目的开展手卫生在职教育活动，强化医务人员手卫生意识，进一步规范医务人员手卫生的执行。方法对某院2011年12月在岗的工作人员开展以“预防院感，从手开始”为主题的在职教育活动。活动形式包括现场承诺签名，门诊、住院大厅设置宣传画展板,院内局域网上传学习手卫生知识及技能培训，洗手明星理论与操作竞赛。结果此次在职教育活动参加总人数达622人，包括医生、护士、药剂、检验、行政后勤人员等。评选出五星、四星、三星洗手明星科室（分别为1、2、3个）和个人（分别为5、10、15人），其中洗手为五星的明星科室是耳鼻咽喉科，5位五星的明星个人分别来自妇产科、烧伤泌尿外科、耳鼻咽喉科、骨科、功能科室。结论通过开展手卫生在职教育活动，使全院各级各类人员正确理解了手卫生规范要求，改变了错误的手卫生观念，营造出良好的手卫生氛围，使手卫生受到全员重视。

目的了解西安市医院临床护理人员执行手卫生的效果及其影响因素，以促进手卫生质量的提高。方法按照《消毒技术规范》要求，对西安市部分专科门诊、综合医院、职工医院、三级甲等医院共116家医疗机构中从事临床护理工作的668名护理人员进行手卫生监测、比较。结果专科门诊、综合医院、职工医院、三级甲等医院临床护理人员手卫生合格率分别为67.69%（44/65）、87.50%（210/240）、71.92%（187/260）、86.41%（89/103），不同类型医院护理人员手卫生合格率差异有统计学意义（χ2=28.16，P＜0.01）。不同科室中，手术室、产房护理人员手卫生合格率最高，分别为98.37%、96.15%，其次是儿科（84.48%）、内科（75.90%）、外科（69.54%）、妇产科（68.97%）、口腔科（53.97%）。结论不同医院和科室临床护理人员执行手卫生效果参差不齐，应进一步加强对医务人员手卫生的管理，提高其手卫生依从性。

ObjectiveTo investigate the hand hygiene compliance among healthcare workers(HCWs) in hospitals in Yichang, and evaluate the approach to improve hand hygiene compliance.MethodsQuestionnaires of hand hygiene compliance were filled out by HCWs at 37 hospitals.ResultsA total of 238 HCWs were surveyed, the overall hand hygiene compliance rate was 32.38%(125/386), and the rates varied significantly with the kinds of the hospitals as below: 46.81% in tertiary, 53.19% in secondary, 23.53% in private, 7.69% in township, and 17.95% in primary, hand hygiene compliance rate was significantly different among all hospitals(P<0.05). Of 6 time points for hand hygiene (before contact with patients, before aseptic procedure, after body fluid exposure, after contact with patients, after contact with environmental surface in the vicinity of patients, and after glove removal), hand hygiene compliance rates before aseptic procedure and after removing gloves were the highest, which was 89.58%(43/48) and 80.49%(33/41) respectively. Nurses’ hand hygiene compliance rate was 54.82%(74/135), which was significantly higher than in the other groups (P<0.01); of all departments, hand hygiene compliance rate of HCWs in obstetrics and gynecology was 83.78%(31/37), which was significantly higher than in the other departments (P<0.01). Of all hospitals, 18.92% equipped with nontouch taps and 43.24% equipped with handdrying facilities. After washing, 39.76% (33/83) HCWs used tissue or handdrying facilities, 13.25%(11/83) dried hands naturally, and 46.99%(39/83) wiped hands with their uniforms. The major factors influencing the hand hygiene compliance were heavy workload (42.86%), insufficient attention (38.24%) and hand hygiene facilities(36.56%).ConclusionThe overall hand hygiene compliance rate in Yichang is low, hand hygiene compliance need to be improved.

目的应用简便、省时、有效的手卫生方法，提高门诊医务人员手卫生执行度。方法随机抽取162名门诊医务人员分为2组，一组采用六步洗手法于流动水下洗手，另一组采用卫生手消毒法（速干手消毒凝胶）免水揉搓双手，比较2组手卫生前后手采样细菌数、合格率和手卫生消耗的总时间。结果六步洗手法组与卫生手消毒法组医务人员执行手卫生后，手的菌落总数分别为（2.40±1.28）CFU/cm2、（2.37±1.31）CFU /cm2,均达到手卫生目的（P>0.05），合格率分别为97.50%、93.90%，差异无显著性（P>0.05）；采用卫生手消毒法每进行手卫生100次较六步洗手法洗手可平均节省时间（3.60±0.30）h。结论卫生手消毒法可节省手卫生时间，效果好，提高了工作效率，在手部无明显污染时可替代六步洗手法广泛应用于门诊医务人员操作后的手卫生。

目的调查某院医务人员手卫生的依从性现状。方法采用隐蔽式现场观察的方法，根据《医务人员手卫生规范》，对128名医务人员接触患者前后手卫生的依从性进行调查。结果128名医务人员中，接触患者前后执行手卫生者40人，手卫生依从率31.25%。手卫生依从率最高的科室为重症监护室（53.85%），其次为妇产科（36.36%）、内科（34.62%）、急诊科（25.00%）和外科（20.00%）；不同岗位间，手卫生依从率最高的是护士（48.57%），其次为医生（38.71%）、实习护士（20.83%）、实习医生（16.67%）、护工和保洁员（15.38%）。结论该院医务人员手卫生依从性不高，应加强宣教、监督和管理。

目的了解某院免费提供手卫生用品和增加手卫生投入，对医务人员手卫生依从性及环境和医务人员手卫生微生物学监测合格率的影响。方法将该院7个病区作为试点科室免费配置手卫生用品，血液科一病区为对照组（不予免费配置手卫生用品），比较试点科室和对照组科室的医生、护士、进修生和实习生的手卫生依从性，以及环境和医务人员手卫生微生物学监测合格率。结果实施手卫生活动后（7月份），试点科室手卫生依从率为93.21%（2 170/2 328），与活动前（4月份）的49.78%（569/1 143）比较，差异有统计学意义（χ2=868.952，P＜0.001）。7月份，各试点科室物体表面和医务人员手卫生微生物监测整体合格率分别为92.73%(153/165)、99.40%(167/168)，较4月份的70.81%(114/161)、72.19%(109/151)显著提高（χ2值分别为26.414、50.519,均P＜0.001）。作为对照组的血液科一病区，活动前后医务人员手卫生依从性、环境及医务人员手卫生微生物学检测合格率差异均无统计学意义（P＞0.05）。结论医院免费提供手卫生用品，增加手卫生投入，可提高医务人员手卫生依从性及手卫生合格率。

目的方法结果结论调查流动采血车医务人员手细菌及乙型肝炎病毒（HBV）污染状况。对流动采血车医务人员手消毒后工作状态下未戴手套及戴手套的手指采样，进行细菌培养和乙型肝炎表面抗原（HBsAg）检测（酶联免疫吸附试验）。结果显示，未戴手套操作时，采血人员、检验人员、后勤人员、体检人员的手平均菌落数分别为4.20、7.30、8.60、10.50 CFU/cm2，手合格率分别为82.72%、64.17%、52.26%、45.33%；HBsAg阳性检出率分别为0.00%、2.08%、0.00%、0.00%。采血人员和检验人员戴手套操作时手（于手套上采样）平均菌落数分别上升至6.80 CFU/cm2和12.60 CFU/cm2，检验人员手HBsAg污染率上升至9.38%。提示流动采血车医务人员手细菌污染严重，戴手套操作时手消毒不规范增加了微生物污染的危险性。

目的探讨通过实施全方位综合干预措施，对增强医务人员手卫生意识和提高手卫生执行率的效果。方法分别于2009年9月和2010年9月对某院进行两次手卫生问卷调查。根据第1次调查结果，针对性采取全方位综合干预措施，对比分析采取手卫生综合干预措施后（第2次调查）手卫生的依从性。结果经过全方位综合干预后，医务人员参加手卫生知识培训率，由2009年的78.87%提高至2010年的94.83%（χ2=41.65，P＜0.01）；2010年医务人员工作一天洗手4～9次及遵循六步洗手法者所占比率分别为93.30%、76.80%，显著高于2009年的43.36%、44.35%（χ2分别为272.21、80.31，均P＜0.01）。2010年手卫生专项检查分数和微生物监测合格率分别为（96.79±3.56）分、95.29%，较2009年的（92.49±4.72）分和69.57%显著提高（分别t=6.65，χ2=16.67；均P＜0.01）。结论全方位强化手卫生措施使全院医务人员手卫生知识、手卫生执行率均明显提高。

目的通过调查护工的手卫生现状并分析其影响因素，予以手卫生培训等干预措施，提高护工的手卫生依从性。方法利用床旁视频对某院综合重症监护室（ICU）内10名护工进行手卫生现状调查，医院感染管理兼职护士利用讲课和现场操作等方法对其进行手卫生的行为干预，并比较干预前后的手卫生依从性。结果干预前观察的护工手卫生依从率为28.01%（142/507），干预后提高至63.09%（306/485），差异有统计学意义（χ2=121.79，P＜0.001）。结论医院感染管理兼职护士对护工进行行为干预，提高了护工的手卫生意识及手卫生依从性。

随着医疗技术的发展，大量侵入性操作的临床应用以及抗菌药物的广泛使用，医院感染率逐年上升。医护人员做好手卫生是控制医院感染的重要措施，而洗手被认为是非常必要的、最基本的、最简便易行的预防和控制病原体传播的手段之一［1］。正确的洗手可降低手部细菌量尤其是致病菌数量，从而降低通过手传播疾病的可能性，最终达到降低医院感染发生率的目的［2］。本文就近年来医护人员手卫生相关研究综述如下。

ObjectiveTo evaluate the effect of hand hygiene in the prevention of ventilatorassociated pneumonia (VAP) in neonates. MethodsBy combination of retrospective and prospective methods, the occurrence of VAP of neonates in neonatal intensive care unit (NICU) was compared before and after the improvement of hand hygiene between 2004—2007. ResultsWhen the other conditions were not changed, the incidence of VAP reduced obviously from 30.00% (2004—2005) to 18.18%(2006—2007) after improving the hand washing method and facilities, there was significant difference between the two(χ2=9.44, P<0.01).ConclusionHand hygiene is an important process to prevent VAP, one of the key measures to reduce the occurrence of VAP are perfect hand washing methods and facilities and the compliance of health care workers.

目的了解某病区静脉药物配制护士手卫生状况，加强输液环节的医院感染管理。方法对医院Ⅲ类环境中44名静脉药物配制护士的手进行随机采样检测。结果44份样本中， 27份检出细菌，其中9份样本细菌数超标。检出细菌居前4位的是凝固酶阴性葡萄球菌、微球菌属、真菌、不动杆菌属，分别占46.15%、28.21%、7.69%、7.69%。结论该病区静脉药物配制护士手卫生状况较差，有必要加强病区配药护士的手卫生监管。

目的方法结果结论为有效提高医务人员手卫生的依从性，降低医院感染率。某院于2008年8月—2009年6月，采取了一系列手卫生干预促进措施：全员手卫生知识培训、ISO9001质量体系文件管理、洗手前后手部细菌连续监测对照、统计各科洗手液使用情况、制作洗手宣传图片等。经干预后，医务人员在接触患者前后的洗手率（均为95.05%）、手卫生监测合格率（98.10%）等均高于干预前（分别为75.10%、90.00%、73.06% ），两两比较，差异均有高度显著性（均P＜0.01）。提示采取积极有效的手卫生促进策略，能有效提高医务人员手卫生的依从性。

ObjectiveTo investigate the efficacy of ATP bioluminescence assay on improving the compliance and qualifying rate of hand hygiene of rotating doctors in an intensive care unit.MethodsBaseline status of hand hygiene of doctors were investigated firstly,then the frequency and methods of monitor according to the results were made, hand hygiene were monitored by ATP bioluminescence assay, results were performed feedback, the status of hand hygiene after intervention were investigated.ResultsA total of 120 doctors participated in the baseline investigation, the total qualified rate of hand hygiene was 73.33%, hand hygiene compliance rate was only 14.17%. After field detection by ATP and feedback intervention, the qualified rate of hand hygiene increased to 82.24%（χ2=13.68，P=0.008）; handwashing compliance rate increased most during the intervention process (69.44%).ConclusionATP bioluminescence assay on the field detection and timely feedback of doctors’ hand hygiene status can improve the hand hygiene compliance and qualified rate.

