作 者：董宏亮
導(dǎo) 讀：
住院患者是醫(yī)院中數(shù)量最多的人群，他們與醫(yī)務(wù)人員一樣在醫(yī)院中存在，而大多數(shù)的患者由于身患疾病，攜帶病原體的風(fēng)險(xiǎn)較醫(yī)務(wù)人員更高，而他們?cè)卺t(yī)院中活動(dòng)，會(huì)將身體上攜帶的各種病原菌四處“播散”，這是我們作為醫(yī)務(wù)人員很容易理解的道理。而由于知識(shí)結(jié)構(gòu)的不同，住院患者對(duì)手衛(wèi)生重要性的認(rèn)識(shí)遠(yuǎn)不及醫(yī)務(wù)人員，他們的手衛(wèi)生依從性情況也影響著醫(yī)院感染發(fā)生率。
有研究人員評(píng)估了提高住院患者的手衛(wèi)生依從性在降低艱難棱菌感染率的作用，研究人員通過對(duì)住院患者進(jìn)行教育使患者了解手衛(wèi)生的重要性，包括向患者強(qiáng)調(diào)手衛(wèi)生在預(yù)防交叉感染上的重要作用以及什么時(shí)候必需進(jìn)行手衛(wèi)生，使用速干手消毒劑等內(nèi)容。干預(yù)后，對(duì)醫(yī)院的艱難棱菌的感染情況進(jìn)行統(tǒng)計(jì)分析。結(jié)果發(fā)現(xiàn)，經(jīng)過干預(yù)后，住院患者的手衛(wèi)生依從性顯著提高，而且艱難棱菌的感染情況較干預(yù)后連續(xù)6個(gè)月降低。研究人員認(rèn)為，患者的手衛(wèi)生依從性況可以通過教育明顯改善，而改善后可以使艱難棱菌的感染率下降。
通過此研究我們可以得知住院患者的手衛(wèi)生依從性在預(yù)防醫(yī)院感染上的重要作用，雖然研究人員的監(jiān)測(cè)指標(biāo)為艱難棱菌（因?yàn)槠D難棱菌目前在國外關(guān)注度較高，據(jù)估計(jì)每年美國有超過45萬例感染者，自2000年到2010年翻一翻，根據(jù)筆者的了解艱難棱菌目前在國內(nèi)的關(guān)注度并不太高），但相信其他類型的病原體的檢出也會(huì)明顯下降。研究推測(cè)患者感染艱難棱菌可能是由于手衛(wèi)生不良通過糞口途徑吞下艱難棱菌孢子而感染，那么其他類型的病原體也可能通過這一途徑而造成交叉感染的發(fā)生。
國外有研究表明患者入院后48小時(shí)內(nèi)，39%的患者手上至少污染有1種醫(yī)院常見病原體，而污染超過2種醫(yī)院常見病原體的患者有8%，提高患者的手衛(wèi)生依從性可以使其主動(dòng)將其手上污染的病原體通過手衛(wèi)生去除，對(duì)于降低患者后續(xù)的醫(yī)院感染發(fā)生有重要作用。研究認(rèn)為患者手衛(wèi)生的4個(gè)重要時(shí)刻為：接觸傷口前后，吃東西前，使用衛(wèi)生間后，進(jìn)入和離開病房前后。
病從口入，是老百姓關(guān)于疾病傳播最為樸素的認(rèn)識(shí)，病從口入的過程中手起了至關(guān)重要的作用，這也說明關(guān)注患者手衛(wèi)生的重要性和必要性！因此，我們?cè)陉P(guān)注醫(yī)務(wù)人員手衛(wèi)生依從性的同時(shí)必需關(guān)注患者的手衛(wèi)生依從性，對(duì)于患者來說至少有四個(gè)時(shí)刻應(yīng)該進(jìn)行手衛(wèi)生，這是我們作為醫(yī)務(wù)人員應(yīng)該向患者所囑咐的內(nèi)容。否則如遇醫(yī)院感染暴發(fā)時(shí)，請(qǐng)將患者的手衛(wèi)生依從情況也納入影響因素。
WHO對(duì)于患者參于手衛(wèi)生也有建議，即WHO鼓勵(lì)患者參與提高醫(yī)務(wù)人員的手衛(wèi)生依從性的活動(dòng)。筆者把這個(gè)建議翻譯了一下，有需要的老師可以對(duì)照參考。
WHO在醫(yī)療機(jī)構(gòu)提高手衛(wèi)生依從性：對(duì)患者的建議
Why clean hands are important– Doctors andnurses care for many sick people each day, often touching patients and theirsurroundings. While providing this much-needed care, they risk spreading germsto you if they did not clean their hands!
