,1984.1:18- 22.
2.Semmelweis L Etiology, concept, and prophylaxis of childbed fever[M]. Madison WI: The University of wisonsin Press, 1983:5.
3.Coppage CM. Hand washing in patient care [M]. Wash-ington, DC.US public Health Service,1961.
4.Larson E.Guideline for use of topical antimicrobial agents[J].Am J Infect Control, 1988,16:253.
5.Larson EL. APIC Guidelines Committee. APIC guideline for hand washing and hand antisepsis in health caresettings[J].Am J Infect Control, 1995, 23:251.
6.Boyce JM.,Pitter D. Guideline for hand hygiene in health-care settings[J]. Am J Infect Control, 2002,30:51-546
7 .钟秀玲 , 程棣研 . 现代医院感染护理学 [M]. 北京 : 人民军医出版社,1995.107~115.
8. 苏冬梅,李春林,刘巧云,等. 静脉穿刺前后操作者一手的细菌学监测与洗手消毒液的选择[J]. 护士进修杂志.1997;12( 9):8.
9.尹湘毅,等.医护人员手部带菌状况的调查分析与对策[J].医学研究生学报,2004;10(7):908.
10.刘振声,金人鹏,陈增辉. 医院感染管理学[M]. 北京:军事医学科学出版社,2000;425- 454.
11.蓝才燕,陈式一,苏伟东,等. 医护人员手污染细菌的调查[J]. 广西预防医学,2001;7(3):142.
12.喻红波,等.护士手指细菌谱调查及消毒效果的观察[J].中华医院感染学杂志,2003;13(1):85.
13 . 沈 伟 . 洗 手 消 毒 的 概 念 与 方 法 选 择 [J]. 上 海 预 防 医 学 杂志,1998,10(8):342.
14.王晓敏,苟淑萍.洗手现状与对策[J].实用护理杂志,1995,11(9):43-44.
15.王常卿,王淑香,王云芳,等.109 名医护人员手带菌的监测和分析[J].中华医院感染学杂志,1995,5(1):47
16.尚少梅,郑修霞,王宜芝,等.临床护理人员洗手行为的观察与分析[J].中华医院感染学杂志,2001,11(6):455-456
17.李文玉.某医院 312 名医护人员洗手情况调查[J].解放军预防医学杂志,2001,19(4):303
18.刘瑞红,唐炎红.临床医护人员洗手行为的观察与分析[J].河南医药信息,2002,10(17):72
19.郑子轩,韩鹏飞. 医生手部卫生状况欠佳[N].南方日报 2004-9-2.
20. Boyce JM,Pitter D. Guideline for hand hygiene in health-care settings[J]. Am J Infect Control, 2002,30:51-546
21.Kirkland K. B., Weinstein ,I. M. Adverse effects of contact isolations[J]. Lancet, 1999, 354: 1177-1178.
22.Tibballs J. Teaching hospital medical staff to handwash[J]. Med J Aust. 1996, 164:395-398.
23.张晓春,林树德,吴建明.200 名护士洗手的调查[J].中华医院感染学杂志,2001,11(4):261.
24.许景云,黄世生,程和平.医务人员洗手情况调查与分析[J].湖北预防医学杂志,2001,12(1):26.
25.陈杰,程秀华.2000~2001 年医护人员洗手质量分析[J].湖北预防医学杂志,2003,14(1):51.
26 . Larson E,Kretaer EK .Compliance with handwashing and barrier precautions[J]. J Hosp Inf,1995,30(9suppl):88.
27. 金玲,金涛.从医护人员手带菌情况谈防止医院内感染[J].中华微生物学杂志, 1995, 7(4): 59.
28.Peter W, Kim MD, Pereucevich EN, et al. Rates of hand disinfection associated with gloveuse, patient isolation, and changes between exposure to variou sbody sites[J]. Am J Infect Control, 2003, 31(2): 97-103.
29.Didier Pittet, Mourouga P, Pernegar TV. Compliance with handwashing in a teaching hospital[J]. Annals ofI nternal Medicine, 1999, 130(2): 126-130.