目的了解边远地区某三甲医院手卫生设施的配置、医务人员对手卫生知识的认知及洗手依从性状况。方法对120 名医务人员进行随机抽样问卷调查，对全院洗手设施进行实地察验。结果共发出问卷120份，回收有效答卷112份，回收率93.33%；其中医生37名，护士75名。医护人员普遍对手卫生相关知识知晓率不高；不能按规范洗手的原因主要为洗手后无干手设施（医生占48.65%，护士占61.45%）、工作忙（医生占32.43%，护士占51.81%）；最常用的干手方法是自然晾干（48.39%），其次是在白大衣上擦干（26.45%）。洗手设施配置较差。结论该院医务人员手卫生相关知识缺乏，亟需加强培训教育；洗手及干手设施配置有待完善。

目的方法结果结论对辖区内19所医院97名产房助产人员的手消毒效果进行监测。手消毒总合格率为84.54%，其中公立医院助产人员手消毒合格率为91.55%，显著高于民营医院的65.38%（χ2=9.966，P＜0.05）。城区医院助产人员手消毒合格率为90.00%，稍高于农村医院助产人员手消毒合格率78.72%，但两者差异无显著性（χ2=2.357，P＞0.05）。所调查的一般情况中（医院是否具有健全的手卫生制度；洗手设施是否符合要求；医院是否对助产人员定期进行手卫生知识培训；助产人员洗手方法是否正确；医院是否有手消毒监测记录；使用消毒剂是否合格）每项内容，公立医院与民营医院差异均无显著性（均P＞0.05）。提示应加强产房助产人员手消毒工作，改善洗手设施，改进手消毒方法，有效预防经手导致产房交叉感染。

ObjectiveTo evaluate the effect of continuous hand hygiene quality improvement on healthcareassociated infection. MethodsHand washing facilities were installed and equipped with liquid soap and hand disinfection in 2007. Hand hygiene quality was enforced through target management and supervision and feedback. ResultsFrom 2007 to 2010, hand washing facilities improved continuously, handdry method changed from hand dryer to paper towel; the number of departments with hand washing liquid and hand disinfection consumption of 20 mL/bed day increased from 4 in 2009 to 17 in 2010, the number of departments with hand washing liquid and hand disinfection consumption of 10-20 mL/bed day increased from 13 in 2009 to 47 in 2010; the qualified rate of hand hygiene increased from 93.93% in 2008 to 98.67% in 2010; healthcareassociated infection rate decreased from 2.74% in 2008 to 1.73% in 2010.ConclusionContinuous hand hygiene quality can improve the healthcare workers’ compliance to hand washing, and decrease healthcareassociated infection.

ObjectiveTo assess the  prevalence of hand hygiene compliance rates of health care workers (HCWs) at general hospitals in China in 2010-2012.  MethodsLiteratures  about  hand hygiene compliance  of  HCWs from 2010 to 2012 were retrieved from  China Biology Medicine disc (CBM）, China National Knowledge Infrastructure（CNKI）,Wan Fang database, VIP ，and PubMed database , Comprehensive Meta Analysis V2 software and Stata12.0 software were adopted to conduct statistical analysis . ResultsNinety literatures  were selected with heterogeneity（Q=48 118.32，P＜0.01）, random effect model was used. The  overall  hand hygiene compliance rate of HCWs  was 47.83%（95%CI：43.27%-52.42%）; When stratified by occupation group， the overall compliance rate of doctors，nurses, and unclassified HCWs was 40.36%（95%CI：35.42%-45.49%）, 46.70%（95%CI：41.81%-51.65%）, and 40.72%（95%CI：27.75%-55.13%） respectively. According to subgroup analysis， there was no statistical difference in compliance rate between doctors and nurses（Q=3.12，P＞0.05）; the compliance rate after patient contact was higher than before patient contact （54.33% ［95%CI : 44.76%-63.59%］ vs 20.21%［ 95%CI: 14.12%-28.06%］）（Q=32.59，P＜0.01）; hand compliance rate from field observation was higher than from covert observation （70.91% ［95%CI ：70.71%- 71.10%］ vs  41.20%［95%CI ：37.55% -44.94%］）（Q=247.66，P＜0.01）.ConclusionThe overall hand hygiene compliance rate of HCWs in 2010-2012 was low,  in order to reduce the risk of healthcareassociated infection, hand hygiene compliance of HCWs need to be increased .

ObjectiveTo evaluate the improvement of hand hygiene in medical institutes after the carrying out of “monthly activity of hand hygiene”,  the knowledge of hand hygiene among health care workers (HCWs), and the improvement of HCWs’compliance with hand hygiene. MethodsCompliance with hand hygiene  before and after the carrying out of  “monthly activity of hand hygiene” was supervised by experts, evaluation was performed according to  uniformed  standard. ResultsBefore and after the carrying out of  “monthly activity of hand hygiene”, The putting up of standard hand washing figures in key departments rose from 37.95% to 93.37% （χ2=113.07, P＝0.00）, the change of nontouching faucets from  21.08% to 60.84% （χ2=54.25, P＝0.00）, the supply of rapiddry hand disinfectant from 15.66% to  56.63% （χ2=60.34, P＝0.00）, the handdrying method against a  second contamination from  9.04% to 45.18% （χ2=54.88,  P＝0.00）, the correct hand washing methods of doctors and nurses from 17.39%,19.57% to  89.13%, 93.48% （χ2=69.57，P＝0.00；χ2＝78.10, P＝0.00）, the differences were significant, respectively. Conclusion“Monthly activity of hand hygiene” promoted the improvement of hand hygiene installation, hand hygiene knowledge is  popularized among all levels of persons in hospital, and hand hygiene awareness and compliance are enhanced.

ObjectiveTo explore the effective measures to improve hand hygiene compliance among health care workers(HCWs) in a hospital.MethodsIn 2012,comprehensive management measures were taken to intervene hand hygiene compliance among HCWs in a hospital.ResultsA total of 72 times of inspection of hand hygiene among HCWs in the whole hospital were conducted, 86 nonhandtouching water taps were transformed, 420 posters pictures and hand washing flow charts were put up. Hand hygiene compliance rate in 2012 was higher than in 2011(60.48% vs 34.50%)（χ2=458.70，P＜0.05）；qualified rate of hand hygiene was higher than in 2011 (82.13% vs 60.04%)(χ2=188.41，P＜0.05）.The consumption of fastacting hand disinfectant of whole hospital and intensive care unit was significantly higher than in 2011(3.15mL /bed/day vs 0.39mL/bed/day,t=2.59; 21.82 mL/bed/day vs 17.81mL/bed/day,t=2.76，both P＜0.05）.ConclusionComprehensive management measures can effectively improve hand hygiene compliance among HCWs.

ObjectiveTo investigate hand hygiene compliance of health care workers (HCWs) in a hospital, and evaluate intervention measures.MethodsQuestionnaires were designed and filled out by HAI management professionals through unannounced visits and random quiz. ResultsFrom July to September 2013, a total of 1 188 HCWs were surveyed , hand hygiene compliance rate was 61.87%, of which handwashing correct rate was 58.90%.Hand hygiene compliance rate of nurses  (71.00%) was higher than doctors (57.80%) and  other HCWs (32.14%)，correct hand washing rate (65.43%) was higher than other HCWs (38.89%) (P<0.0125) . Hand hygiene compliance of different work opportunities and different professions were different slightly, hand hygiene compliance rate after contact with patients’ blood, body fluid and wound dressing was the highest(81.58%);hand hygiene rate before contact with patients was the lowest(34.62%) .Only 297 patients (25.00%) used rapidly act hand disinfectant. ConclusionHand hygiene compliance rate of HCWs in this hospital need to be  improved.

ObjectiveTo realize effect and impact factors of intervention in hand hygiene of health care workers (HCWs) in intensive care units (ICUs)， and evaluate rational and practical hand hygiene intervention methods, so as to enhance the compliance with hand hygiene among HCWs.MethodsThe first intervention stage was in 2008, educational and productive intervention were implemented in general, neurosurgical and neonatal ICUs; The second intervention stage was in 2009, individualized intervention was performed in addition to the above basic intervention strategies. HCWs’ compliance with hand hygiene was investigated based on the questionnaires and onthespot observation of hand hygiene process, the compliance rates before and after implementation of intervention was analysed. ResultsHCWs’ compliance rate of hand hygiene before and after implementing intervention was 25.06% and 41.52% respectively, the compliance rate increased most obviously between medical care activities, which enhanced from 10.11% before implementing intervention to 28.33% after implementing intervention (P=0.01).Compliance rates of hand hygiene were all improved in HCWs in 3 ICUs, and there was significant difference in compliance rate among 3 types of education (P=0.01).ConclusionIntervention with hand hygiene product, basic and individualized education can promote ICU HCWs’ compliance with hand hygiene.

ObjectiveTo explore feasible methods of hand hygiene intervention, and improve the compliance with hand hygiene among health care workers (HCWs).MethodsHand hygiene promotion activities were carried out in 20 medical institutes of Wuhan city, questionnaires and field observation were used to evaluate the change before and after the intervention.ResultsAfter intervention, hand hygiene knowledge among HCWs increased significantly, the compliance rate of hand hygiene rose from 60.59% （143/236）to 84.08%（243/289）(χ2=36.82,P＜0.001) before direct contact with patients; healthcareassociated infection (HAI) in patients in intervened department decreased from 39.33% (118/300）to 31.20%（83/266）（χ2=4.07,P=0.04）, the difference was statistically significant (P＜0.05）.ConclusionTaking positive and effective hand hygiene promotion activities can obviously enhance hand hygiene compliance of HCWs,and reduce the incidence of HAIs.

ObjectiveTo realize hand hygiene status and effect of handdrying measures on handwashing of health care workers(HCWs) in an intensive care unit(ICU). MethodsFrom February to April 2013, 210 HCWs in an ICU were selected and randomly divided into three groups， group A dried hands with paper towel， group B with hand drier，and group C with personal towel，specimens from hands before handwashing, after handwashing, and after handdrying were taken and performed detection.ResultsHand microorganism count in group A,B and C before washing hands after contacting patients was (29.10±15.08)CFU/cm2,(31.42±14.76)CFU/cm2 and (30.36±15.52)CFU/cm2 respectively, the difference was not statistically different（F=0.048，P＞0.05）； After sixstep handwashing, hand microorganism count before hand drying in group A,B and C was (3.26±0.61)CFU/cm2, (2.98±0.59)CFU/cm2  and (3.87±0.67)CFU/cm2 respectively,compared with hand microorganism count before handwashing,  the difference was statistically different(all P<0.01）. After adopting different  handdrying methods, microorganism count in three groups was statistically different（F=1.892，P＜0.05）, group A (［1.29±0.58］CFU/cm2 )was significantly lower than group B and C, group B (［9.51±0.73］CFU/cm2 )was significantly lower than group C(［22.76±4.11］CFU/cm2); the qualified rate in group A （90.00%）was significantly higher than group B and C, group B （68.57%）was significantly higher than group C （47.14%）.The top 5 pathogens isolated from HCWs’ hands were Pseudomonas aeruginosa， Acinetobacter baumannii， Klebsiella pneumoniae，Escherichia coli，and  Coagulase negative Staphylococcus, these strains were highly consistent with the top 5 multidrugresistant organisms (MDROs) isolated from ICU patients in this hospital in 2013. ConclusionHCWs’ hands  are seriously contaminated after all kinds of medical performance; if hands are improperly dried，secondary contamination may occur; pathogens isolated from HCWs’ hands are highly consistent with MOROs from patients,timely and correct handwashing and  handdrying is the key link to ensure the quality of hand hygiene，and  is of great significance to reduce the occurrence of MDROs infection in ICU patients.

ObjectiveTo investigate the influence of participation of healthcareassociated infection (HAI) management department in ward round presided over by hospital director on hand hygiene compliance of health care workers (HCWs) in a basiclevel hospital.MethodsImplementation of hand hygiene in JanuaryJune 2012 (control group : HAI management department didn’t participate ward round) and JanuaryJune 2013 (trial group : HAI management department participated ward round) were investigated, the compliance of hand hygiene of two groups of HCWs and consumption of hand hygiene products of each department were compared.ResultsHAI case rate in trail group was significantly lower than control group (1.49% vs 2.01%)（χ2=4.31，P＜0.05）; HCWs’ hand hygiene compliance rate was significantly higher than control group(71.56% ［3 249/4 540］ vs 44.00%［1 914/4 350］）, hand hygiene compliance rates in nurses were higher than doctors of both groups（χ2=151.30, 179.92， respectively，both P＜0.001）, hand hygiene compliance rate in trial group from high to low was department of pediatrics, obstetrics and gynecology, surgery,and internal medicine. The consumption of rapid hand disinfectant of trail group and control group was 5.38mL/bedday and 1.88 mL/bedday respectively, the consumption of hand sanitizer was 11.51 mL/bedday and 7.03 mL/bedday respectively.ConclusionHand hygiene checked during the ward round presided over by hospital director can improve HCWs’ hand hygiene compliance,reduce the incidence of HAI,and ensure medical safety.

