世界卫生组织全球手卫生行动-香港经验ppt课件

1、WHO Hand Hygiene Initiative Hong Kong Experience 世界卫生组织全球手卫生行动-香港經驗 TWHFYKHDKCHMMRCQMHGHTYHIntroduction 引见Part 1: Review of scientific data 科学资料Part 2: Consensus 共识建議recommendationsPart 3: Outcome 结果測量measurementsPart 4: Promoting hand hygiene on a large scale大规模推行Part 5: Information to the public 给

2、公众的信息743 references 附註The Core Group Launch October 13, 2005Riyadh & GulfWHO, GenevaHong KongLondon, UKOttawa, CanadaBrisbaneHUG, GenevaLaunch October 13, 2005Hong Kong connected with Geneva香港与日内瓦Hong Konglinked to WHO Headquarter,GenevaCOUNTRIES PLEDGING AND IMPLEMENTING PARTS OF WHO HAND HYGIENE G

3、UIDELINES - 6 PILOT SITES WORLDWIDE FOR GOLD STANDARD GPSC IMPLEMENTATION - GENEVA GPSC SUPPORT TEAM AND TOOLS - GLOBAL PATIENT SAFETY CHALLENGE (GPSC) IMPLEMENTATION STRATEGY WORLDWIDEPILOT SITESCOMPLEMENTARYSITESCENTRALHUG INFECTIONCONTROL TEAM拥抱感染控制队试点中环互补性网站日内瓦gpsc支持团队和工具6.pilol网站全球黄金规范执行gpsc国家承

4、诺和执行部分是谁的手部卫生准那么WHO tools and resources to aid country implementation世卫组织的工具和资源，以协助国家执行Pilot Test Sites实验地点Pledge Countries承诺国Complementary Test Sites互补测试地点 Regional workshops区域研讨会 WHO technical and financial support世卫组织的技术和财政支持 Implementation pack, including:执行包，其中包括： Guide to implementation & sust

5、ainability实施指南与可继续性Suite of tools (evaluation, education, promotion, technical)套装工具评价，教育，推行，技术 On site visits (as necessary) 在实地调查视需求 Access to all tools and resources (website and hard copies)获得一切的工具和资源网站和硬拷贝 Limited WHO technical and financial support世卫组织技术和财政支持 Access to all tools and resources (

6、website and hard copies) Limited WHO Technical and financial supportAll Countries一切国家 Access to a range of tools and resources electronically via the GPSC website经过电子网站GPSC，获得一系列工具和资源，WHO - Hand Hygiene Guidelines手卫生指南Hand HygieneSingle most important practice to prevent the transmission of infectio

7、n 预防感染传播最重要的部份Single most effective way to prevent Healthcare Associated Infections (HAI) 是预防医院感染的最有效的方法The 5 indications 5迹象AFTER B-FLUID后乙液BEFORE CLEAN/INVASIVE前清洁/侵入AFTER PAT后干什么BEFORE PAT前英保通AFTER PATs OBJECT后轻拍的对象Direct transition between 2 patients直接过渡到2例Opportunity机遇AFTER contact接触后，(indicati

8、on 1) 阐明1 BEFORE contact )前后联络(indication 2阐明2 Direct transition between 2 patientsOpportunityKey Changes Needed in Hong Kong 关键的变化需求在香港1.Alcohol rub most of the time 擦酒精的大部分时间2.No mixing of hand washing and alcohol rub 没有混合洗手和酒精擦3.Removal of disinfectant detergent 去除消毒洗涤剂4.Broad Provision of WHO fo

9、rmula 广泛的规定卫生组织公式5.Implement guideline as a evaluation center 实施准那么作为评价中心Time constraint = major obstacle for hand hygiene 时间限制=主要妨碍对于手部卫生handwashinghand antisepsis 洗手1 to 1.5 minalcohol-basedhand rub 酒精擦手15 to 20 secHandwashing with soap and water when hands are visibly dirty手有可见赃物Adoption of alcoh

10、ol-based hand rub is the gold standard in all other clinical situations, whenever possible酒精液擦手Disinfectant soap消毒肥皂Key Changes Needed in Hong KongAlcohol rub most of the timeNo mixing of hand washing and alcohol rubRemoval of disinfectant detergentBroad Provision of WHO formulaImplement guideline a

11、s a evaluation centerHow much do you pay for it ?Answer: 1.5 x the price in BostonNairobi, Kenya, Africa, January 2005Formulation I To produce final concentrations of ethanol 80% (V/V), glycerol 1.45%, hydrogen peroxide 0.125%: Pour in a 1000 ml + 1.0 ml graduated flask: Ethanol 95% V/V 842.0 ml Hum

12、ectant-like substance: glycerol 14.5 ml Hydrogen peroxide 3% 41.7 ml Top up to 1000.0 ml with distilled or boiled water. Formulation II To produce final concentrations of isopropyl alcohol 75% (V/V), glycerol 1.45%, hydrogen peroxide 0.125%: Pour in a 1000 ml + 1.0 ml graduated flask: Isopropyl alco