30.手部卫生:旨在降低医院感染的策略(二)——手部卫生创议接受度试验报告 [J].中国医院,2005,9(2):78-79.
31.陶红.护理人员手清洁方法的实验研究[J].护理学杂, 2002, 17(3): 226- 227.
32.陈杰,程秀华.2000~2001 年医护人员洗手质量分析[J].湖北预防医学杂志,2003,14(1):51.
33.邢红霞,张红英,武建英,等.医务人员手卫生现状与管理[J].中华医院感染学杂志.2002. 12(8):639- 640.
34.Didier Pittet. Improving adherence to hand hygiene practice: A multidis- ciplinary approach [J]. Emerging In fectious Diseases,2001,7(2):234-240.
35.Weeks A. Handwashing: Why I don.t wash my hands between each patient contact [J]. BMJ,1999,319:518.
36.Zimakoff J, Kielsberg AB, Larsen SO, et al. A multicenter questionnaireinvestigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway[J]. Am J Infect Control,1992, 20(2):58-64.
37 . Andrej T.Andreas F.Hand hygiene:A frenuently missed lifesaving opportunity during Patient care[J].Mayo Clinic Proceedings, 2004, 79:109.
38.徐秀华.临床医院感染学[M].湖南:湖南科学技术出版社,1998:4.
39.曾光.中国的手部卫生行动[J].中华医药信息导报.2004.19(15):14.
40.牛秀成,张树德,周素琴,等.医务人员洗手技术与手再污染研究[J].中华医院感染学杂志,1998, 8(2):88- 89.
41.朱士俊.现代医院感染学[M].北京:人民军医出版社,1998.3~68.
42.夏毅.现代医护人员手卫生的理论和实践[J].现代临床护理, 2004, 3(1): 51-56.
43.卫生部.医院感染管理规范[Z].2000.10.
44.广东省卫生厅.关于印发“世界卫生组织——中国广东医院感染管理项目合作医院手卫生项目质量评价标准(试行)”的通知[Z].粤卫医政函[2005]10 号.2005.8.
45.杜杏利,曾铁英译.医疗保健机构手部卫生指南[J].中国感染控制杂志.2004,3(2):189-190.
46.李六亿,贾会学.手卫生与医院感染的预防与控制[J].临床药物治疗杂志.2005,3(6):11-15.
47.消毒技术规范(2002 年版)[Z].中华人民共和国卫生部.2002. 202-203, 206-207.
48.GB15982-1995.医院消毒卫生标准[S].
49.洪锡田,李惠平,白献红.医务人员手细菌污染调查及消毒效果评价[J].中国卫生检验杂志.2000,10(3):307-308.
50.赵莲英,刘煜,曹俊梅.医务人员手细菌污染调查及消毒效果调查[J].医学动物防制.2006,22(7):513-514.
51.吕一欣,任南.清洁洗手存在的问题及对策.中华流行病学杂志[J]. 1998, 19(5): 78.
52.袁洽匡.医院感染管理学[M].军事医学科学出版社.2000,397-425.
53.手部卫生:旨在降低医院感染的策略(十一)——行政管理的措施[J].中国医院,2005,9(11):79-80.
54.刘玉琼,蒋莉玲.李辉.医务人员洗手认知及监测现状[J].护理研究.2004.18(3):524-525.
55.万荣,曾韶美,郑慧英.基层医院医护人员洗手状况调查. [J]护理研究.2006,20(2 中):401-401.
56.同俏静,苏关关,袁玉华.手部卫生与医院感染的研究进展[J].中华医院管理杂志.2004,20(4):241-244.
57.连冬梅,王丹华.手卫生现状及研究进展[J].中华护理杂志.2005, 40(3): 220- 222.
58.余阳,廖晚珍. 加强洗手肥皂管理预防医院感染[J].江西医学检验. 2002, 20(5): 303.
