Nosocomial Infection ----Prevention and control Wang kefang (王克芳) wangkf@sdu.edu.cn

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Transcript of Nosocomial Infection ----Prevention and control Wang kefang (王克芳) wangkf@sdu.edu.cn

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Nosocomial Infection ----Prevention and control Wang kefang wangkf@sdu.edu.cn Slide 2 2008 10 15 ____ ? 10 15 Global Handwashing Day 2005 2008 2008 10 15 Slide 3 Clean Hands are Safer Hands SAVE LIVES: Clean Your Hands 3 Hand Hygiene Slide 4 ( hand hygiene )? A general term referring to any action of hand cleansing including handwashing, antiseptic handrubbing and surgical hand antisepsis --WHO hand hygiene guideline Slide 5 hand washing / , (antiseptic handrubbing) (Surgical hand antisepsis) / Slide 6 Todays topics Why is hand hygiene important for health care workers(HCWs)? When should hand hygiene be performed? How to perform hand hygiene? Slide 7 After petting a dog or cat 42%(16%) Before handling Or eating food 77%(14%) After coughing or sneezing 32%(23%) After using the bathroom in your home 83%(10%) After changing a diaper 73%(4%) After handling Money 21%(18%) After using a public restroom 91%(6%) Hand Washing Habits How often do you wash your hands (Americans,2005 ) usualy wash my hands (always wash my hands ) Total Sample Slide 8 Why is hand hygiene important? Germs are present on patient skin and surfaces in the patient surroundings 1 Slide 9 13-25% 40% 30-39% Percent of Patients with MRSA Slide 10 Why is hand hygiene important? By direct and indirect contact, patient germs contaminate health- care workers' hands Germs survive and multiply on health-care workers' hands 2 Slide 11 24 Slide 12 2015-12-312 10 20% Slide 13 Defective hand cleansing results in hands remaining contaminated Why is hand hygiene important? 3 Slide 14 Maternal Mortality Rates 0 2 4 6 8 10 12 14 16 18 1841184218431844184518461847184818491850 First Second Semmelweis IP, 1861 Intervention May 15, 1847 Percentage Hand Hygiene: Not a New Concept Slide 15 Impact of hand hygiene promotion YearHospital setting Increase of hand hygiene complianceReduction of HCAI ratesFollow-upReference 1989 Adult ICU14% to 73% (before pt contact) HCAI rates: 33% to 10%6 yearsConly et al 2000 Hospital-wide48% to 66%HCAI prevalence: 16.9% to 9.5%8 yearsPittet et al 2004 NICU43% to 80%HCAI incidence: 15.1 to 10.7/1000 patient-days2 yearsWon et al 2005 Adult ICUs 23.1% to 64.5%HCAI incidence: 47.5 to 27.9/1000 patient-days21 monthsRosenthal et al 2005 Hospital-wide62% to 81%Significant reduction in rotavirus infections4 yearsZerr et al 2007 Neonatal unit 42% to 55%HCAI incidence: overall 11 to 8.2 i/1000 patient- days in very low birth weight neonates from 15.5 to 8.8 /i1000 patient-days 27 monthsPessoa-Silva et al 2007 NeurosurgeryNASSI rates: 8.3% to 3.8%2 yearsThu et al 2008 1) 6 pilot health- care facilities 2) all public health- care facilities 1) 21% to 48% 2) 20% to 53% MRSA bacteraemia: 1)0.05 to 0.02/100 patient-discharges per month; 2)0.03 to 0.01/100 patient-discharges per month 1) 2 years 2) 1 year Grayson et al 2008 NICUNAHCAI incidence: 4.1 to 1.2/1000 patient-days18 monthsCapretti et al Slide 16 Evidences Hand hygiene is the single most effective measure to reduce HCAIs Protect the patient and Protect yourself Slide 17 When should hand hygiene be performed? Slide 18 Your 5 Moments for Hand Hygiene Slide 19 Use What to Perform Hand hygiene Plain soap / Antimicrobial soap / Alcohol-based handrub Slide 20 Ability of Hand Hygiene Agents to Reduce Bacteria on Hands 0.0 1.0 2.0 3.0 060180minutes 0.0 90.0 99.0 99.9 log% Bacterial Reduction Alcohol-based handrub (70% Isopropanol) Antimicrobial soap (4% Chlorhexidine) Plain soap Time After Disinfection Baseline Slide 21 110 4-5 /g 110 6-7 /g / >100 34 54.0 11-100 9 14.3 1.1 10 4 6.3 1 16 25.4 Solid Soap Contamination of 63 Hospitals Slide 22 Slide 23 Adoption of alcohol-based handrub is the gold standard in all other clinical situations Handwashing with soap and water when hands are visibly dirty or following visible exposure to body fluids Slide 24 How to perform hand hygiene? Slide 25 Slide 26 Slide 27 Handwashing Rub hands together for at least 15 seconds 40-60 40-60 Slide 28 handrubbing 20-30 20-30 Tips on using an alcohol-based hand rub Apply 1.5 to 3 ml of an alcohol gel to the palm of one hand, and rub hands together; Cover all surfaces of your hands and fingers, including areas around/under fingernails; Continue rubbing hands together until alcohol dries (about 15-25 seconds). Make sure your hands are completely dry prior to putting on gloves. Slide 29 To clean your hands, you should prefer handrubbing with an alcohol-based formulation, if available. Requires less time Acts faster More effective Better tolerated More accessible Handwashing 40-60 seconds Handrubbing 2030 seconds Slide 30 Scenario 6a 6b6a6b Scenario 7a 7b7a7b Scenario 8a 8b8a8b Hand Hygiene Scenarios Slide 31 Slide 32