Article(id=1241025205330571981, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409205, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726156800000, receivedDateStr=2024-09-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773813066084, onlineDateStr=2026-03-18, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773813066084, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773813066084, creator=13701087609, updateTime=1773813066084, updator=13701087609, issue=Issue{id=1241025201983508979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773813065285, creator=13701087609, updateTime=1773815493878, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035388320543403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035388320543404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1274, endPage=1277, ext={EN=ArticleExt(id=1241025205674504914, articleId=1241025205330571981, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research progress of artificial intelligence in improving hand hygiene compliance of medical staff, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=

Hand hygiene is the most basic and simplest intervention measure for preventing hospital infections. To improve the hand hygiene compliance of medical staff, various new technologies, methods, and models have been adopted in different countries, and artificial intelligence technology has also been gradually introduced into this field. This paper reviews the research progress of existing artificial intelligence technologies in the hand hygiene compliance of medical staff, aiming to provide reference methods for medical institutions in China to improve the hand hygiene compliance of medical staff, thereby reducing the hospital infection rate and ensuring the safety of medical quality.

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手卫生是预防医院感染最基本、最简单的干预措施。为提高医务人员的手卫生依从性,各国采用了各种新技术、新方法、新模式,人工智能技术也逐渐被引入这一领域。本文将现有人工智能技术在医务人员手卫生依从性方面的研究进展进行综述,旨在为我国医疗机构提升医务人员手卫生依从性提供借鉴方法,进而降低医院感染率,保障医疗质量安全。

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李诗雨,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=6f3FngiG5wFZPxy1Rumv6A==, magXml=SGp6et6O+T0jcVSTddTmFA==, pdfUrl=null, pdf=vSlZeV9eJdi7rY2lPd60nA==, pdfFileSize=469684, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=TV9BxyfLke0lAYFtwZAFYA==, mapNumber=null, authorCompany=null, fund=null, authors=

陈梦贤(2004—),女,本科在读,研究方向:医院感染

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陈梦贤(2004—),女,本科在读,研究方向:医院感染

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陈梦贤(2004—),女,本科在读,研究方向:医院感染

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人工智能在提升医务人员手卫生依从性方面的研究进展
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陈梦贤 1 , 乔甫 2 , 彭雅兰 2 , 林吉 2 , 陈亿 2 , 李诗雨 2
现代预防医学 | 卫生政策与管理 2025,52(7): 1274-1277
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现代预防医学 | 卫生政策与管理 2025, 52(7): 1274-1277
人工智能在提升医务人员手卫生依从性方面的研究进展
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陈梦贤1, 乔甫2, 彭雅兰2, 林吉2, 陈亿2, 李诗雨2
作者信息
  • 1.四川大学华西临床医学院,四川 成都 610041
  • 2.四川大学华西医院医院感染管理部,四川 成都 610041
  • 陈梦贤(2004—),女,本科在读,研究方向:医院感染

通讯作者:

李诗雨,E-mail:
Research progress of artificial intelligence in improving hand hygiene compliance of medical staff
Meng-xian CHEN1, Fu QIAO2, Ya-lan PENG2, Ji LIN2, Yi CHEN2, Shi-yu LI2
Affiliations
  • West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-04-10 doi: 10.20043/j.cnki.MPM.202409205
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手卫生是预防医院感染最基本、最简单的干预措施。为提高医务人员的手卫生依从性,各国采用了各种新技术、新方法、新模式,人工智能技术也逐渐被引入这一领域。本文将现有人工智能技术在医务人员手卫生依从性方面的研究进展进行综述,旨在为我国医疗机构提升医务人员手卫生依从性提供借鉴方法,进而降低医院感染率,保障医疗质量安全。

医院感染  /  人工智能  /  手卫生  /  依从性

Hand hygiene is the most basic and simplest intervention measure for preventing hospital infections. To improve the hand hygiene compliance of medical staff, various new technologies, methods, and models have been adopted in different countries, and artificial intelligence technology has also been gradually introduced into this field. This paper reviews the research progress of existing artificial intelligence technologies in the hand hygiene compliance of medical staff, aiming to provide reference methods for medical institutions in China to improve the hand hygiene compliance of medical staff, thereby reducing the hospital infection rate and ensuring the safety of medical quality.

