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目的探索两种手消毒方法的效果及推荐性,以期更准确、有效地指导临床手卫生实践,为构建新生儿重症监护病房感染控制临床实践指南提供证据支持。方法计算机检索Cochrane图书馆、Pub Med、JBI、CNKI等数据库中关于洗手消毒和免洗手消毒液在新生儿重症监护医护人员手卫生应用论文,对论文进行评价,采用Revman软件分析。结果本研究共纳入4项RCT及3项类实验性研究,洗手消毒组和免洗手消毒液组总采集标本数各为1 447个和1503个。分析结果显示:免洗手消毒液杀菌效果优于洗手消毒效果(SMD=-0.672,95%CI:-1.291~-0.052,I~2=98%,P=0.040),进一步进行亚组分析,以免洗手消毒液/剂醇类浓度60%分组,醇类浓度大于60%,免洗手消毒液组杀菌效果优于洗手消毒组(SMD=-1.052,95%CI:-1.702~-0.391,I2=97%,P<0.001);醇类浓度小于60%免洗手消毒液组杀菌效果低于于洗手消毒组(SMD=0.721,95%CI:0.542~0.913,I2=0%,P<0.001)。结论采用免洗手消毒液/剂对新生儿重症监护人员手消毒,可更显著减少手中细菌菌落计数,有助于降低医院感染率,但在使用中应注意手消液浓度应大于60%。
Objective To explore the effect and recommendation of two hand disinfection methods in order to guide clinical hand hygiene practice more accurately and effectively and provide evidence support for the construction of clinical practice guideline of infection control in neonatal intensive care unit. Methods A computer-based online search of the Cochrane Library, Pub Med, JBI, CNKI and other databases was conducted to evaluate the hand hygiene application of hand-washing disinfectant and hand-washing disinfectant in neonates with intensive care and health care workers. Revman software was used to analyze the paper. Results A total of 4 RCTs and 3 experimental studies were included in this study. The total number of specimens collected in the hand-washing and hand-washing disinfectant groups was 1 447 and 1,503, respectively. The results of the analysis showed that the bactericidal effect of hands-free disinfectant was better than that of hand-washing (SMD = -0.672, 95% CI: -1.291 ~ -0.052, I ~ 2 = 98%, P = 0.040) Hand sanitizer / agent alcohol concentration of 60% group, the alcohol concentration greater than 60%, no-hand disinfectant group disinfection better than the hand-washing disinfection group (SMD = -1.052,95% CI: -1.702 ~ -0.391, I2 = 97 %, P <0.001). The bactericidal effect of the hands-free disinfectant solution with less than 60% alcohol concentration was lower than that of the hand-washing disinfectant group (SMD = 0.721, 95% CI: 0.542-0.913, I2 = 0%, P <0.001). Conclusion Disinfection of neonatal intensive care staff with hands-free disinfectant / agent can significantly reduce the number of bacterial colonies in hands and help reduce the nosocomial infection rate. However, care should be taken when using hand-lotion concentration should be greater than 60%.