為什么洗手很重要：醫(yī)生和護(hù)士每天要診療和護(hù)理很多危重的患者，經(jīng)常會(huì)接觸這些患者和他們周圍的物品，當(dāng)他們來為你診療護(hù)理時(shí)如果不洗手可能有會(huì)將細(xì)菌傳染給你的風(fēng)險(xiǎn)。
What do we mean by “infections” – Aninfection you catch while receiving health care, through the transmission ofyour own or another patient’s germs, is called a health care-associated infection.They are a major global patient safety concern.
我們所謂的感染是什么意思：當(dāng)你接受診療護(hù)理時(shí)受到的感染，這些造成感染的細(xì)菌可能來自你自身或其他患者，叫醫(yī)院相關(guān)感染。這是一個(gè)主要的全球患者安全所關(guān)注的問題。
Hand hygiene is the simplest, mosteffective way to reduce the chance of catching these infections. Thoughcleaning hands in easy, health-care workers might forget or be too busy to dothis.
手衛(wèi)生是最簡單最有效的減少感染機(jī)會(huì)的方法。雖然洗手非常簡單，但是醫(yī)護(hù)人員可能忘記洗手，或他們由于太忙所以不能洗手。
How you can help – Your participationstarts by gathering information about this problem and hand hygiene bestpractices. You and your families may also help remind health-care workers notto touch your skin and critical sites (e.g. your catheters) if their hands havenot been cleaned yet.
你能幫些什么忙：你通過開始收集關(guān)于洗手和手衛(wèi)生最好的方法來參與這項(xiàng)活動(dòng)。你和你的家人可以幫助提醒醫(yī)護(hù)人員如果他們沒有洗手就不要接觸你的皮膚和危險(xiǎn)的部位（比如你的導(dǎo)尿管）。
Simply asking or thanking your doctor,nurse, or other health-care workers to clean his or her hands before touchingyou, can help you avoid a health care-associated infection.
簡單的的詢問或感謝你的醫(yī)生、護(hù)士或其他的醫(yī)護(hù)人員在接觸你之前洗手，可以幫助你避免醫(yī)院相關(guān)感染。
These tips will help you understand how toparticipate in hand hygiene improvement while receiving care.
這些建議將幫助你了解在接受診療護(hù)理時(shí)如何參與手衛(wèi)生的改善。
There are 4 main things you and/or yourfamily can do:
這里有4件主要的事情你和/或你的家人可以做：
1. Ask if an initiative involving patients or a patient participationprogramme exists. If yes, ask whether there is a leaflet or information sheetabout it and express your interest in participating.
1、問一下是否有一個(gè)關(guān)于患者主動(dòng)參與的手衛(wèi)生活動(dòng)，如果有，問一下是不是有一個(gè)活動(dòng)的說明書或關(guān)于此活動(dòng)的小冊(cè)子，表示你很有興趣參加這個(gè)活動(dòng)。
2. Don’t be afraid to ask about handhygiene practices in the facility. While health-care workers make everypossible effort to provide you with the best care, you have the right to askfor information and to check if best practices are in place. This cansignificantly help improve health-care delivery.
2.在醫(yī)院不要害怕去問關(guān)于手衛(wèi)生的措施。雖然醫(yī)護(hù)人員會(huì)盡總大的努力來為您提供最好的醫(yī)療護(hù)理，但您有權(quán)利去詢問或檢查最好的措施是否已到位。這將會(huì)顯著的改善醫(yī)療護(hù)理的提供。
3. Observe if alcohol-based handrubdispensers, as well as sinks, soap and towels are available in your room or ifhealth-care workers carry pocket bottles.If not, gently ask why hand hygieneproducts are not available and possibly ask for a small bottle of alcohol-basedhandrub product to keep by your bed.