ObjectiveTo evaluate the intervention efficacy of hand hygiene of health care workers(HCWs) in a hospital before and after the comprehensive interventions were taken. MethodsThe baseline investigation stage was in AprilJune,2013 , intervention was performed from July,2013, postintervention efficacy evaluation stage was in OctoberDecember ,2013. Hand hygiene compliance was observed by investigators , and questionnaires were filled out.ResultsAfter multiple interventions were taken, hand hygiene compliance rate of HCWs increased from 38.02% to 53.86% （χ2=181.82，P＜0.05）, postintervention compliance rates of hand hygiene improved significantly  in departments of internal medicine, surgery and intensive care unit (all P<0.05).After intervention, the  overall hand hygiene compliance rate at different work opportunities rose from 41.87%(1 740/4 156) to 53.45%(2 044/3 824)（χ2=107.2，P＜0.05）;except sterile manipulation, the other 4 manipulation opportunities were all higher than preintervention(all P<0.05); HCWs of different  professions were all higher than preintervention(all P<0.05).ConclusionActive hand hygiene intervention can effectively improve hand hygiene compliance of HCWs.

目的了解采取手卫生管理策略对提高医护人员手卫生依从性的效果。方法对某院临床科室手卫生设施配备情况和医护人员手卫生执行情况进行督查，比较2012年4月和2013年4月（干预前后）医护人员手卫生的依从性。结果2013年4月，抗菌洗手液和干手物品配备合格率分别为88.89%、66.67%，明显高于2012年4月的18.18%和0；医护人员洗手方法合格率（96.43%）和手卫生依从率（81.15%）亦显著高于2012年4月（分别为63.64%、51.40%），差异有统计学意义（均P＜0.05）；医护人员接触患者前后和接触患者物品后手卫生依从性均显著高于2012年4月（均P＜0.05）。结论采取有效的手卫生管理策略，可提高医护人员手卫生依从性，保障医疗安全。

目的了解某院临床科室医务人员手卫生依从性，分析存在的问题，为提高医务人员手卫生依从性提出对策。方法对该院2013年8月临床科室在岗医务人员手卫生执行情况进行调查，并对结果进行分析。结果共调查医务人员2 189人次，手卫生依从率为62.13%。在所设计的6种情况下，医务人员手卫生依从率为54.46%～92.00%，其中摘手套后手卫生依从率（92.00%）最高，其次为无菌操作前(74.03%)、接触体液等后(72.43%)、接触患者环境后(66.23%)、接触患者后(61.03%)和接触患者前(54.46%)。不同岗位医务人员手卫生依从性差异有统计学意义（χ2=12.807，P=0.002）；医生手卫生依从率为67.70%，明显高于护士的59.92%（χ2=10.903，P=0.001），医生在无菌操作前、接触患者后和接触体液等后手卫生依从性明显高于护士，差异具有统计学意义（均P＜0.01）。结论该院手卫生管理体系已初具模型；完善手卫生管理制度，对有效干预手卫生、提高手卫生依从性具有重要意义。

ObjectiveTo analyze the present medical teaching textbooks and practice skill guidelines, and explore the profound causes of poor hand hygiene idea among doctors. MethodsThree sets of unified textbook series used for domestic medical colleges and universities and two sets of manipulation skill guidelines were studies. Statistical method was conducted to analyze whether concepts and methods of hand hygiene, handwashing and antiseptic handrubbing were included in these teaching textbooks; as to eight aseptic manipulation skills, coverage of knowledge, steps of handwashing and antiseptic handrubbing in manipulation skill guidelines were also analyzed. ResultsThe mentioning rate of hand hygiene, handwashing and antiseptic handrubbing in 8year and 5year program teaching textbooks were both 0, in nursing teaching textbooks was 100%; as to 8 aseptic manipulation in 2 sets of skill practice guidelines, mentioning rate of  hand washing was 37.50%, and method and steps of antiseptic handrubbing were both 0. ConclusionSchool teaching and skill assessment are the basis, it is difficult to form the right idea by only relying on continuing education without basic education. Hand hygiene should be stressed in the written of teaching textbooks, guidelines should be written following the newest progress, so as to form the correct idea of hand hygiene among doctors.

目的调查某中医院重点科室医务人员手卫生知识掌握情况及影响手卫生执行的因素。 方法随机抽查该院重点科室的医务人员，进行问卷调查。 结果共发放问卷142份，其中有效问卷130份，有效率91.55%。医务人员手卫生知识平均得分为（18.97±1.44）分（总分21分），不同年龄、性别、工龄、学历、职业、职称、工作科室医务人员手卫生知识得分差异无统计学意义（P＞0.05）；影响医务人员执行手卫生的因素主要有：清洁剂、消毒剂刺激皮肤（74.62%）, 洗手池旁未配备干手用具（55.38%），无足够清洁剂（45.38%）等。 结论该院医务人员对手卫生的认知水平较高；改善手卫生用品及设施，加强管理，多措并举，可切实提高医务人员手卫生水平。

ObjectiveTo investigate cognitive status and influencing factors for hand hygiene(HH) among health care workers(HCWs) , and provide basis for scientific management of HH.MethodsIn April 2013,  HCWs in a general hospital were selected  by randomly sampling method, questionnaires were used to survey the implementation of HH in recent one month and HCWs’ cognition on knowledge about HH.ResultsA total of 750 HCWs were investigated, 652 available questionnaires were collected. The frequency of hand washing and hand disinfection per day among most HCWs were 10-19 times, accounting for 46.62% and 47.85% respectively;  30.52% of HCWs washed their hands for ≥30 seconds each time, 60.58% of HCWs dried hands with paper towel after washing hands, 57.21% of HCWs  abided by  sixstep hand washing method. The overall correct rate of cognition on ten opportunities that requiring HH in clinical practice was 68.68%.The main factors influencing the implementation of HH were as follows: skin irritation of hand sanitizer and hand disinfectant subjectively considered by HCWs(63.34%), inadequate hand washing facilities( 41.10%);  high cost of hand sanitizer ,  hand disinfectant, and dry paper towel (38.96%),et al.ConclusionIn addition  to intensifying education on HH, installing rational HH facilities and improving HH standard are  key points in strengthening HH in general hospital.

ObjectiveTo investigate the influence of different handling factors in the hand hygiene compliance rate of health care workers’(HCWs). MethodsEight clinical departments in JulyDecember 2012 were selected for study, the baseline data of hand hygiene in July were investigated. In AugustOctober, 6 departments were provided free hand disinfectant, only 2 departments took comprehensive intervention measures; in NovemberDecember, all selected  hospitals took intervention measures, but without being provided free hand disinfectant. Hand hygiene compliance rates among HCWs were compared. ResultsThe overall hand compliance rate of HCWs in JulyDecember 2012 was 59.50%，hand compliance rate of  different months were significantly different (P<0.01), compliance rate was lowest in July（36.73%），after providing free hand disinfectant plus performing comprehensive intervention, hand compliance rates of different months increased obviously （57.20%-72.08%）;When disinfectant was not provided free, compliance rate in each month still maintained a high level（65.20%-65.50%）; compliance rates in AugustOctober were all  higher than July （［45.41%-73.63%］vs ［18.97%-47.17%］）(all P≤0.05）;except north section of intensive care unit （ICU）, compliance rates in NovemberDecember （61.67%-72.73%）were both higher than July (both P<0.05).Healthcareassociated infection rate decreased from 3.39% in July to 1.75% in NovemberDecember （χ2=5.122，P=0.024）.ConclusionProviding free hand disinfectant can promote  HCWs’ hand hygiene compliance, repeated stressing hand hygiene awareness is the key measure to improve hand hygiene compliance.

ObjectiveTo train health care workers (HCWs) by method of conventional training plus survey of hand contamination status, the influence of two kinds of methods in hand hygiene compliance of HCWs was evaluated. MethodsFrom November 2013 to April 2014, all HCWs in a cardiovascular internal medicine department were as trained subjects, they were divided into two groups (trial group and control group).Hand hygiene compliance status was investigated 1 month before training. In the  first month after training, conventional training method was adopted by both groups， from the second to fifth month, conventional training plus hand contamination survey was adopted by trial group, hand hygiene compliance between two groups were compared.ResultsHand hygiene compliance rates of trial group and  control group was 42.63% (107/251) and 41.80% (102/244) respectively before training, there was no significant difference（P＞0.05）.In the first and second month after training， hand hygiene compliance rate of  trial group was 55.70% (132/237) and 63.11% (154/244) respectively,control group was 56.52% (130/230) and 62.61% (149/238) respectively， compared with pretraining， the differences were significant (both P＜0.05), but the difference was not significant between two groups(P＞0.05); From the third to fifth month, hand hygiene compliance rates of trial group was 60.73%（150/247）,61.44%（145/236）,and 61.22%（150/245）respectively, control group was 51.68%（123/238）,51.02%（125/245）,and 52.32%（124/237）respectively, there was significant difference between two groups(P＜0.05).ConclusionConventional training combined with survey of hand contamination status can promote hand hygiene compliance of HCWs.

ObjectiveTo realize the effect of WHO multimodal hand hygiene improvement strategy  (MHHIS) on improving hand hygiene compliance of health care workers(HCWs). MethodsFrom June to December 2012, HCWs in a hospital was intervened by adopting MHHIS, hand hygiene compliance rate before and after intervention was compared, and effectiveness of intervention was assessed. ResultsHand hygiene compliance of doctors and nurses improved from 14.06%（35/249） and 28.62%（81/283） before intervention  to 31.73%（79/249） and 57.60%（163/283）after intervention respectively（both P＜0.05）. Except outpatient and emergency department, hand hygiene compliance of the other departments significantly improved (all P<0.05); hand hygiene compliance of various hand hygiene indicators significantly improved except ‘after contact with patient surrounding’ (all P<0.05), the differences were statistically different (P＜0.05).ConclusionUsing WHO MHHIS can effectively improve hand hygiene compliance of HCWs.

ObjectiveTo improve hand hygiene compliance among healthcare workers (HCWs) in a stomatological hospital， and effectively reduce healthcareassociated  infection(HAI) rate.MethodsAccording to WHO hand hygiene guideline and implementation scheme of hand hygiene, a systemic and step by step hand hygiene promotion plan was formulated, the plan was divided into five steps: full alert, baseline investigation, improvement, tracking, and retrospective analysis. Hand hygiene compliance among HCWs before and after the promotion of activities was analyzed and compared.ResultsThrough hand hygiene promotion activities, the questionnaires showed that average score of knowledge about hand hygiene among HCWs enhanced from 58.33  to 77.40 (increased by 32.69%); the average hand hygiene compliance rate increased from 24.28%（59/243）to 49.81%（133/267），the difference was significant（χ2=35.331，P =0.000）；hand hygiene status at five moments for hand hygiene improved markedly.ConclusionHand hygiene promotion has a significant influence in hand hygiene among HCWs in this stomatological hospital.

ObjectiveTo investigate hand hygiene status of health care workers (HCWs) in a hospital, and provide guides for improving hand hygiene compliance．MethodsHand hygiene intervention was adopted in a hospital between 2012 and 2014, hand hygiene compliance among HCWs and healthcareassociated infection in patients between August 1 and August 31 of each year were investigated and analyzed statistically. ResultsIn 2102-2014, hand hygiene compliance rate of HCWs was 59.55%，62.13%,and 65.16% respectively, which showed a increased trend (χ2=10.018, P=0.002), HAI rate was 2.13%，1.48% and 1.06% respectively, which showed a decreased trend (χ2=82.377, P<0.001); hand hygiene compliance rate of doctors was lower than nurses  （57.97% vs 65.97%）; Of different hand hygiene moments, hand hygiene compliance rate was the lowest before touching a patient（41.32%）, and highest after body fluid exposure （76.47%）. ConclusionComprehensive hand hygiene intervention in this hospital has achieved preliminary results, improvement of HCWs’ hand compliance is helpful for preventing HAI.

