بررسي مقايسه اي نحو ي اسكراب دست قبل از عمل جراحي با روش اسكراب صحيح در بيمارستان هاي آموزشي شهر همدان

Study of rate performance of surgical hand scrub standard in Hamadan educational hospitals

مقدمه و هدف: عفونت ناشي از جراحي ، يكي از انواع عفونت هاي بيمارستاني و از عوارض هر عمل جراحي است.از روش هاي موثر براي پيشگيري از اين عفونتها اسكراب دست قبل از جراحي است. جهت اسكراب دست از مواد ضدعفوني كننده مختلف استفاده مي-شود لذا پژوهشي به منظور مقايسه نحو ي اسكراب دست قبل از عمل جراحي با روش اسكراب صحيح در بيمارستانهاي آموزشي شهر همدان انجام گرديد. روش كار: در اين بررسي توصيفي،جامعه و نمونه پژوهش تمام پرسنل جراحي و جراحان اتاق عمل بيمارستان هاي آموزشي منتخب دانشگاه علوم پزشكي همدان بودند. ابزار جمع آوري اطلاعات شامل 4 چك ليست در مورد نحوه اسكراب با محلول هاي الكلي و غير الكلي، وسايل اسكراب با محلول هاي الكلي و بدون الكل بود. جهت گردآوري اطلاعات هر يك از نمونه ها، 3 مرتبه حين اسكراب دست ، تحت مشاهده قرار گرفتند. نتايج: ميانگين اسكراب با محلول هاي با پايه الكل 5/11(6/67% امتياز كامل) بود كه تفاوت معني داري با بيمارستان هاي تحت بررسي و نوع عمل جراحي وجود داشت. ميانگين امتياز اسكراب با محلول هاي بدون الكل 1/11 (4/69%امتياز كامل) بود و ارتباط معني داري با نوع عمل جراحي مشاهده شد. نتيجه نهايي: جهت اجراي اسكراب صحيح دست، لازم است: ابتدا كميته كنترل عفونت يا دفتر پرستاري بيمارستان ها پروتوكل مشخصي را جهت اجرا ، مطابق با آخرين تغييرات علمي تعيين نمايند. آموزش و امكانات لازم براي اجرا مطابق با دستورالعمل اسكراب فراهم شود و بطور مستمر نظارت بر اجراي اين پروسيجر صورت گيرد.

Introduction & Objective: Surgical infection that caused by every surgery is one of nosocomial infection. Hand disinfection or scrub is an effective method to prevent this infection. There are many antiseptic solutions that used for hand scrubbing. For accessing to the most quality of hand scrubbing, it is necessary this procedure be according to correct principle or standard. Therefore this survey was conducted in order to determine of rate performance of surgical hand scrub standard in Hamadan educational hospitals. Materials & Methods: in this descriptive study, population and sample were all surgeons and operating room nurses of Hamadan educational hospitals. Data collection tools were 4 check lists about process of hand surgical protocol with alcohol-based and non alcoholic hand antiseptic solutions, instruments of these protocols. In order to gathering data, each sample was observed 3 times when he or she was accomplished hand scrub. Results: The average score of surgical hand scrub process with alcoholic solutions was 67.6% of total score. Mean score of scrub instruments with alcohol base solutions was 100% and about non alcoholic solutions was %90.3 of total score of its instruments of essential and important points in hand antisepsis process with both solutions that was report in least performance, were to washing hands with water and soap before scrub and after removal of sterile gloves, to disinfect all parts of hand and to clean under nails. Time of scrub was 108 seconds and with alcoholic solutions and 215.6 seconds with nonalcoholic solutions. Differences between antisepsis duration in according to hospital and kind of surgery were significant (p < 0.001). Difference between alcohol –base solutions scrub process with hospital under surgery and kin of surgery, was reported significant (p < 0.001). Difference between nonalcoholic solutions and kind of surgery, was reported significant too( p < 0.001). Conclusion: for correct performance of hand scrub, it is required: 1- infection committee or nursing supervisor office of hospitals, determine hand scrub standards according to latest scientific changes for implementation. 2- Personnel education and equipments were provided to do this procedure correctly according to surgical hand scrub protocol . 3- Surveillances for correct performance were done continuously.