医院交叉感染应该是这个世界上最让人不爽的事之一，大家想想“如果你因为不适或外伤到医院看医生或接受某项治疗而感染某种疾病特别是乙肝或艾滋那是什么样后果？是不太悲催了？”这也就是为何不少医院如今设置了“感染控制科，简称感控科”的缘故。

如今，大家对在接受注射、拔牙或超声洁牙、手术和输液输血等治疗过程中极可能被感染某种病菌的事实大多已知，但对在医院内更为经常发生的事情，如接受医生或护士的双手检查亦可能传播某些疾病之事实则知道的人不多，因而警惕性则不够或不重视。例如，您去医院看医生，您的医生是否在检查完前一名病友后洗净双手，然后再为您作检查呢？这种情况恐怕不多见吧？

日前，美国学者公布了他们的研究成果（请参阅以下英文字样），即在医院的关键点增设摄相头可以增加医生和护士的洗手率（rates of hand-washing compliance）。为了让医护工作人员按要求洗手，美国人摄相头都用上了，如此看来医生护士在接触不同病友之前后洗手者真的不多，看来加强教育与监管势在必行！

When cameras are watching, more doctors wash up

NEW YORK (Reuters Health) - A new study found that more doctors and nurses washed their hands when video cameras were installed in every room in their unit and the staff was continuously informed about rates of hand-washing compliance.

While the hand-washing turnaround was "pretty amazing," one of the study's authors said, it's unclear whether the measure helped achieve the ultimate goal -- preventing infection transmission in the hospital -- and whether it would be cost-effective in other settings.

"Hand washing is an integral part of infection control," said Dr. Bruce Farber, from North Shore University Hospital in Manhasset, New York. But, "rates of hand washing among health care workers are less than perfect."

Cameras and timely feedback seem to be a strategy that can address that, he told Reuters Health. "It's certainly one tool that can be used. I certainly don't think it's ever going to be used by everyone, everywhere."

Farber and his colleagues conducted the new study in their intensive care unit between 2008 and 2010. They installed $50,000 worth of cameras in hallways and patient rooms -- pointing at every sink and hand sanitizer dispenser -- as well as motion sensors in all doorways.

Off-site reviewers monitored those videos and checked whether any doctor or nurse who came through a patient's door washed their hands within ten seconds, and if they did the same on the way out. Doing that earned workers a "pass," while waiting too long to wash up or not doing it at all counted as a "fail."

Then, the system sent compliance rates by room to electronic boards in the ward's hallways and to supervisors, so all staff could see how well they were doing as a unit.

Before health workers started getting that constant feedback, less than seven percent of them washed their hands immediately when entering or before leaving a patient's room, according to video records.

That shot up to 82 percent in the weeks after the hallway messages started, and reached an average high of 88 percent over the next year and half of monitoring.

The researchers acknowledged in their report published in Clinical Infectious Diseases that the monitoring didn't take into account the quality of hand washing, and Farber said the criteria for adequate hand hygiene were "very strict and very difficult to adhere to."

It's possible, the researchers added, that there are some cases when hand-washing isn't necessary, for example when a doctor is going into a patient's room but doesn't plan on touching the patient.

Or, if a patient is falling out of bed or needs immediate pain relief, heading to the sink first might not be the best choice, added Dinah Gould, who has studied hand-washing interventions as a researcher at City University in London, but wasn't involved in the new study.

Still, many studies have documented generally low rates of hand washing among health care workers.

"Logically, according to common sense hand hygiene is a good thing to do because if you do it properly it removes bacteria from the skin," Gould said. "Doctors and nurses should do it and patients in their care should expect it's going to be done."

　　Whether it definitely prevents infection, she said, hasn't been proven.

Farber said that he and his colleagues were starting to see a trend of fewer hospital-acquired infections, including those caused by drug-resistant bugs like methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. But more time is needed to determine if that has anything to do what hand hygiene, he cautioned.

Gould said the study shows that the video-taping method for encouraging better hand hygiene is possible. But she questioned whether installing cameras and analyzing videos would be feasible on a day-to-day basis outside of research studies. "I think that the cost would probably preclude it," she told Reuters Health.

In addition to the up-front cost for installing the cameras, the CEO of the company that provided the feedback services, Arrowsight, Inc., said those services cost about $3,000 per month for a single ICU. For the current study, monitoring and feedback were funded by the hospital, and the equipment was bought with a state grant.

SOURCE: http://bit.ly/tgeVQN Clinical Infectious Diseases, online November 21, 2011.