目的探讨品管圈（QCC）对提高重症监护病房（ICU）护士手卫生依从性的效果。方法2013年6—12月应用QCC管理模式对ICU 56名护士手卫生行为进行管理，通过现状调查，找出手卫生依从性低的要因，采取有效措施进行持续质量改进。结果护士对手卫生知识的认知率由QCC活动前的65.74%提升至活动后的95.45%（P＜0.001），手卫生依从率由活动前的33.33%提升至活动后的80.18%（P＜0.001）；护士在接触患者前、接触患者后、接触患者周围环境后手卫生依从率由活动前的32.93%、15.19%、24.62%，分别提升至活动后的71.43%、73.08%、79.66%，差异均有统计学意义（均P＜0.05）。结论应用QCC进行持续质量改进，可有效提高ICU护士手卫生意识及其依从性。

ObjectiveTo investigate hand hygiene compliance of health care workers(HCWs)  in a tertiary hospital, and to explore effective methods to improve hand hygiene compliance.MethodsBy direct observation method, hand hygiene compliance and practice among HCWs in 23 clinical departments were surveyed in SeptemberDecember 2012, and hand hygiene compliance monitor forms were filled in. ResultsA total of 721 opportunities of hand hygiene were recorded, overall compliance rate of hand hygiene was 58.53%, 32.18% used instant hand antiseptic, 26.35% selected running water, and 19.42% wore gloves without taking hand hygiene measures. For different occupations, hand hygiene compliance among nurses was the highest (68.65%), and cleaners was the lowest (39.25%). Of the five moments for hand hygiene, hand hygiene compliance after body fluid exposure was the highest (73.75%), followed by the moment after touching a patient (65.00%), while the moment after touching patients’ surroundings was the lowest (47.85%). ConclusionHand hygiene compliance of HCWs needs to be improved, and the management should be further strengthened, corresponding measures should be taken for different personnel.

ObjectiveTo investigate the qualified rate of midwives’ surgical hand disinfection and perineal incisional infection in parturients, so as to provide reference for reducing perineal incisional infection. MethodsData of 7 148 women who delivered naturally in an obstetrics department between January 2012 and December 2013 were collected, 3 569 midwives who weren’t intervened in surgical hand disinfection between January and December 2012 were as control group, and 3 579 midwives who were intervened between January and December 2013 were as intervention group, the perineal incisional infection rate of parturients and qualified rate of midwives’  hand hygiene of two groups were compared. ResultsThere were no significant difference in maternal age, body mass index, underlying diseases, No. of  vaginal delivery examination, delivery season, delivery lasting time, incision suture technique, antimicrobial prophylaxis, and neonatal weight between intervention group and control group (all P>0.05). The qualified rate of midwives’ surgical hand disinfection method increased from 19.31%（n=689）before intervention to 71.03%（n=2 542） after intervention, the difference was significant between two groups（χ2=752.58，P＜0.05）. Perineal incisional infection rate in intervention group was significantly lower than control group (［(0.28%,10/3 579］ vs ［0.81%， 29/3 569］）, there  was significant difference between two groups （χ2=9.36，P＜0.05）. ConclusionThe improvement of qualified rate of midwives’ hand hygiene can reduce perineal incisional infection rate of parturients.

ObjectiveTo evaluate the comprehensive medical goal appraisal system on hand hygiene compliance rate of health care workers(HCWs). MethodsComprehensive medical goal appraisal system was adopted to intervene hand hygiene compliance rate of HCWs  in a comprehensive hospital , hand hygiene compliance rates of HCWs and consumption of instant hand sanitizer per bedday before (December 2012) and after intervention (January 2013-June 2014) were compared. ResultsHand hygiene compliance rate after intervention was higher than before intervention (85.17% ［18 208/21 379］vs 39.92%［853/2 137］)，hand hygiene compliance rate enhanced by 113.35%（χ2=2 590.81，P＜0.001）.Hand hygiene compliance rates of HCWs of different departments, different occupations and different hand hygiene moments were all higher than before intervention (all P＜0.001）; after intervention , hand hygiene compliance rate revealed a increased tendency, and has maintained high since October 2013 (>90%), consumption of instant hand sanitizer before and after intervention was 7.24 mL/ bedday（4 200 L/579 841 bedday） and 10.54 mL/bedday（9 323.5L/884 489 bedday）respectively, the consumption after intervention increased by 45.58% compared with that before intervention.  ConclusionComprehensive medical goal appraisal can effectively enhance hand hygiene compliance rate , and maintains at a high level; the measure can affect hand hygiene behavior of HCWs by hawthorne effect, and is an effective and longterm measure to improve hand hygiene compliance of HCWs.

目的探讨提高护理人员手卫生依从性的有效方法。 方法某院开展“感染控制宣传周”干预活动，对干预前后该院当班护理人员进行手卫生现状调查，比较干预前后护理人员手卫生依从性。 结果干预后，护理人员手卫生知识知晓率为79.50%，高于干预前的54.00%，两组比较，差异有统计学意义（χ2=29.30，P＜0.05）。干预后，护理人员的手卫生依从率、正确率、细菌检测合格率分别为66.97%、96.50%、95.00%，均高于干预前（分别为36.56%、79.00%、62.50%），各组比较，差异均有统计学意义（均P＜0.05）。结论开展“感染控制宣传周”干预活动可提高护理人员手卫生依从率。

ObjectiveTo evaluate the effect of controlling cost by introducing hand hygiene products with lower price on promoting hand hygiene compliance.MethodsThe application status and cost of hand hygiene products in 2012 was as preintervention group，2013 was as postintervention group. Effective and lower price hand hygiene products were introduced in 2013, consumption and cost of hand hygiene products before and after the intervention was compared.ResultsConsumption of hand hygiene products per patientday before and after the intervention was significantly different (［10.56±16.46］ mL vs ［13.79±16.93］ mL，Z=4.14,P<0.01); cost of hand hygiene products per patientday before and after the intervention was not significantly different (［1.23±2.07］ yuan vs ［0.92±0.59］ yuan， P>0.05).ConclusionIntroduction of hand hygiene products with lower price in this hospital can improve hand hygiene compliance to certain degree without increasing the cost of hand hygiene.

目的探讨感染性腹泻患儿家长手卫生依从性，并分析影响其依从性的原因，提出相应干预措施。方法采用隐蔽性现场观察与自制调查问卷相结合的方法，对92例患儿家长的手卫生依从性和影响其依从性的原因进行调查。结果患儿家长给患儿冲奶或喂奶、喂水前手卫生依从率为49.78％；给患儿擦净鼻涕、口水或更换尿布后手卫生依从率为73.12％。影响患儿家长手卫生依从性的原因排名居前2位的为患儿家长觉得没有必要 (70.65％)、无频繁进行手卫生的习惯 (57.61％)。结论医护人员应采取有效的干预措施，提高感染性腹泻患儿家长的手卫生依从性。

ObjectiveTo explore the effect of bundle hand hygiene intervention in controlling  healthcareassociated infection(HAI) in a primary comprehensive hospital, so as to improve hand hygiene compliance and correct rate,  and reduce AHI rate. MethodsIn JanuaryJune 2014, bundle hand hygiene intervention among health care workers (HCWs) in a hospital was performed, hand hygiene knowledge awareness rate, hand hygiene compliance and correct rate, hand sanitizer usage and HAI rate before and after intervention were compared. ResultsAfter performing intervention for six months, the awareness rate of hand hygiene knowledge(concept, significance, indications, methods, sanitizer use) of HCWs improved compared with before intervention (P＜0.05);hand hygiene compliance and correct rate were significantly higher than before intervention (77.92% vs 49.78%; 76.47% vs 37.72%) (P＜0.05). Hand sanitizer usage increased from  2.14mL/ bedday to 4.63 mL/ bedday , HAI rate decreased from 1.97% to 1.54% (P＜0.05).ConclusionBundle hand hygiene intervention can improve HCWs’ knowledge awareness, compliance and execution rate of hand hygiene, and effectively reduce HAI rate.

ObjectiveTo evaluate the feasible hand hygiene intervention methods to improve health care workers’ (HCWs) hand hygiene compliance, and reduce healthcareassociated infection(HAI) rate.MethodsThe surgical department in a hospital was selected as intervention department, intervention department was conducted baseline investigation in JanuaryFebruary 2013, multimodel intervention measures were conducted  between  March  2013 and April 2014, postintervention survey was performed by the same method as baseline survey in MayJune 2014, hand hygiene of HCWs as well as  occurrence of HAI between before  and after intervention was compared respectively. ResultsAfter intervention, HCWs’ hand hygiene compliance  before and after patient contact both enhanced significantly; HCWs’ hand hygiene compliance rate increased from 53.32% before intervention to 69.27% after intervention, the difference was significant(χ2=26.19, P<0.001). HCWs’ hand hygiene modes before patient contact: liquid soap plus running water before intervention(67.02%), alcoholbased hand rub after intervention (61.08%); HCWs’ hand hygiene modes after patient contact : both liquid soap plus running water before and after intervention (86.40% and 70.41% respectively). Before intervention， hand dry method of  HCWs before and after patient contact was by wiping with uniforms， after intervention was by wiping with paper towel. HAI in intervention department decreased from 3.08% before intervention to 2.00% after intervention, the difference was significant(χ2=7.76, P=0.005).ConclusionMultimodel intervention measures in intervention department can effectively improve HCWs’ hand hygiene compliance rate.

ObjectiveTo construct a questionnaire for patients to participate  in hand hygiene promotion in medical institutions, and provide a measuring tool for patients to participate in hand hygiene promotion.MethodsA questionnaire was constructed by methods of literature research, expert panel discussion, preinvestigation, and Delphi.ResultsThis questionnaire was designed respectively for patients and health care workers, each contained 20 questions, involving hand hygiene perception, willingness to participate in promoting hand hygiene, and participation method, et al.ConclusionA  questionnaire for patients to participate hand hygiene promotion in medical institutions is preliminary constructed, which can be used for evaluating patients’ and HCWs’ willingness and relevant influencing factors of patients’ participation in hand hygiene promotion in medical institutions.

ObjectiveTo intervene hand hygiene(HH)  of health care workers (HCWs) in an intensive care unit(ICU) of a hospital,  and evaluate HH compliance of  HCWs and influencing factors.Methods37 HCWs from an ICU of a teaching hospital were chosen as studied subjects, HH status before and after intervention was observed and analyzed by direct and indirect methods.ResultsIn the first monitoring stage, HH rate in baseline and postintervention survey stage was significantly different （46.96% vs  63.30%, χ2=7.344，P=0.007); in the second monitoring stage, HH compliance rate increased from 57.85%  to 88.58%. HH compliance rate was positively correlated with consumption of HH product per  bedday（r=0.725,P＜0.001）, but negatively correlated with incidence of healthcareassociated infection(HAI) and case rate of HAI（r=-0.983, -0.990, respectively, both P＜0.001）, HH rate to alcoholbased hand sanitizers was positively correlated with consumption of HH product per bedday （r=0.391, P＜0.001）.ConclusionLongterm monitoring and intervention of HH compliance is necessary, combination of direct observation and indirect assessment of HH product consumption is helpful for effective monitoring and intervention of HH compliance among HCWs.

ObjectiveTo investigate the influence of health care workers’(HCWs) hand hygiene intervention in healthcareassociated infection(HAI) in an intensive care unit(ICU).MethodsIntervention measures of hand hygiene were adopted,  effective supervision and management systems were established, hand hygiene compliance and HAI rate before intervention(JanuaryDecember 2012) and after intervention (the first stage: JanuaryJune 2013; the second stage: JulyDecember 2013）were compared. ResultsA total of 4 066 patients were surveyed, HCWs’ hand hygiene compliance rate before intervention was 50.03%, the first and  second stage after intervention was 61.80%  and 64.57% respectively, there was increasing trend  （rs=1.00, P<0.001）.HAI before intervention was 5.48%, the first and second stage after intervention was 3.86% and 3.30% respectively, there was decreasing trend （rs=-1.00, P<0.001）. Significant decreasing trends were found in rates of catheterrelated bloodstream infection(CRBSI), catheterassociated urinary tract infection(CAUTI) and ventilatorassociated pneumonia(VAP) (rs=-1.00, P<0.001). There were negative correlations between hand hygiene compliance rate and the infection rate of ICU, infection rate of CRBSI,CAUTI and VAP  (P<0.05).ConclusionThe improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.

ObjectiveTo evaluate the influence of the placement of instant hand disinfectant in compliance and qualified rate of hand hygiene of clinicians. MethodsHand hygiene compliance of clinicians in departments of gynecology, obstetrics, and general surgery were observed after the placement of instant hand disinfectant at the doorway of wards, hand specimens were taken to check hand hygiene effectiveness. ResultsBefore and after placement of instant hand disinfectant at the doorway of wards of above departments, hand hygiene behaviors of 300 persontimes were observed. Hand hygiene compliance rate among clinicians in department of gynecology, obstetrics, and general surgery increased from 32.33% to 74.33%, 33.67% to 85.67%, and  26.33% to 64.00%，respectively（all P＜0. 001）. Each department selected 98 hand hygiene specimens, the qualified rate was 98.98%,100.00% and 94.90% respectively.  ConclusionThe placement of instant hand disinfectant at the doorway of each ward can effectively improve clinicians’ hand hygiene compliance and hand hygiene effectiveness.