Hospital infection  /  Artificial intelligence  /  Hand hygiene  /  Compliance
陈梦贤, 乔甫, 彭雅兰, 林吉, 陈亿, 李诗雨. 人工智能在提升医务人员手卫生依从性方面的研究进展. 现代预防医学, 2025 , 52 (7) : 1274 -1277 . DOI: 10.20043/j.cnki.MPM.202409205
Meng-xian CHEN, Fu QIAO, Ya-lan PENG, Ji LIN, Yi CHEN, Shi-yu LI. Research progress of artificial intelligence in improving hand hygiene compliance of medical staff[J]. Modern Preventive Medicine, 2025 , 52 (7) : 1274 -1277 . DOI: 10.20043/j.cnki.MPM.202409205
医院感染(healthcare associated infection,HAI)是一个全球的公共卫生问题,据报道[1-2],每年数以亿计的住院患者发生医院感染,我国每年发生医院感染的人数超过400万[3],对个人、社区及公共医疗预算构成巨大的挑战。医院感染不仅会延长患者的住院时间,增加患者医疗费用,甚至会导致患者死亡[4]。当前,预防医院感染的措施众多,而手卫生(hand hygiene)被认为是最简单、最经济、有效的干预措施之一[5]
研究表明,改善手卫生依从性(hand hygiene compliance,HHC)可有效降低医院感染发病率[6-7]和治疗成本[8]。一项对全院进行手卫生干预的研究显示,HHC从干预前的48%提高至干预后的66%,与此同时,HAI发生率从16.9%下降至9.9%[9]。据估计,推广手卫生的总成本小于HAI相关成本的1%[10]。然而,当前医务人员的HHC低,全球平均为38.7%[11]。幸运的是,随着人工智能技术的快速发展,将其运用于手卫生领域,能有效提升HHC。本文旨在综述人工智能在手卫生管理中的应用,以为提升医务人员手卫生依从性提供借鉴方法。
尽管手卫生十分重要,但不少医务人员对于手卫生知识的知晓率不足[12-15],仍然存在提升空间。Dehghan Manshadi等人[16]的研究发现,德黑兰的一所三级医院不同病房的护士对于手卫生知识的平均得分为(66.53±9.41)分,结果并不令人满意。印度尼西亚最近的一项研究发现[1],护士手卫生知识的平均得分为11.61分(满分为15分)。同时,由于存在知识和行为不对等关系,不少医务人员尽管知道手卫生知识,仍然会留长指甲。国内医务人员对手卫生知识的知晓率仍然有所欠缺[217]。杨亚红等人[18]对甘肃69所医院的HAI管理专职人员进行手卫生认知情况调查,结果显示,66.4%的受访者对手卫生的相关知识尚未完全掌握,整体认知水平普遍较为薄弱。杨晶等人[19]对华北地区医疗机构手卫生知识知晓率进行调查,发现二级机构医务人员在手卫生时刻、手卫生设施和医用手套的使用方法方面掌握不足,需要重点加强。
现有研究表明,医务人员的HHC仍然处于较低水平。一项对2010—2021年所有高收入国家医生和护士HHC文献的系统分析显示,护士的加权合并依从率为52%,而医生的加权合并依从率为45%[20]。与此同时,由于设备缺乏等因素,中低收入国家的HHC预计将更低。Lambe等人[21]纳入61篇关于ICU医务人员HHC的研究,发现依从率平均水平为59.6%,其中高收入国家为64.5%,低收入国家为9.1%。不仅国外,国内研究也发现了依从率低这一现象。2019年全国医疗机构医务人员诊疗过程手卫生监测报告显示,1 480所医疗机构的平均依从率为79.84%[22]。李慧等人[23]对2017—2020年关于我国三级公立医院依从率的相关文献进行了系统分析,结果显示护士的依从率为60.7%,而医生的依从率为50%。而民营医疗机构更低,一项对十堰市区26所民营口腔诊所的调查发现,其医务人员依从率仅为26.20%[24],远低于我国卫健委在《医院感染管理医疗质量控制指标(2024年版)》提出的标准要求[25]
人工智能的诞生使培训不再单纯依靠人力,通过游戏、虚拟现实等也可以有效传递手卫生相关知识。研究发现使用自动化游戏技术培训,并利用三磷酸腺苷(ATP)监测系统来评估洗手效果,医务人员对手卫生正确方法的掌握程度加深,一年内洗手技术通过率从52%提升到79%,并且HHC首次提高到80%以上[26]。一个基于视频分析的人工智能系统被实践证明是强大的手卫生培训技术,可以自动测量酒精洗手液手卫生合规性,并实时提供反馈,从而帮助医务人员学习正确的手卫生、有效减少感染[27]。Clack等人[28]进一步创新创造虚拟现实技术,通过让医务人员参与模拟体验的方式来进行更好的培训和提供反馈,达到提高手卫生知晓率和依从性的目的。
电子洗手计数装置与射频识别技术的应用,为手卫生监测提供了高精度的解决方案,能有效降低传统的直接观察方法所引起的霍桑效应[29]。根据Arai[30]的研究,利用电子计数设备进行远程监控手卫生活动,是一种创新的监测方式,其设计通过在洗手设备上安装电子计数器,实现对手部卫生行为的实时跟踪及依从率的计算,尤其适用于大型医院的门诊环境。此外,远程视频审计设备结合摄像头监控洗手池和消毒剂分配器,通过运动传感器监测出入情况,能够实时查看医务人员的手卫生执行情况,并定期向其反馈,从而持续有效地提升HHC[31]。更进一步,使用结合红外与射频识别技术的电子徽章与洗手液分配器的设备,不仅能够实时更新手卫生监测数据,还能定期提供佩戴者的手卫生合规率,从而改善医务人员手卫生的依从性和合规性[4]。通过这些创新措施,医疗机构可以建立更为安全和健康的环境,为患者和医务人员的安全保驾护航。