59.高延秀,刘文莲,李宝香.医护人员应用 3 种干湿度不同肥皂洗手的效果分析[J].齐鲁护理杂志.1998,4(4):47.
60.Forrester BG, Roth VS. Hand dermatitis in intensive care units[J]. Occup Environ Med. 1998, 40: 881-885.
61.张晓春.200 名护士洗手的调查[J].中华医院感染学杂志,2001, 11(4):261.
62.李文玉.某医院 312 名医护人员洗手情况调查[J].解放军预防医学杂志.2001, 19(4): 303.
63.田洪明,舒逸萍,王莉.擦手毛巾染菌量与潜在医源性感染分析[J].中华医院感染学杂志.1996,6(3):162-163.
64.刘荣辉.热风烘干器气流中的细菌检测分析[J]. 中华医院感染学杂志.2003,13(4):356.
65.尚少梅,王宜芝,郑修霞,等.促进护理人员洗手行为依从性的研究[J].中华医院感染学杂志,2003,13(6):507-510.
66.手部卫生:旨在降低医院感染的策略(三)——手部卫生创议接受度试验报告[J].中国医院,2005,9(3):79-80.
67 . Bjerke, Nancy B.The Evolution: Handwashing to Hand Hygiene Guidance[J]. Critical Care Nursing Quarterly, 2004,27(3):295-307.
68.Pittet D. Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital[J] .Ann Intern Med, 1999,130:126-130.
69.Voss A. Widmer AF. No time for handwshing? Handwashing versus alcoholic rub: can we afford 100% compliance[J]. Infect Control Hosp Epidemiol, 1997,18:205-208.
70.Pitte tD. Improving compliance with hand hygiene in hospitals[J]. Infect Control Hosp Epidemiol, 2000,21:381-386.
71.Ayliffe GA,Babb JR,Davies JG,et al. Hand disinfeelions:a comparison of various agents in laboratory and wardatudies[J].J Hosp lirfect, 1988,11:226.
72.McGuckin m.,Wateman R.,Storr J.,et al.[J].J Hospital Infect,2001,48: 222- 227.
2.Semmelweis L Etiology, concept, and prophylaxis of childbed fever[M]. Madison WI: The University of wisonsin Press, 1983:5.
3.Coppage CM. Hand washing in patient care [M]. Wash-ington, DC.US public Health Service,1961.
4.Larson E.Guideline for use of topical antimicrobial agents[J].Am J Infect Control, 1988,16:253.
5.Larson EL. APIC Guidelines Committee. APIC guideline for hand washing and hand antisepsis in health caresettings[J].Am J Infect Control, 1995, 23:251.
6.Boyce JM.,Pitter D. Guideline for hand hygiene in health-care settings[J]. Am J Infect Control, 2002,30:51-546
7 .钟秀玲 , 程棣研 . 现代医院感染护理学 [M]. 北京 : 人民军医出版社,1995.107~115.
8. 苏冬梅,李春林,刘巧云,等. 静脉穿刺前后操作者一手的细菌学监测与洗手消毒液的选择[J]. 护士进修杂志.1997;12( 9):8.
9.尹湘毅,等.医护人员手部带菌状况的调查分析与对策[J].医学研究生学报,2004;10(7):908.
10.刘振声,金人鹏,陈增辉. 医院感染管理学[M]. 北京:军事医学科学出版社,2000;425- 454.
11.蓝才燕,陈式一,苏伟东,等. 医护人员手污染细菌的调查[J]. 广西预防医学,2001;7(3):142.
12.喻红波,等.护士手指细菌谱调查及消毒效果的观察[J].中华医院感染学杂志,2003;13(1):85.
13 . 沈 伟 . 洗 手 消 毒 的 概 念 与 方 法 选 择 [J]. 上 海 预 防 医 学 杂志,1998,10(8):342.
14.王晓敏,苟淑萍.洗手现状与对策[J].实用护理杂志,1995,11(9):43-44.