ObjectiveTo improve hand hygiene compliance among health care workers(HCWs) through continuous quality improvement, and effectively reduce the incidence of healthcareassociated infection(HAI). MethodsContinuous quality improvement was performed by adopting plandocheckaction(PDCA) cycle, all HCWs were trained, hand hygiene was stressed, periodical  and random checking was conducted. ResultsAfter the implementation of PDCA cycle, the acknowledge  rate of hand hygiene enhanced from 48.00% to 63.99%; hand hygiene compliance rate enhanced from 65.11％ to 82.40％，the difference were both significant（χ2=12.75, 259.65， respectively， both P＜0.05）.The daily consumption of instant hand antiseptic per 1 000 bed day increased obviously, which was 2.95fold of preimplementation. ConclusionContinuous quality improvement through PDCA cycle can effectively improve hand hygiene compliance rate of HCWs.

ObjectiveTo investigate the current status of compliance with hand hygiene  among health care workers (HCWs) in a comprehensive hospital in Xi’an. MethodsStatus of hand hygiene among HCWs in 73 clinical departments was observed directly.Results404 moments for hand hygiene of 404 HCWs were observed,  255 times of hand hygiene were implemented, 181 times of hand hygiene were correct, the total compliance rate was 63.12%, and correct rate was 44.80%. Compliance  rate and correct rate of hand hygiene of HCWs in intensive care unit were both  higher than general wards (91.89% vs 60.22%,χ2=14.485，P＜0.001; 81.08% vs  41.14%, χ2=5.671，P=0.017）. Among HCWs of different occupations, compliance rate and correct rate of  hand hygiene of nurses were both the highest （73.76% and 60.18% respectively）, while auxiliary persons were both the lowest （40.90% and 10.20% respectively）；among five moments for hand hygiene,  compliance rate was highest  after body fluid and blood exposure (80.00%),  correct rate was highest before aseptic procedure  (62.96%). ConclusionThere is a high compliance rate and low correct rate of hand hygiene among HCWs in this hospital. Compliance rate and  correct rate of hand hygiene among HCWs in different departments, different occupations and different hand hygiene moments are varied,  compliance with hand hygiene among HCWs should be paid extensive attention.

ObjectiveTo explore strategies and measures to improve hand hygiene (HH) compliance and correctness of health care workers (HCWs) in a large hospital.MethodsThe WHO multimodal hand hygiene improvement strategy was adopted by healthcareassociated infection(HAI) management department of a hospital, measures consisted of five key components, including: system change, education and training, evaluation and feedback, reminders in the workplace, and institutional safety climate. HH compliance and correctness of HCWs were observed by infection control practitioners, HH compliance and correctness in JanuaryJune of 2012 (preintervention) and JanuaryJune of 2014 (postintervention) were compared, effectiveness of intervention strategies were evaluated.ResultsHH compliance rate and correctness rate of postintervention were both higher than preintervention (75.92%［8 369/11 023］ vs 53.67%［5 127/9 553］, P＜0.001;   94.11%［7 782/8 269］ vs 83.88%［3 642/4 342］, P＜0.001）. Of different occupations, HH compliance rates of doctors and nurses were significantly different before and after intervention (both P＜0.001）, while workers and staff of other occupations before and after intervention were not significantly different(both P>0.05）. Except ‘after body fluid exposure’, HH compliance rates of the other four indications for HH before and after intervention were significantly different(all P＜0.001）.ConclusionHH compliance and correctness of HCWs can be improved after adopting WHO multimodal hand hygiene improvement strategy.

ObjectiveTo evaluate the effect of comprehensive intervention measures on improving hand hygiene(HH) compliance of health care workers(HCWs) in intensive care units (ICUs) by multicenter study. MethodsA total of 47 hospitals in 12 provinces and cities were enrolled in the study, from October 2013 to September 2014,  HH compliance among HCWs in ICUs was investigated according to World Health Organization HH investigation method, HH compliance rates before and after intervention were compared. ResultsHH compliance rate of HCWs  in ICUs increased from 73.70%(11 155/15 135) before intervention to 78.70%(18 206/23 132) after intervention（χ2=128.16，P＜0.01）; except northeast region , HH compliance of HCWs in the other provinces increased significantly after intervention（all P＜0.05）; among all departments, HH compliance of HCWs in general ICUs, respiratory ICUs, emergency ICUs, and surgical ICUs increased significantly（all P＜0.05）; HH compliance of HCWs of all kinds of occupations  increased significantly（all P＜0.05）; HH compliance rates before touching a patient，before clean/aseptic procedure，after touching a patient，and after touching patient surroundings increased significantly after intervention（all P＜0.01）. ConclusionComprehensive interventions are helpful for improving HH compliance of HCWs in ICUs.

ObjectiveTo analyze the effect of hand hygiene compliance on the incidence of ventilatorassociated pneumonia(VAP) in children,  and explore the role of hand hygiene in the prevention and control of VAP. MethodsHand hygiene compliance among HCWs in a pediatric intensive care unit  (PICU) was intervened, hand hygiene compliance rate of HCWs and incidence of VAP in children with mechanical ventilation from March 1, to October 31, 2012  (before intervention)  and from January 1, to August 31,2013  (after intervention) were compared.  ResultsHand hygiene compliance rate after intervention was higher than before intervention( 37.31%［97/260］ vs 24.17% ［58/240］) （χ2=10.08，P＜0.01）;  the consumption of hand washing liquid and alcoholbased handrub enhanced from 3.48mL /bed day before intervention to 4.49 mL/bed day after intervention,which  increasing by 29.02%. The incidence of VAP after intervention was lower than before intervention (2.21‰［5/2 261］ vs 6.50‰［13/2 001］）（χ2=4.67，P＜0.05）. ConclusionImplementation of comprehensive measures and improvement of HCWs’ hand hygiene compliance can reduce the incidence of VAP in children.

ObjectiveTo improve hand hygiene (HH) compliance of health care workers (HCWs) in neonatal intensive care units(NICUs) in China through a series of intervention measures.MethodsA multicenter study was conducted, 17 tertiary first class hospitals in 9 provinces and cities were selected, HH compliance of HCWs in these hospitals were investigated every month according to HH investigation method of World Health Organization.From October 1 ，2013 to March 31，2014 was preintervention stage； from April 1, 2014 to September 30,2014 was postintervention stage, timely feedback and intensified training were conducted at postintervention stage. ResultsHH compliance rates of HCWs before and after intervention were 80.29% and 80.85% respectively, there was no significant difference (P＞0.05). HH compliance rates of  HCWs in different sizes of ICUs were significantly different before and after intervention (all P<0.05), in NICUs with<20 beds and  20-30 beds after the intervention were both significantly higher than before intervention (both P<0.05), while ＞30 beds were significantly lower than before intervention(P<0.001); HH compliance rate of cleaners increased from 58.82% before intervention to 68.09% after intervention (P<0.05); Of different hand hygiene indications, except before clean/aseptic task, compliance to the other HH indications were significantly different between before and after intervention(all P<0.05).ConclusionHH compliance is high among HCWs in NICUs in China, intervention measures, such as intensified training and timely feedback have certain influence in compliance to HH among HCWs at different sizes of ICUs, of different occupations, and at different HH indications.

ObjectiveTo investigate the effect of implementation of hand hygiene(HH) activities on HH compliance among health care workers(HCWs).MethodsIn MayDecember 2013, a series of HH intervention measures in a hospital were implemented, compliance to HH among all clinical and laboratory HCWs in AprilDecember 2013 (before and after intervention) were surveyed and compared.ResultsAfter implementing HH activities, HH compliance rate of HCWs increased from 39.82% before intervention to 80.77% after intervention, HH compliance rates of doctors, nurses and cleaning staff increased from 41.09%,41.30% and 34.33% before intervention to 83.87%,91.89%, and 59.54% after intervention respectively， the differences between before and after intervention were all statistically significant (all P<0.001). Except intensive care unit, HH compliance rates of HCWs in departments of surgery, internal medicine, and radiotherapy were all higher than preintervention(all P<0.001). Compliance to five indications for HH among HCWs after intervention were all higher than preintervention(all P<0.001), HH  compliance rate before touching a patient increased from 23.88% to 73.37%，before clean/aseptic procedure increased from 58.65% to 94.23%.ConclusionThrough the implementation and supervision of HH activities, both the awareness and compliance of HH among HCWs have been significantly improved, good HH habit is gradually developed.

ObjectiveTo understand the status of hand hygiene(HH) among patients hospitalized in departments of infectious diseases and their families in Yantai City, and provide reference for HH intervention.MethodsPatients and their families(n=221) in  departments of infectious diseases of secondary and above levels of hospitals as well as infectious diseases hospitals in Yantai in JulyAugust 2015 were selected for questionnaire survey, education and implementation status of HH were investigated; hand bacteriological sampling was performed on some patients and their families (n=62) to investigate effect of handwashing. Results61.99% of patients and their families had received verbal HH education, only 18.55% indicated to have seen health care workers(HCWs) to perform the six step handwashing method; 50.68% of the respondents didn’t understand the six step handwashing method, and 85.52% never performed the six step handwashing, the main reason is that they didn’t know how to perform. 93.21% of patients(n=206) and their families believed that handwashing was important. The cognition of HH opportunities in daily life was relatively higher(61.54%94.51%)，and in hospital environment was relatively lower(36.15%49.23%)，only 36.15% of the families washed hands before left the hospital. Unqualified rate of detection results of sampling of hands of patients with infectious diseases and their families was 83.87%. ConclusionPatients with infectious diseases and their families are deficient in HH knowledge and behavior, medical institutions should carry out systematic and standard HH education to reduce the risk of healthcareassociated infection.

ObjectiveTo investigate the current status of hand hygiene(HH) among health care workers(HCWs) in clinical laboratories in medical institutions in Xi’an City. MethodsHH status of HCWs in clinical laboratories in medical institutions in Xi’an was performed random onthespot sampling and monitoring. ResultsA total of 240 HH specimens of HCWs in clinical laboratories in 80 medical institutions in Xi’an City were collected, 127 detected results were qualified, the total qualified rate was 52.92%. The qualified rates of medical institutions were as follows: municipal hospitals 62.67%，workers’ hospitals 55.95%，private hospitals 40.74%；comprehensive medical institutions 67.68%，specialized medical institutions 42.55%；tertiary medical institutions 79.63%（n=43），secondary and below medical institutions 45.16%（n=84），there were significant differences in HH qualified rate among HCWs in different types of medical institutions（all P＜0.01）. Of different HH detection items, detection rates of Escherichia coli and Staphylococcus aureus were 0.83% and 8.33% respectively. There were significant differences in HH compliance rates among HCWs of all age groups(χ2=9.103，P<0.05), HCWs aged≥50 years had the highest qualified rate of HH（71.43%）, followed by those aged＜30 years (67.82%)，HCWs in 40～ year age group had the lowest HH qualified rate (39.66%). ConclusionThe qualified rate of HH of HCWs in clinical laboratory of medical institutions in Xi’an City is low, it is necessary to enhance the procaution awareness of HCWs in clinical laboratories, strengthen quality control of HH, strictly implement standard handwashing procedures to reduce occurrence of HAI.

ObjectiveTo carry out hand hygiene(HH) quality control circle(QCC) activity by using WeChat group, improve HH compliance of health care workers(HCWs), and enhance the circle members’ ability to solve problems.MethodsIn June 2015, 11 healthcareassociated infection control professionals in a hospital created HH WeChat group by using cellphones, activity cycle was once every two weeks, professionals analyzed the existing problems, and formulated countermeasures as well as implemented methods by group chat form, circle members introduced and implemented strategies to HCWs in their departments, so as to achieve the implementation effect.ResultsAfter the creating of WeChat QCC, HCWs’ HH compliance increased from 56.71% before activity to 85.94% after activity, difference was statistically significant (χ2=61.928, P<0.05); QCC members’ responsibility, selfconfidence, enthusiasm, harmony degree, team cohesiveness, quality control technique, communication, coordination, and problemsolving skill were all significantly improved.ConclusionApplication of WeChat QCC activity can improve HH compliance of HCWs and the ability of circle members.

