Nosocomial Infection ----Prevention and control Wang kefang （王克芳） [email protected].
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Transcript of Nosocomial Infection ----Prevention and control Wang kefang （王克芳） [email protected].
你知道吗？ 从 2008 年起， 10 月 15 日是个 ____ 日吗 ?
10 月 15 日是“ Global Handwashing Day”
2005 年世界卫生组织提出， 2008 年正式设立
＿＿ 2008 年 10 月 15 日的＜健康报＞
Clean Hands are
Safer Hands
SAVE LIVES: Clean Your Hands
3 Hand Hygiene
何谓手卫生 (hand hygiene)?
A general term referring to any action of hand cleansing ， including handwashing, antiseptic handrubbing and surgical hand antisepsis
--WHO hand hygiene guideline
洗手（ hand washing） 用普通肥皂 / 液和流动水洗手 , 去除手部皮肤
污垢、碎屑和部分致病菌的过程。卫生手消毒 (antiseptic handrubbing)
指用速干消毒剂擦搓手的过程。
外科手消毒 (Surgical hand antisepsis)
外科手术前医护人员用肥皂 / 液和流动水洗手，再用手消毒剂清除或杀灭暂住菌和减少常居菌的过程。
Today’s topics
Why is hand hygiene important for health care workers(HCWs)?
When should hand hygiene be performed?
How to perform hand hygiene?
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 HabitsHow often do you wash your hands ……(Americans,2005 )
usualy wash my hands
(always wash my hands)
– Total Sample –
Why is hand hygiene important?
Germs are present on patient skin and surfaces in the patient surroundings
1
13-25%
40%
30-39%
腋下
手、手腕
腹股沟
Percent of Patients with MRSA
（耐甲氧西林金黄色葡萄球菌）
人体不同部位皮肤细菌量
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
某位护士的手印培养 24小时后
23/4/18 12
手部皮肤细菌类型 暂住菌
原皮肤不存在，主要通过接触而附在皮肤上，处于皮肤表面或角质下表皮细胞上
常住菌 寄宿于皮肤毛囊和皮脂腺开口处，种类、数量
常恒定，多无致病性，占总菌量 10 ～ 20% 由于常居皮肤深层，肥皂搓刷不易将它们去除
干净，需要用化学消毒剂才能将其杀死或抑制
Defective hand cleansing results in hands remaining contaminated
Why is hand hygiene important?
3
Maternal Mortality Rates
0
2
4
6
8
10
12
14
16
18
1841 1842 1843 1844 1845 1846 1847 1848 1849 1850
First
Second
Semmelweis IP, 1861
Intervention May 15, 1847
Per
cen
tag
e
Hand Hygiene: Not a New Concept
Impact of hand hygiene promotion
Year Hospital setting
Increase of hand hygiene compliance Reduction of HCAI rates Follow-up Reference
1989 Adult ICU 14% to 73% (before pt contact)
HCAI rates: 33% to 10% 6 years Conly et al
2000 Hospital-wide 48% to 66% HCAI prevalence: 16.9% to 9.5% 8 years Pittet et al
2004 NICU 43% to 80% HCAI incidence: 15.1 to 10.7/1000 patient-days 2 years Won et al
2005 Adult ICUs 23.1% to 64.5% HCAI incidence: 47.5 to 27.9/1000 patient-days 21 months Rosenthal et al
2005 Hospital-wide 62% to 81% Significant reduction in rotavirus infections 4 years Zerr 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 months Pessoa-Silva et al
2007 Neurosurgery NA SSI rates: 8.3% to 3.8% 2 years Thu et al
2008 1) 6 pilot health-care facilities2) 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 years2) 1 year
Grayson et al
2008 NICU NA HCAI incidence: 4.1 to 1.2/1000 patient-days 18 months Capretti et al
Evidences…Hand hygiene is the single most effective measure to reduce HCAIs
Protect the patient ， and Protect yourself
When should hand hygiene be performed?
Your 5 Moments for Hand Hygiene
Use What to Perform Hand hygiene
Plain soap 普通肥皂 / 皂液Antimicrobial soap 抗菌肥皂 / 皂液Alcohol-based handrub 酒精擦手液
Ability of Hand Hygiene Agents to Reduce Bacteria on Hands
0.0
1.0
2.0
3.0 0 60 180 minutes
0.0
90.0
99.0
99.9log%
Bac
teri
al R
edu
ctio
n
Alcohol-based handrub(70% Isopropanol)
Antimicrobial soap(4% Chlorhexidine)
Plain soap
Time After Disinfection
Baseline
1×101×104-54-5
个个 /g/g1×106-7
个 /g
污染程度 细菌数 / 克肥皂 医院数 构成比
极严重 >100万 34 54.0％
严重 11-100万 9 14.3％
中度 1.1－ 10万 4 6.3％
轻微 ≤ 1 万 16 25.4％
×
Solid Soap Contamination of 63 Hospitals
消毒液浸泡：错误的手消毒方法
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
How to perform hand hygiene?
如何进行手卫生？
Handwashing
Rub hands together for at least 15 seconds
40-60秒
40-60秒
handrubbing
20-30秒
20-30秒
Tips on using an alcohol-based hand rubApply 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.
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
Handwashing40-60 seconds
Handrubbing 20–30 seconds
Scenario 6a 6b Scenario 7a 7b Scenario 8a 8b
Hand Hygiene Scenarios