15.王常卿,王淑香,王云芳,等.109 名医护人员手带菌的监测和分析[J].中华医院感染学杂志,1995,5(1):47
16.尚少梅,郑修霞,王宜芝,等.临床护理人员洗手行为的观察与分析[J].中华医院感染学杂志,2001,11(6):455-456
17.李文玉.某医院 312 名医护人员洗手情况调查[J].解放军预防医学杂志,2001,19(4):303
18.刘瑞红,唐炎红.临床医护人员洗手行为的观察与分析[J].河南医药信息,2002,10(17):72
19.郑子轩,韩鹏飞. 医生手部卫生状况欠佳[N].南方日报 2004-9-2.
20. Boyce JM,Pitter D. Guideline for hand hygiene in health-care settings[J]. Am J Infect Control, 2002,30:51-546
21.Kirkland K. B., Weinstein ,I. M. Adverse effects of contact isolations[J]. Lancet, 1999, 354: 1177-1178.
22.Tibballs J. Teaching hospital medical staff to handwash[J]. Med J Aust. 1996, 164:395-398.
23.张晓春,林树德,吴建明.200 名护士洗手的调查[J].中华医院感染学杂志,2001,11(4):261.
24.许景云,黄世生,程和平.医务人员洗手情况调查与分析[J].湖北预防医学杂志,2001,12(1):26.
25.陈杰,程秀华.2000~2001 年医护人员洗手质量分析[J].湖北预防医学杂志,2003,14(1):51.
26 . Larson E,Kretaer EK .Compliance with handwashing and barrier precautions[J]. J Hosp Inf,1995,30(9suppl):88.
27. 金玲,金涛.从医护人员手带菌情况谈防止医院内感染[J].中华微生物学杂志, 1995, 7(4): 59.
28.Peter W, Kim MD, Pereucevich EN, et al. Rates of hand disinfection associated with gloveuse, patient isolation, and changes between exposure to variou sbody sites[J]. Am J Infect Control, 2003, 31(2): 97-103.
29.Didier Pittet, Mourouga P, Pernegar TV. Compliance with handwashing in a teaching hospital[J]. Annals ofI nternal Medicine, 1999, 130(2): 126-130.
30.手部卫生:旨在降低医院感染的策略(二)——手部卫生创议接受度试验报告 [J].中国医院,2005,9(2):78-79.
31.陶红.护理人员手清洁方法的实验研究[J].护理学杂, 2002, 17(3): 226- 227.
32.陈杰,程秀华.2000~2001 年医护人员洗手质量分析[J].湖北预防医学杂志,2003,14(1):51.
33.邢红霞,张红英,武建英,等.医务人员手卫生现状与管理[J].中华医院感染学杂志.2002. 12(8):639- 640.
34.Didier Pittet. Improving adherence to hand hygiene practice: A multidis- ciplinary approach [J]. Emerging In fectious Diseases,2001,7(2):234-240.
35.Weeks A. Handwashing: Why I don.t wash my hands between each patient contact [J]. BMJ,1999,319:518.
36.Zimakoff J, Kielsberg AB, Larsen SO, et al. A multicenter questionnaireinvestigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway[J]. Am J Infect Control,1992, 20(2):58-64.
37 . Andrej T.Andreas F.Hand hygiene:A frenuently missed lifesaving opportunity during Patient care[J].Mayo Clinic Proceedings, 2004, 79:109.
38.徐秀华.临床医院感染学[M].湖南:湖南科学技术出版社,1998:4.
39.曾光.中国的手部卫生行动[J].中华医药信息导报.2004.19(15):14.
40.牛秀成,张树德,周素琴,等.医务人员洗手技术与手再污染研究[J].中华医院感染学杂志,1998, 8(2):88- 89.
41.朱士俊.现代医院感染学[M].北京:人民军医出版社,1998.3~68.
42.夏毅.现代医护人员手卫生的理论和实践[J].现代临床护理, 2004, 3(1): 51-56.
43.卫生部.医院感染管理规范[Z].2000.10.
44.广东省卫生厅.关于印发“世界卫生组织——中国广东医院感染管理项目合作医院手卫生项目质量评价标准(试行)”的通知[Z].粤卫医政函[2005]10 号.2005.8.