实时提醒系统通过徽章、视频等技术快速获取手卫生信息,实时发送给医务人员,并能够将相关数据上传至数据库进行分析,从而显著提高HHC。Armellino的设备收集数据后,通过电子发光二极管板、电子邮件摘要和每周绩效报告及时向医务人员反馈手卫生执行情况,从而有效改善HHC[31]
视听系统可以作为一个提醒和反馈系统。将可感应挥发性酒精的电子徽章佩戴在胸前口袋中,在进行手卫生后,医务人员将清洁的手握在徽章上,徽章通过检测酒精来实现手卫生执行情况的可视化:红色指示表示未执行,绿色则表示已执行。当医务人员在30 s内未按照规定进行手卫生(徽章未检测到酒精)时,设备会发出可听见的哔哔声,以便及时反馈给医务人员[32]。由一个多学科团队构建的红外引导传感器系统具备自动识别功能,能够在医务人员接触患者之前主动通知患者进行手卫生,从而有效地改善和监测手卫生行为[33]。这一方法不仅前景广阔,还有较高的成本效益。
自动手卫生检测系统(Automated Hand Hygiene Monitoring Systems,AHHMS)包括用于记录直接观察数据的数字辅助应用程序、放置在分配器内的电子计数设备、自动组监控系统、基于徽章的监控系统以及使用摄像机。Wang等人[34]进一步根据技术将其分为应用辅助直接观察、相机辅助观察、传感器辅助观察和实时定位系统。应用辅助直接观察指研究员借助设备(如浏览器)来使用应用程序以帮助受过培训的审核员观察HHC,但其仅依靠人工审核员观察。相机辅助观察则进一步可以利用算法进行分析,Kim等人[35]提出运用二维和三维卷积神经网络算法技术可以在实际临床场景中进行有效的连续监测。除相机可以辅助观察之外,电子分配器等传感器设备也被证实可以用于辅助观察。对于实时定位系统,根据其底层技术分类,主要包括射频识别、红外线、超声波、低功能蓝牙、IEEE 802.15.4/ZigBee和Wi-Fi,通过以上技术来进行识别、监测、跟踪医务人员的手卫生情况[34]
运用物联网技术提高HHC是新趋势。利用物联网管理系统,医务人员可以通过佩戴的徽章与病房内五个区域信号发射机相识别,若医务人员洗手,徽章的指示灯将呈现绿色,未按照要求进行手卫生,红色指示灯会亮起,从而使医务人员实时得到手卫生的信息,从而促进HHC的提升,降低HAI发生率[36]。Abubeker等人[37]构建一个由物联网提供支持的远程网络,该网络可以监测、监控和跟踪医务人员的手卫生习惯,并被证实可以有效提高HHC,最终有助于减少感染。Wu等人[38]进一步提出结合不同物联网技术的自主手部卫生跟踪系统,该系统可以记录洗手活动,并在未使用可穿戴设备和智能分配器按要求进行洗手时提供及时反馈。收集的数据通过蓝牙低功耗(BLE)和远程(LoRa)无线技术传输到网关,以实现远程网络覆盖。洗手数据在网络边缘(即路由器和网关)进行处理,以提供低延迟反馈。数据还可以转发到云服务器进行存储、分析和可视化。并且Wu等人[38]所提出的手部卫生追踪原型已在模拟病房的不同场景下进行了测试和评估,证明了其在医院环境中的适用性。
现有的人工智能技术虽各具优势,但普遍存在下述问题:(1)手卫生时刻的检测不全面[29-33]。大部分的人工智能技术仅监测接触患者前后的手卫生情况,未全面涉及WHO规定的五个手卫生时刻,如O Filho[29]研究的电子手部卫生监测系统只能监测每个患者遇到的第一次和最后一次手卫生。(2)成本问题[29-303336-38]。如使用的物联网技术费用昂贵,目前我国大多数医院无法配置,如Xu[36]使用的设备本身及安装成本为150 000~200 000元人民币,后期的系统更新等服务要额外收费,导致我国多数基层医院难以购入。(3)伦理问题[42738]。使用可穿戴设备可能暴露医务人员的隐私,从而导致医务人员拒绝使用设备,如Boyce[4]的研究中,部分医务人员由于担心数据如何被使用而拒绝佩戴徽章。
运用人工智能可以有效提高医务人员手卫生知晓率和依从性,但针对目前存在的问题,仍有待研制更全面的普适性技术。未来的研究可以充分考虑手卫生发生的具体场景,预防HAI的发生;同时,在选择人工智能技术时,应注重成本的预防和控制,使其成本效益达到最大化,以最小的输出得到最大的输入。此外,在设备使用过程中,应充分向医务人员解释其用途,保障徽章等设备仅与涉及医疗行为的区域感应,以此保证医务人员的隐私和数据安全,可以避免涉及潜在的伦理问题。
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2025年第52卷第7期
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doi: 10.20043/j.cnki.MPM.202409205
  • 接收时间:2024-09-13
  • 首发时间:2026-03-18
  • 出版时间:2025-04-10
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  • 收稿日期:2024-09-13
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    1.四川大学华西临床医学院,四川 成都 610041
    2.四川大学华西医院医院感染管理部,四川 成都 610041

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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