目的了解医务人员手卫生依从性实际情况，探讨改进观察模式和施行手卫生干预措施对医务人员手卫生依从性的影响。方法2014年4月—2015年12月对某院所有临床科室医务人员进行手卫生调查。其中2014年10月开始改进手卫生观察模式，采用直接观察法，观察人员由10名新入院实习生组成，分为10组交叉进行调查。2015年4月开始实施手卫生干预措施，分别比较改进观察模式前后和实施干预措施前后手卫生依从率。结果改进观察模式前（2014年4—9月）医务人员手卫生依从率为74.69%（484/648），改进观察模式后（2014年10月—2015年3月）医务人员手卫生依从率为65.63%（401/611）。观察模式改进前后医务人员手卫生依从率比较，差异有统计学意义（χ2=12.36，P＜0.01）。实施手卫生干预后（2015年4月—2015年12月），手卫生依从率提高至76.05%，高于干预前（2014年10月—2015年3月）的65.63%（χ2=24.78，P＜0.01）。医生的手卫生依从率由干预前的60.14%提高至干预后的71.12%，护士的手卫生依从率由干预前的70.79%提高至干预后的80.93%，差异均有统计学意义（χ2值分别为12.14、13.78，均P＜0.01）。结论改进观察模式可减少霍桑效应，获得手卫生依从性的真实水平，强化手卫生干预可有效提高医务人员手卫生依从性。

ObjectiveTo understand hand hygiene(HH) among health care workers(HCWs) in primary medical institutions in Shijiazhuang, and evaluate HH compliance, so as to formulate the strategy for HH management.MethodsIn 2015, one countylevel comprehensive medical institution and two township medical institutions from each of seven counties of Shijiazhuang city were randomly selected, HH qualified rates of HCWs in all divisions of internal medicine before clinical procedures and after HH were analyzed statistically.Results118 HCWs before clinical procedures and 130 HCWs after HH were monitored. The qualified rate of HH of physicians and nurses before clinical procedures were 44.26%(27/61) and 40.35%(23/57) respectively; HH qualified rate of nurses in township hospitals before clinical procedures were higher than countylevel hospitals（χ2=6.447，P=0.011）; the qualified rate of HH of physicians and nurses after HH were 98.41%(62/63) and 98.51%(66/67) respectively; there were significant differences in the qualified rates before clinical procedures as well as after HH in HCWs at different levels and types of medical institutions（all P<0.05）.ConclusionThe qualified rate of HH among HCWs in primary medical institutions in Shijiazhuang before clinical procedures is low, medical institutions should improve the HH compliance among HCWs from various aspects.

ObjectiveTo understand the current status of hand hygiene(HH) compliance among doctors and nurses, and strengthen the management of HH of health care workers(HCWs). MethodsOnthespot observation of HH implementation in clinical departments of the whole hospital was performed by a singleblind method, data were collected for statistical analysis. ResultsHH compliance rate of all clinical departments was 69.28%（309/446）, HH compliance rate of intensive care unit was the highest(87.93%)，department of internal medicine was the lowest(63.03%), there were significant differences among different departments（P=0.001）. Compliance rate of HH of nurses was higher than that of doctors（74.47% vs 39.39%），difference was significant（P＜0.001）； of different indications for HH, the lowest compliance rate was before contact patients（43.04%）， HH of doctors after contact with patients and patients’ surrounding were both lower than nurses, difference was significant(both P<0.05).  ConclusionHH compliance rate of doctors is lower than nurses, compliance rate  of HH is the lowest before contact patients, awareness of HH among doctors and nurses before contact patients should be emphasized, targeted training should be conducted, thus reduce the incidence of healthcareassociated infection.

目的调查分析某院重症监护病房（ICU）和普通病房医护人员手卫生依从性差异。方法对某院2015年8月临床科室在岗的医生及护士进行手卫生依从性调查。结果共调查医护人员手卫生指征5 109次，执行手卫生3 745次，依从率73.30%。ICU医护人员手卫生依从率为92.24%（1 319/1 430），普通病房医护人员手卫生依从率为65.94%（2 426/3 679），ICU医护人员手卫生依从率高于普通病房，差异有统计学意义（χ2=52.772，P＜0.001）。接触患者前、接触患者后及接触患者周围环境物品后3个时刻ICU医护人员的手卫生依从率均高于普通病房（χ2值分别为12.264、6.650、37.430，均P＜0.05）。结论ICU与普通病房医护人员手卫生依从性存在差异，需有针对性的采取措施提高手卫生依从性。

ObjectiveTo investigate hand hygiene(HH) status among health care workers(HCWs) in municipal hospitals in Chongqing City, and provide the basis for making effective HH management strategies. MethodsIn AprilJune 2016, HH status among 111 HCWs in 24 municipal hospitals of this city were investigated through questionnaire survey, onsite observation, and hand surface sampling.ResultsAll surveyed departments are installed special hand washing facilities, all surveyed HCWs were performed HH through handwashing by running water. The proportion of HCWs’ handwashing by disinfectant was higher than sixstep hand washing (73.87% ［n=82］ vs 37.84%［n=42］, χ2=29.23, P＜0.01）；the implementation rate of HH before touching patient was higher than that after touching patients ( 99.10%［n=110］ vs 89.19%［n=99］, χ2= 9.88, P＜0.01）. During the process of diagnosis and treatment activities, the maximal total number of bacteria on the surface of hand before and after HH were 475 CFU/cm2 and 85 CFU/cm2 respectively, hand surface colony count after HH was higher than before HH（P＜0.01）.  Age, gender, department, and occupation are important factors influencing HH. The total number of bacteria on hand surface of nurses was higher than nonnurse HCWs, the total number of bacteria on hand surface of female, nurses, and HCWs in class I environment were all higher than male, nonnurse HCWs and HCWs in other types of environment, there were significant difference among the groups （all P＜0.05）. Qualified rates of HH of each group improved after hand washing, the total number of bacterial colony on hands of HCWs all decreased. ConclusionHand washing facilities and HH efficacy are good in Chongqing municipal hospitals, however，HH compliance needs to be improved among HCWs aged≥35 years，male HCWs， HCWs in class III and IV environmental departments, as well as nonnurse HCWs.

ObjectiveTo explore effect of application of quality control circle (QCC) on improving the correct rate of hand hygiene (HH) among health care workers (HCWs)  in intensive care unit(ICU). MethodsQCC activity group was set up, the activity theme was established, correct rate of HH among HCWs in March 2014 (preintervention group) was monitored, the causes of incorrect HH behavior were analyzed, goals were set; from May 2014,  QCC activities were initiated, correct rate of HH between before performing QCC activities and September 2014 (postintervention group) was compared. Results834 and 900 times of HH among HCWs were investigated before and after performing QCC activities,  the number of correct HH before and after QCC activities were 360 and 714 respectively, correct rate of HH after implementing QCC was higher than before QCC activities （79.33% vs 43.17%， χ2=240.19， P＜0.05）.  The correct rate of HH  among HCWs of this ICU and HCWs engaging in advanced studies in this ICU after implementing QCC activities were both higher than before QCC activities（χ2=264.44, 6.36，respectively, both P＜0.05）. The main incorrect HH  before and  after  QCC was nonimplementation of HH indication. ConclusionApplication of QCC activities for the management of HH among HCWs can effectively improve the correct rate of HH among HCWs in ICU.

ObjectiveTo summarize and analyze the effect of hand hygiene（HH） cost on the incidence of healthcareassociated infection (HAI), evaluate continuous improvement method, and provide data for hospital management.MethodsThe cost of HH project and incidence of HAI in a hospital from January 2013 to June 2014, as well as HH compliance in the first half year of 2014 were investigated.ResultsSemiannual statistics were performed， the cost of HH project in the first half of 2013, second half of 2013,and first half of 2014 were 283 490, 414 232, and 522 345 yuan respectively，compared with the first half of 2013, the cost of HH in the first half of 2014 increased by 84.26%; incidence of HAI were 3.13%, 3.33%, and 3.03% respectively，difference was significant（χ2=10.37，P＜0.001）.In the first half of 2014, HH compliance rate increased from 35.00% in January to 59.49% in June. The top three factors that affecting the implementation of HH were busy work, had no time for handwashing; inadequate HH facilities or supplies; inadequate knowledge about HH.ConclusionIncreasing the investment of HH products can improve HH compliance and reduce the incidence of HAI.

ObjectiveTo understand the status of awareness of hand hygiene(HH) knowledge and compliance among health care workers (HCWs) in China,  and provide scientific basis for further improvement of HH practice. MethodsA multicentre retrospective survey on awareness of HH knowledge and compliance was conducted in 200 nationwide hospitals in 2015. ResultsThe awareness rates of HH methods and HH indications among HCWs were 86.5% and 82.5% respectively; cleaning staff had the lowest awareness rate of HH indications（69.9%）, followed by the other interns and advancedstudy students （70.2%）, as well as medical technicians (79.8%); attendants had the lowest awareness rate of HH methods(76.9%), followed by advancedstudy students and interns（81.0%）, and cleaning staff （82.4%）； HH knowledge awareness rate among HCWs in secondary hospitals was lower than tertiary hospitals，and the districtlevel hospitals had the lowest awareness rate of HH. HH compliance rate and correct rate were 70.1%  and 74.9% respectively; the interns and advancedstudy students were at a low level of compliance and correct rates (61.4% and 60.9% respectively); the municipal hospitals had the lowest compliance and correct rates，nonteaching hospitals were lower than teaching hospitals. ConclusionHH in primary hospitals is weak,  HH of interns， advancedstudy students，as well as attendants and cleaning staffs are not enough, HH management should be strengthened,  awareness and compliance of HH should be improved.

目的采用医院感染主动监测系统调查某院医务人员手卫生现状，探讨信息化手段对提高手卫生依从性的作用。方法自2015年起采用医院感染主动监测系统对该院医务人员手卫生情况进行监测，2014年采用普通观察法，对比采用信息化监测前后医务人员的手卫生依从性、洗手消毒剂消耗情况。结果2014、2015年各观察医务人员应执行手卫生为2 016、3 275次，实际执行手卫生1 139、2 297次，依从率分别为56.50%、70.14%，2015年手卫生依从性高于2014年，差异有统计学意义（χ2=4.551，P＜0.05）。2015年护士依从率最高（85.30%），工勤员最低（54.34%）。手卫生依从性较差人群（工勤员）第一季度手卫生依从率为50.00%，对其加强重点培训后，第二季度手卫生依从率提升至52.17%，第三季度持续提高，第四季度手卫生依从率达60.32%。2015年全院手消毒剂人均日消耗量与2014年相比明显增加，其中2015年每月人均日消耗量平稳上升。结论采用医院感染主动监测系统能及时发现问题，明确手卫生依从性较弱的人群，并进行针对性改进，提高医务人员整体手卫生依从性。

ObjectiveTo construct a good reliability and validity of questionnaire for patients participating in hand hygiene (HH) promotion in medical institutions. MethodsQuestionnaires for patients participating in HH promotion in medical institutions were constructed by research group, 195 hospitalized patients and 207 health care workers(HCWs) in two medical institutions of Xi’an city were randomly selected and investigated, questionnaire items were analyzed with critical ratio, correlation coefficient, and factor analysis method. ResultsOriginal questionnaires included questionnaires for patients and HCWs, each had 3 dimensions and 20 items. The revised formal questionnaires for patients and HCWs had 17 items respectively, questionnaires for patients included 8 items in cognitive dimension, 7 items in willingness dimension, all were closed problems; 2 items for participation ways, both were openended questions. Questionnaires for HCWs included 9 items in cognitive dimension, 5 items in willingness dimension, 1 item for participation status, all were closed problems; 2 items for participation ways, both were openended questions.ConclusionThe questionnaires for patients participating in HH promotion in medical institution are further optimized though analyzing and revising the items based the investigated data.

目的评价科室兼职感染控制人员（兼职人员）进行手卫生依从性目标性监测的可靠性。方法2014年12月某院医院感染管理科专职人员（专职人员）及兼职人员均采取隐蔽性观察方法进行手卫生依从率调查，前者在上午临床查房、治疗及护理操作高峰时段观察，后者在日常工作中进行观察，比较两种方法调查的数据。结果专职人员调查的医务人员手卫生依从率为36.67%（110/300）,低于兼职人员调查的61.90%（533/861）；不同科室、不同手卫生时刻，专职人员调查的手卫生依从率均低于兼职人员调查的数据（均P＜0.01）。专职人员与兼职人员的调查结果均显示，血液透析室、重症监护室病房（ICU）的手卫生依从率较高；清洁/无菌操作前、血液/体液暴露后、接触患者后手卫生依从率较高。 结论兼职人员调查的手卫生依从率偏高，但不同时刻手卫生依从率的高低与专职人员调查一致，有一定的可取之处。

Antimicrobial resistance (AMR) is increasing rapidly worldwide［1］. The European Centre for Disease Prevention and Control (ECDC) estimates that 25 000 deaths, 2.5 million extra hospital days, and 1.5 billion extra Euros are associated with AMR infection in Europe each year ［2］. In the United States, according to the Centers for Disease Control and Prevention(CDC), healthcareassociated infections (HAIs) caused by carbapenemresistant Enterobacteriaceae are responsible for 610 deaths annually［3］. Therefore, it’s urgent to prevent and control the spread of AMR.