45.杜杏利,曾铁英译.医疗保健机构手部卫生指南[J].中国感染控制杂志.2004,3(2):189-190.
46.李六亿,贾会学.手卫生与医院感染的预防与控制[J].临床药物治疗杂志.2005,3(6):11-15.
47.消毒技术规范(2002 年版)[Z].中华人民共和国卫生部.2002. 202-203, 206-207.
48.GB15982-1995.医院消毒卫生标准[S].
49.洪锡田,李惠平,白献红.医务人员手细菌污染调查及消毒效果评价[J].中国卫生检验杂志.2000,10(3):307-308.
50.赵莲英,刘煜,曹俊梅.医务人员手细菌污染调查及消毒效果调查[J].医学动物防制.2006,22(7):513-514.
51.吕一欣,任南.清洁洗手存在的问题及对策.中华流行病学杂志[J]. 1998, 19(5): 78.
52.袁洽匡.医院感染管理学[M].军事医学科学出版社.2000,397-425.
53.手部卫生:旨在降低医院感染的策略(十一)——行政管理的措施[J].中国医院,2005,9(11):79-80.
54.刘玉琼,蒋莉玲.李辉.医务人员洗手认知及监测现状[J].护理研究.2004.18(3):524-525.
55.万荣,曾韶美,郑慧英.基层医院医护人员洗手状况调查. [J]护理研究.2006,20(2 中):401-401.
56.同俏静,苏关关,袁玉华.手部卫生与医院感染的研究进展[J].中华医院管理杂志.2004,20(4):241-244.
57.连冬梅,王丹华.手卫生现状及研究进展[J].中华护理杂志.2005, 40(3): 220- 222.
58.余阳,廖晚珍. 加强洗手肥皂管理预防医院感染[J].江西医学检验. 2002, 20(5): 303.
59.高延秀,刘文莲,李宝香.医护人员应用 3 种干湿度不同肥皂洗手的效果分析[J].齐鲁护理杂志.1998,4(4):47.
60.Forrester BG, Roth VS. Hand dermatitis in intensive care units[J]. Occup Environ Med. 1998, 40: 881-885.
61.张晓春.200 名护士洗手的调查[J].中华医院感染学杂志,2001, 11(4):261.
62.李文玉.某医院 312 名医护人员洗手情况调查[J].解放军预防医学杂志.2001, 19(4): 303.
63.田洪明,舒逸萍,王莉.擦手毛巾染菌量与潜在医源性感染分析[J].中华医院感染学杂志.1996,6(3):162-163.
64.刘荣辉.热风烘干器气流中的细菌检测分析[J]. 中华医院感染学杂志.2003,13(4):356.
65.尚少梅,王宜芝,郑修霞,等.促进护理人员洗手行为依从性的研究[J].中华医院感染学杂志,2003,13(6):507-510.
66.手部卫生:旨在降低医院感染的策略(三)——手部卫生创议接受度试验报告[J].中国医院,2005,9(3):79-80.
67 . Bjerke, Nancy B.The Evolution: Handwashing to Hand Hygiene Guidance[J]. Critical Care Nursing Quarterly, 2004,27(3):295-307.
68.Pittet D. Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital[J] .Ann Intern Med, 1999,130:126-130.
69.Voss A. Widmer AF. No time for handwshing? Handwashing versus alcoholic rub: can we afford 100% compliance[J]. Infect Control Hosp Epidemiol, 1997,18:205-208.
70.Pitte tD. Improving compliance with hand hygiene in hospitals[J]. Infect Control Hosp Epidemiol, 2000,21:381-386.
71.Ayliffe GA,Babb JR,Davies JG,et al. Hand disinfeelions:a comparison of various agents in laboratory and wardatudies[J].J Hosp lirfect, 1988,11:226.
72.McGuckin m.,Wateman R.,Storr J.,et al.[J].J Hospital Infect,2001,48: 222- 227.