3.觀察一下在你的病房是否有含酒精的手消劑，洗手水槽，肥皂和毛巾或醫(yī)護(hù)人員口袋里有手消劑。如果沒有，禮貌的詢問一下為什么沒有提供手衛(wèi)生用品，可能的話要一小瓶含酒精的手消劑放在你的床邊。
4. If hand hygiene products are available, start by thanking your doctor,nurse, or other health-care workerwhen you see them cleaning their hands beforetouching you or any critical site (e.g. catheter, wound dressing, drainagetube).
4、如果提供了手衛(wèi)生用品，要開始感謝你的醫(yī)生、護(hù)士或其他的醫(yī)護(hù)人員當(dāng)你看見他們接觸你或危險(xiǎn)部位（如導(dǎo)尿管，傷口敷料，引流管）時(shí)先進(jìn)行手衛(wèi)生。
The following highlights will help youunderstand the right moment and the right way to remind your doctor, nurse, orother health-care worker about hand hygiene:
以下幾個(gè)重點(diǎn)將會(huì)幫助你了解在正確的時(shí)刻使用正確的方法來提醒你的醫(yī)生、護(hù)士或其他的醫(yī)護(hù)人員進(jìn)行手衛(wèi)生：
Doctors, nurses and any other health-careworker (such as technicians and assistants) who touch you. Your relatives andvisitors should also clean their hands upon arrival, especially before touchingyou, and then before leaving too.
醫(yī)生、護(hù)士和任何接觸你的醫(yī)護(hù)人員（如技師和助手）。你的親戚和探望你的人也應(yīng)該在到達(dá)你的病房時(shí)洗手，特別是在接觸你之前，當(dāng)然在離開時(shí)也要進(jìn)行手衛(wèi)生。
When a health-care worker enters thezone/area where you receive care (near your bed, for example), before theytouch you or any critical site (e.g. catheter, wound dressing, drainage tube),you can ask them to clean their hands with an alcohol-based handrub. Or, youcan thank them in advance, as they approach you, as a polite reminder.
當(dāng)一位醫(yī)護(hù)人員進(jìn)入你接受診療的區(qū)域（比如在你的床邊），在他們接觸你或任何危險(xiǎn)的部位（比如導(dǎo)尿管，傷口敷料，引流管），你可以要求他們使用含酒精的手消劑進(jìn)行手衛(wèi)生?；蛘吣憧梢栽谒麄兘咏愕耐瑫r(shí)禮貌的提醒一下他們進(jìn)行手衛(wèi)生。
The five important times you should remindhealth-care workers about hand hygiene:
有五個(gè)重要的時(shí)刻你應(yīng)該提醒醫(yī)護(hù)人員進(jìn)行手衛(wèi)生：
1. Before anyone touches you
1. 任何人接觸您之前；
2. Before health-care workers perform a clean/aseptic procedure, such asinserting an IV (intravenous catheter)
2.在醫(yī)護(hù)人員進(jìn)行清潔/無菌操作之前，如靜脈插管；
3. Aftertasks which might lead to exposure to body fluids, such as emptying yoururinary catheter
3. 在可能導(dǎo)致暴露在您的體液的操作之后，如排空你的導(dǎo)尿管時(shí)。
4. After anyone touches you
4. 任何人接觸您之后；
5. After anyone touches things in your care area, such as bedrails or yourmedical chart.
5、任何人接觸您周圍的物品之后，如您的床欄桿或你的醫(yī)護(hù)記錄單。
Wherever health care takes place, whetherin a hospital, clinic, or doctor’s office.
在任何進(jìn)行醫(yī)療護(hù)理的地方，不管是醫(yī)院，診所或醫(yī)生辦公室都要進(jìn)行上述提醒。
Reminding and thanking are positiveinteractions and your health-care provider will understand your positiveintentions to avoid an infection. Keep it simple, and do it often!
提醒和感謝是積極的醫(yī)患互動(dòng)，您的醫(yī)生或護(hù)士或其他醫(yī)護(hù)人員會(huì)明白您的真正意圖是避免院內(nèi)感染。簡單化，經(jīng)常這樣做！
· “Thank you for your hand hygiene action.”
“謝謝您的做的手衛(wèi)生”
· “Did you clean your hands?”
“您已經(jīng)洗過手了嗎？”
· “Did I remind you about hand hygiene?”
“我有沒有提醒過您進(jìn)行手衛(wèi)生？”
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