ObjectiveTo investigate status and influencing factors of hand hygiene(HH) of hospitalized puerperas while breastfeeding, and take intervention measures to improve HH status of puerperas.MethodsA selfdesigned questionnaire was used to investigate puerperas in the department of obstetrics in a hospital from April to May 2017, training about HH knowledge and skill was carried out, compliance rate and correct rate of HH among puerperas before and after training were observed.ResultsA total of 48 puerperas were included in the investigation. The survey results showed that only 54.17% of puerperas washed their hands before breastfeeding; compliance rate and correct rate of HH before intervention were 44.05% and 45.95% respectively, after intervention were 79.49% and 61.29% respectively, difference in compliance rate was statistically significant before and after intervention (χ2 =21.37, P＜0.01）.ConclusionSystematic and standardized training on HH knowledge and skill for puerperas is helpful for improving their compliance and standardization of HH, which is of great significance for reducing maternal and infant infection.

ObjectiveTo understand the effect of quality control circle (QCC) on improving hand hygiene(HH) compliance of health care workers(HCWs) in department of neurology. MethodsQCC activity group was established, activity plan was formulated, and selfdesigned questionnaire was adopted to investigate HH of 62 HCWs in the neurology department of a hospital, the implementation of HH was observed, causes and countermeasures were analyzed, and a 6month continuous quality improvement was conducted. ResultsThe compliance rate and correct rate of HH among HCWs after QCC activities were both higher than that before QCC activities (80.00% vs 44.41%, χ2 =63.652, P＜0.01; 81.55% vs 46.46%, χ2 =39.940, P＜0.01）. The compliance rate and correct rate of HH among doctors and nurses improved from 42.68% and 48.41% before QCC to 85.54% and 78.38% respectively after QCC. The lowest compliance rates of HH moment before QCC activities were as follows: doctors were before contacting with the patients（18.18%），nurses were before performing cleaning/aseptic operation（28.00%）, which improved to 63.16% and 60.00% respectively after QCC activities. Goal achievement rate after QCC activity was 138.43%, improvement rate was 80.14%, ability of circle members improved greatly in the activities. ConclusionQCC activities can fully mobilize the enthusiasm of everyone, develop the team spirit of HCWs, and improve HH compliance of HCWs.

ObjectiveTo carry out patients’ participation in promoting health care workers(HCWs) to improve hand hygiene (HH) compliance in the outpatient transfusion room, obtain real data of HH, and further provide basis for performing the activity in the whole hospital. MethodsHH compliance of nurses in outpatient transfusion room during four stages was observed by using the healthcareassociated infection control toolkit mobile phone APP. Intervention was not implemented at the first stage, HH promotion was implemented at the second stage, simulation of patients participated in promoting HCWs to improve HH compliance was performed at the third stage, and patients actually participated in promoting HCWs to improve HH compliance at the fourth stage. A questionnaire about patients’ willingness to participate in the promotion of HCWs to improve HH compliance was developed and filled out by patients and nurses. ResultsHH compliance rates of nurses in transfusion room at four stages were 21.43%, 44.27%, 61.48%, and 82.88% respectively, differences was significant（χ2=110.35，P＜0.01）; HH correct rates at four stages were 44.44%, 74.14%, 81.33%, and 81.82% respectively, differences was significant（χ2=18.50，P＜0.01）. ConclusionPatients participating in promotion of HH can significantly improve HH compliance of HCWs, which is simple and effective, and worth to be popularized.

ObjectiveTo understand the actual implementation of hand hygiene(HH)  of health care workers(HCWs), and provide evidence for improving HH management. MethodsHH performance appraisal began to implement in a hospital in 2016, at the same time, third party (healthcareassociated infection management professionals in other hospitals) was invited to carry out 4 times of anonymous survey on HH among HCWs in the hospital, change in HH compliance rate among HCWs was compared. ResultsHH compliance of HCWs surveyed by the third party was 60.68%, HH rates in the first half and second half year were 52.72% and 68.62% respectively, difference was statistically significant (P< 0.001). Compliance rate of HH in key departments (intensive care unit and neonatal department, 87.44%) was higher than surgical departments (64.71%) and internal medicine departments (53.74%), difference was statistically significant (both P<0.05). HH compliance rates of HCWs before and after contact with patients and after contact with the surrounding environment of patients were all low (53.59%, 58.07%, 43.97%, respectively). ConclusionHH surveyed by the third party can effectively reduce the Hawthorne effect during the observation process. HH performance appraisal can significantly improve the compliance of HH among HCWs.

ObjectiveTo evaluate the effect of patients’ participating supervision on improving nurses’ compliance to hand hygiene(HH) in intensive care unit(ICU).MethodsImplementation of HH of ICU nurses was investigated by field observation and investigation of patients, intervention measures were began to be implemented in February 2016, HH compliance among ICU nurses after(FebruaryMay 2016) and before (November 2015January 2016) intervention was compared.ResultsA total of 81 patients were included in the study, 38 were in preintervention group and 43 were in postintervention group. 52.63%（20/38）in preintervention group and 88.37%（38/43）in postintervention group seen, heard or recalled that nurses had performed HH, difference was significant(χ2=12.67, P＜0.005)；after intervention, HH rates before and after touching a patient, before aseptic procedure, and after touching patient surroundings were all higher than before intervention (all P<0.01).ConclusionPatients’ participation in improving HH compliance of ICU nurses is feasible, and it is worth to be popularized.

ObjectiveTo explore the effect of 5M1E quality analysis toolbased hand hygiene(HH) comprehensive intervention measures on pediatric healthcareassociated infection(HAI).MethodsHH status of 29 health care workers(HCWs) in the pediatric department of a hospital was monitored, AprilJune 2015 was baseline survey stage, 5M1E quality analysis tool was adopted to analyze various factors affecting the compliance rate of pediatric HH, intervention measures began to be taken in June 2015, and compared with HH in July 2015March 2016. The occurrence of HAI between July 2014March 2015 and July 2015March 2016 was compared.ResultsHH compliance rate of HCWs increased from 30.86% in AprilJune 2015 to 81.94% in JanuaryMarch 2016; HH correct rate increased from 68.14% to 93.75%; HH compliance rate and correct rate of HCWs gradually increased（χ2=2 608.626, 630.798，respectively, both P＜0.001）. Qualified rate of detection of HCWs’ HH sampling increased from 20.69% in AprilJune 2015 to 89.66% in JanuaryMarch 2016（χ2=31.957，P＜0.001）. Incidence of HAI decreased from 7.74% in July 2014March 2015 to 3.62% in July 2015March 2016（χ2=46.717，P＜0.001）.ConclusionApplication of 5M1E quality analysis tool in the investigation, analysis, and comprehensive intervention in HCWs’ HH in pediatric department has greatly enhanced HCWs’ HH compliance rate, and reduced the incidence of HAI in pediatric patients.

ObjectiveTo understand the current management situation of hand hygiene (HH) among health care workers(HCWs) in stomatology medical institutions in Zunyi, and provide basis for the scientific management of HH.MethodsIn OctoberDecember 2014, the onsite observation and questionnaire survey were adopted to investigate current management situation of HH in 127 stomatology medical institutions in Zunyi.ResultsThe rates of qualified installation of sink, faucet, detergent, alcoholbased hand rub, and handdrying facilities were 60.63%, 11.02%, 92.13%, 22.05%, and 37.80% respectively. Except detergent and sink, the installation of other HH supplies in stomatology medical institutions in Zunyi were not ideal. The correct rate of HH among HCWs was 33.07%（42/127）， qualified rates of HH methods among HCWs in departments of stomatology, comprehensive outpatient departments, stomatological clinics, and teethcleaning clinics were 50.00%, 23.08%, 23.53%, and 0 respectively.ConclusionHH facilities are not perfect in primary stomatology medical institutions in Zunyi, health administrative departments’ supervision on HCWs’ HH  is inadequate, the awareness rate of HH knowledge and compliance to HH among HCWs are both low.

ObjectiveTo evaluate the effect of hand hygiene (HH) promotion on awareness, correctness and compliance rates of  HH among health care workers(HCWs).MethodsHH promotion was started to carry out on May 8,2014,  onsite questions, theoretical examination, and direct observation were adopted to survey the  percentage of  HH awareness, correctness of sixstep handwashing method, and compliance to HH among HCWs before and at the phase five of promotion implementation, results before and after implementing promotion were compared.ResultsAfter implementing HH promotion, percentage of  HH awareness, correctness of sixstep handwashing method, and compliance to HH among HCWs increased from 42.50%,35.45%, and 24.00%  to  87.12%, 68.60%, and 43.20% respectively，differences were all significant （all P＜0.05）.ConclusionHH promotion has strengthened HCWs’  HH awareness, standardized HH method, and enhanced compliance to HH.

ObjectiveTo understand hand hygiene(HH) compliance among health care workers(HCWs) and incidence of healthcareassociated infection(HAI) in surgical patients before and after the intervention, analyze the effect of HH on costeffectiveness of HAI. MethodsFrom December 2012June 2014, 78 HCWs in the department of neurosurgery of a hospital were as the intervention objects of HH compliance, 325 patients who underwent craniocerebral clean operation were as the surveyed objects, HH compliance among HCWs, incidence of HAI in surgical patients, cost of HH, and hospitalization expense before and after intervention were compared respectively. ResultsHH compliance among HCWs before and after intervention were 35.24% (216/613) and 73.75%（486/659）respectively (χ2=180.091，P<0.001）; incidence of HAI in surgical patients before and after intervention were 31.85%（50/157）and 18.45%（31/168）respectively（χ2=7.782，P<0.001）. Hospitalization expense before and after intervention were （89 524.90±38 856.70）￥ and （61 401.00±29 237.80）￥ respectively; average length of hospital stay before and after intervention were 36.70 days and 26.90 days respectively（t=3.296, 3.511，respectively, both P＜0.01). ConclusionImproving HH compliance among HCWs can reduce the incidence of HAI and hospitalization cost, and shorten the average length of hospital stay of patients.

Objective To investigate the effect of different hand hygiene(HH) methods and hand drying measures on HH, and improve the quality of HH. Methods Health care workers(HCWs) in different departments of eight hospitals in Henan Province were selected as the surveyed subjects. HH methods and hand drying measures were observed, qualified rates of microbial detection of HH among different HH methods and hand drying measures were compared. Results A total of 699 HCWs were surveyed, 572 times of HH were performed, compliance rate of HH was 81.83%. Hand washing is the most common HH measure, accounting for 39.34%. The qualified rate of HH by alcohol-based hand rub was 97.92%, qualified rate of HH among different HH methods was statistically significant (χ²=20.203,P<0.001). The main HH measures was natural air drying (79.37%), proportion of drying by disposable tissue, automatic air dryer and other methods were 14.69%, 1.75% and 4.20% respectively. There was significant difference in qualified rates of HH after different hand drying measures (P=0.013). In hand washing group and hand disinfection after hand washing group, the qualified rate of using disposable tissue to dry hands was the highest, accounting for 80.70% and 96.30% respectively. Conclusion Application of alcohol-based hand rub is reliable for hand disinfection, the best way of hand drying is to use disposable tissue.

ObjectiveTo investigate compliance and influencing factors of hand hygiene (HH) among health care workers(HCWs).MethodsFrom November 2014 to February 2015, implementation of HH among HCWs in 15 clinical departments in a hospital was investigated through questionnaires, the effect of HH purpose on HH behavior of HCWs was analyzed with multivariate logistic regression method.ResultsA total of 364 HCWs were investigated, 245 (67.31%）of whom implemented  HH  well. Univariate analysis revealed that implementation of  HH among HCWs of different occupations, education levels, and HH purpose were all significantly different (all P<0.05). Multivariate logistic regression analysis showed that HH purpose as well as HH compliance were both significantly different (P=0.042）. Compared with HH purpose of selfprotection among HCWs, HCWs with HH purpose of crossinfection prevention had better HH behavior (OR,2.17［95%CI, 1.29-3.65］).The top five objective factors influencing HCWs’  HH implementation were as follows: lack of warm water in winter (70.73%), heavy workload,had no time (61.38%), skin irritation caused by disinfectant or hand sanitizer (54.88%), without hand dryer (47.56%), and use disposable gloves (45.12%).ConclusionOn the basis of improving HH facilities, changing HCWs’ awareness of HH only for selfprotection may be an another way to improve HH compliance among HCWs.

目的观察殡仪人员手卫生行为模式，提出切实可行的干预措施，改善殡仪人员手卫生状况。方法采用现场观察和采样检测相结合的方法对国内9个殡仪馆90名一线遗体防腐整容工手卫生行为及洗手效果进行调查，选取一线遗体防腐整容工20名，进行为期1周的行为干预试验，评价干预效果。结果9个殡仪馆手控式水龙头配备率为100%，均未配备感应式或脚踏式水龙头，均未配备感应式干手设施。殡仪人员采取手卫生的方式为流水或肥皂洗手，洗手率为100%，55.56%的殡仪人员采用六步洗手法洗手，80.00%的人员洗手不规范;90名殡仪人员洗手后手细菌平均数为（180.51±209.23） CFU/cm2，高于洗手前（154.95±271.95） CFU/cm2，差异有统计学意义（F=0.173，P=0.036）。干预前殡仪职工手卫生依从率为26.99％（95/352）,培训后殡仪职工手卫生依从率为57.32%(227/396),差异有统计学意义（χ2=24.56，P＜0.001）。殡仪人员按六步洗手法洗手后用干手纸巾擦手和使用快速手消剂均能降低手细菌总数（均P＜0.05）。结论殡仪人员手卫生状况不佳，提高殡仪人员的消毒卫生防护知识，规范其六步洗手法、开关水龙头、干手等行为，能有效改善殡仪人员手卫生状况。

ObjectiveTo understand the status of hand hygiene(HH) of health care workers(HCWs) in a tertiary hospital in Zhuhai.MethodsHH compliance of doctors, nurses, and cleaners randomly selected from 15 clinical departments in the whole hospital was observed through concealed observation by medical interns in OctoberNovember 2016. ResultsHH compliance rate and correct rate of clinical departments in the whole hospital were 33.44%(1 131/3 382) and 59.86%(677/1 131) respectively, there was a significant difference in the compliance rate of HH among different types of HCWs （χ2=12.610，P=0.002），HH compliance rate from high to low was  nurses (35.85%), cleaners (32.28%), and doctors (29.50%). Of five HH moments, HCWs’ HH compliance rate after patient’s body fluid exposure was the highest (69.74%), while after touching patient surroundings was the worst (25.03%). HH compliance rates of HCWs with different occupations at different HH moments were all significantly different (all P<0.05), HH compliance rates of doctors before aseptic procedure and after patient’s body fluid exposure were higher than nurses(71.25% vs 32.44%; 82.86% vs 69.78%, respectively), HH compliance rate of nurses was highest after touching a patient(40.06%).ConclusionHH status in this hospital is not optimistic, HH compliance rate and correct rate are low, HH compliance rates of HCWs with different occupations and at different HH moments are both different, which need to be improved.

ObjectiveTo investigate status of hand hygiene(HH) compliance among healthcare care workers(HCWs) in an organ transplant department.MethodsHH compliance among HCWs in an organ transplant department was investigated with concealed field observation once a week from January to June 2017, unified WHO HH observation forms were filled out, and SPSS 18.0 software was used for statistical analysis.ResultsA total of 37 HCWs were investigated, 380 times of HH should be implemented during observation, 86 times of actual implementation of HH was observed, compliance rate and correct rate of HH were 22.63% and 53.49% respectively. Difference in HH compliance rate among HCWs of different occupations was not significant（χ2=1.003，P=0.80）. Difference in HH correct rate among HCWs of different occupations was significant（χ2=8.411，P=0.038）；doctors had the highest correct rate of HH (88.89%), patient care workers had the lowest correct rate of HH(0). Among HH with different professional titles, correct rate of HH among associated chief doctors and attending doctors was highest(100%). There was a significant difference in HH compliance rate under different HH indications（χ2=15.082，P=0.005）；compliance rate of HH after exposure to blood and body fluid was highest(27.27%), compliance rate before aseptic manipulation was lowest(9.91%). There was no significant difference in the correct rate of HH under different indications （χ2=7.150，P=0.128）. There was no significant difference in HH compliance rate and correct rate among HCWs during different periods (both P>0.05). The main reason for the disqualification of HH of HCWs was inadequate time for rubbing (19 times, 47.50%) and the wrong method of rubbing (21 times, 52.50%).ConclusionCompliance of HH among HCWs in organ transplant department is low, compliance rate and correct rate of HH among HCWs of different occupations is significantly different, compliance of HH among HCWs needs to be improved, and corresponding effective intervention measures should be taken.

ObjectiveTo monitor hand hygiene(HH) compliance of health care workers(HCWs) with a new method, compare the advantage and disadvantage with direct observation method.MethodsFrom July to December 2016, HH compliance of HCWs in intensive care unit (ICU) of a tertiary hospital was monitored simultaneously by HH electronic monitoring system and traditional direct observation method, results of two monitoring methods were compared. ResultsICU was observed for 7 days (42 hours), 2 231 HH opportunities were recorded, a total of 4 532 HH opportunities in 7 days were estimated, total bedday was 23 days, the average HH opportunities required for HCWs in ICU was 197 times/bedday. From July to December 2016, HH compliance rate monitored by electronic monitoring system was 54.16% on average, which was lower than 77.72% of direct observation method （χ2=50.53，P<0.001）. Cost of HH electronic monitoring system per hour (4.56 Yuan) was lower than that of direct observation method (20.78 Yuan).ConclusionCompared with traditional direct observation method, HH electronic monitoring system is more timesaving and laborsaving, data are more accurate and objective, and has a certain cost advantage in the economically developed regions.

ObjectiveTo understand hand hygiene(HH) compliance among nursing staff, and evaluate the effective strategies to improve HH compliance.MethodsHH compliance among 59 nurses in the internal medicine ward of a tertiary comprehensive hospital was investigated between January 2016 and June 2017, HH compliance rates of nursing staff with different professional titles and different working years were compared.ResultsHH compliance rate of 59 nurses was 69.6%, HH compliance rates of five moments for HH were: before touching a patient（59.7%）, before clean/aseptic procedure（96.2%）, after body fluid exposure risk （97.7%）, after touching a patient（56.3%）, after touching patient surroundings（42.0%）. Difference in compliance rate of different HH moments was statistically significant （χ2=220.393，P＜0.001）. HH compliance rates among nurses of different professional titles after touching patient were significantly different（χ2=6.521，P=0.038）. HH compliance rates of nurses with different working years before and after touching patient were significantly different（χ2=8.385,16.123，respectively, P＜0.05）.ConclusionThe overall HH compliance rate among nursing staff is low, management of HH compliance of junior nurses should be strengthened, and implementation of HH before and after touching patient should be emphasized.

ObjectiveTo design a concealed investigation scheme to control bias based on direct observation method, evaluate actual hand hygiene(HH) compliance among health care workers(HCWs).MethodsHH compliance among HCWs in 8 general hospitals in Beijing was performed concealed investigation in June 2016, data of HH compliance and correctness were obtained and conducted statistical analysis as well as direct standardization, then compared with HH surveillance data obtained by direct observation method in 2015.ResultsIn 2016, HCWs’ HH compliance rate and correct rate were 58.04% and 88.68% respectively. After direct standardization, ICU had the highest HH compliance rate (81.29%), emergency department had the highest HH correct rate (93.29%), neurology department had the lowest compliance rate and correct rate of HH (42.97% and 82.35% respectively); nurses had the highest compliance rate and correct rate of HH (69.02% and 92.84% respectively), cleaners had the lowest compliance rate and correct rate of HH (37.25% and 71.59% respectively); compliance rate of HH after contacting patients was the highest (71.79%) but correct rate was the lowest (88.76%), compliance rate of HH before cleaning/aseptic procedure was the lowest (43.08%) but the correct rate was the highest (93.50%). HH compliance rate of HCWs investigated by concealed method was lower than that by direct observation(P<0.05), and the extent of discrepancy in correctness was different.ConclusionHH compliance is different in the distribution of departments, personnel, and indication, it is necessary to strengthen intervention in key aspects of HH. There is a certain bias in results of direct observation on HH compliance, HH investigation methods need to be improved.

ObjectiveTo understand the current situation of hand hygiene(HH) facilities in China.MethodsA multicenter study was conducted to select different levels of hospitals (province, district, and county levels) and army hospitals in 14 provinces (municipalities and autonomous regions). HH facilities in hospital wards were conducted field survey, installation of HH facilities in different sections of different wards in 2010 and 2016 were compared.ResultsThe total installation rate of hand wash sink in hospital increased from 69.30% in 2010 to 77.20% in 2016（χ2=37.68，P<0.01）； in 2016, the faucet switch in hospital wards was mainly inductive (39.39%), follows by handtype and foottype switch, accounting for 29.65% and 17.67% respectively；the main way of hand drying was use of paper towel, accounting for 77.30%. The rate of hand drying by using paper towel increased from 38.45% in 2010 to 77.30% in 2016, rate of hand drying naturally fell from 18.65% to 8.04%. The total equipping rate of alcoholbased hand rub in hospitals increased from 50.47% in 2010 to 75.64% in 2016, difference was statistically significant（χ2=402.46，P<0.01）. In 2016, equipping rate of alcoholbased hand rub in different sections of different wards were all significantly different (department of respiratory disease medicine: χ2=69.49，P<0.01；department of general surgery: χ2=66.97，P<0.01；intensive care unit ［ICU］: χ2=88.52，P<0.01）. The equipping rate of alcoholbased hand rub in treatment room was the highest (treatment rooms in departments of respiratory medicine, general surgery, and ICU were 89.50%, 88.50%, and 88.54% respectively), equipping rate of alcoholbased hand rub in patients’ rooms and corridor of common wards was lowest (about 60%). Except for the corridor equipping rate was 56.25%, equipping rate of alcoholbased hand rub in other sections of ICU were all over 80%.ConclusionCompared with 2010, the equipping of hand washing basin, alcoholbased hand rub, faucet switch, and hand drying method have improved significantly in 2016, but allocation of HH facilities is uneven in different wards, it is necessary to improve HH facilities to meet the requirement of healthcareassociated infection prevention and control.

ObjectiveTo explore the application efficacy of quality control circle（QCC） in hand hygiene(HH) management of laboratory staff.MethodsLaboratory staff in a hospital in Neijiang from January to December 2016 were selected as the studied objects, QCC group of HH management of laboratory staff was established, causes of correct rate of HH in laboratory staff were analyzed, corresponding countermeasures were formulated and implemented; data before and after performing QCC activity were compared and analyzed, efficacy of activities was assessed.ResultsAfter implementing QCC activity, correct rate of HH in laboratory staff increased from 29.73% to 91.04%, difference was significant(P<0.001). At the same time, circle members’ ability in QCC skill, responsibility, sense of honor, selfconfidence, cohesiveness were all promoted with varying degrees.ConclusionThe implementation of QCC activities can not only improve the correct rate of HH of laboratory staff, but also enhance team confidence and cohesiveness, it is worthy of further clinical application.

ObjectiveTo systematically evaluate the compliance and correct rate of hand hygiene(HH) among doctors and nurses in secondary and above hospitals in mainland China，and provide data support for HH promotion. MethodsLiteratures about study on HH in mainland China after 2015 were retrieved from Chinese and English databases, researchers evaluated the literatures according to the relevant standards, screened the qualified literatures and extracted the data strictly according to the inclusion and exclusion criteria, Meta analysis was adopted to analyze the compliance and the correct rate of HH of doctors and nurses in different levels of hospitals and at different departments.ResultsThe overall compliance rate of HH of nurses was higher than doctors, compliance rates of HH of doctors and nurses were 55.9% (95%CI: 45.9%, 65.8%) and 66.0%(95%CI: 58.8%, 73.1%） respectively；HH correct rates of doctors and nurses were 65.2% (95%CI: 53.6%, 76.9%) and 67.9%(95%CI: 56.9%, 78.9%) respectively. Compliance rates of HH of doctors and nurses in tertiary hospitals were both higher than secondary hospitals, compliance and correct rates of HH of doctors and nurses in intensive care unit were both higher than general departments.ConclusionThe compliance and correct rate of HH in mainland China need to be further improved, especially the promotion in primary hospitals and general departments.