13、hol (with a purity of 99,8%) 751.5 ml Humectant-like substance: glycerol 14.5 ml Hydrogen peroxide 3% 41.7 ml Top up to 1000.0 ml with distilled or boiled water. WHO formulation配方 I 假设产品的最终浓度为：酒精80% (V/V), 甘油 1.45%, 二氧化氢 0.125%，那么需求将下类物质倒入一支1000毫升有刻度的烧瓶中: 乙醇 95% V/V 842.0 ml 保湿剂物质: 甘油 14.5 ml 二氧化氢 3

14、% 41.7 ml 用蒸馏水或开水添到 1000.0毫升 配方 II 假设产品的最终浓度为： 异丙醇75% (V/V), 甘油1.45%, 二氧化氢 0.125%，那么需求将下类物质倒入一支1000毫升有刻度的烧瓶中: 异丙醇 (纯度为99,8%) 751.5毫升 保湿剂物质: 甘油 14.5 ml 二氧化氢 3% 41.7 ml 用蒸馏水或开水添到 1000.0毫升. 世界卫生组织的酒精类手消毒液配方About $4 HK a bottleKey Changes Needed in Hong KongAlcohol rub most of the timeNo mixing of hand

15、washing and alcohol rubRemoval of disinfectant detergentBroad Provision of WHO formulaImplement guideline as a evaluation centerKey Changes Needed in Hong KongAlcohol rub most of the timeNo mixing of hand washing and alcohol rubRemoval of disinfectant detergentBroad Provision of WHO formulaImplement

16、 guideline as a evaluation centeConduct survey for (调查)present structures e. g. sink, paper towel, hand rub 设备情况Compliance of hand hygiene practice 依从性Initiate hand hygiene program in ALL health care settings hospital, GP clinic, OAH, TCM. 在一切的卫生保健机构中开展Develop a practical protocol from the WHO guide

17、line for local setting 当地的方案。Research for alternative hand hygiene paradigms to enhance compliance in Hong Kong 研讨依从性4 prongs Strategy in Hong Kong Correlate (Spearman) with whether Mean (%) ward had staff infected p1. Mask 990.15 0.53 N95 55 0.23 0.36 Surgical 25 0.06 0.80 both 190.04 0.882. Glove

18、90 0.48 0.853. Gown 810.05 0.854. Faceshield 610.09 0.725. Goggles 460.18 0.476. Cap 76 0.20 0.437. Shoes-cover 150.02 0.928. Hand wash 97 0.09 0.74 Survey9. SARS Patient duration of stay 0.56 0.010 in ward (m = 13.3 days) Correlate (Spearman) with whether Mean % ward had staff infected* p1. Mask 10

19、0 N95 410.11 0.63 Surgical 20 0.10 0.66 both 390.25 0.302. Glove 91 0.29 0.223. Gown 990.15 0.534. Faceshield 690.12 0.625. Goggles 460.13 0.606. Cap 92 0.27 0.247. Shoes-cover 70.22 0.358. Hand wash (b) 65 0.00 0.99 Handwash (a) 78 0.03 0.90Observe Practices* 34 infected staffObjectiveTo explore th

20、e extend of alcohol hand rub (AHR) use in HKTo find out the reasons of preference and non-preferenceTo find out the hand hygiene performance in difference staff groupTo correlate workload and complianceMethodInfection control course participants to survey healthcare staff using a structured question

21、naire Wards are randomly selected from different specialtiesStaff types are stratified to include front-line healthcare workers such as doctors, nurses, and healthcare assistantsStaff are then randomly selected from the duty roster of Am & Pm shiftsResultsHospitals involved=14Staff surveyed=1285Spec

22、ialties=1380%14%5%2%Hospitals surveyed =14%Specialties surveyed distribution by %STAFF TYPETYPES OF STAFF SURVEYED75%15%10%n=1285Hand hygiene performed in last working shiftHand hygiene opportunitiesHand hygiene performed HCANursesDoctors1-2055%21-3937%40-608%1-2024%21-3952%40-6024%1-2028%21-3964%40

23、-6018% p=0.000 p=0.001 p=0.000 Staff report their abilities to copeCoping abilitya, b, c differs significantly p=0.04abcPercentage of time using AHROnly 17% are using frequentlyselfothersCorrelation between self and others using AHRpercentageReasons for not using AHRWorry about skinpercentageReasons

24、 for using AHRAgree about efficiencypercentagePlacement of AHRpercentage43331932Number of sites with AHR80712Types of soap usage955% reporting AHR after hand washingSummary of results50% of surveyed reporting 30 hand hygiene performed in last shiftDoctors has significantly lower HH performed among t

25、he 3 groupsSignificantly higher % of Doctors reported able to copeLess than 20% reporting use AHR frequentlyMost reporting not using AHR because concern of skin damageMost agreed AHR because it is convenientAHR is not available at each bed side (27%)Majority reported placing AHR at nurses station an

26、d cubiclesOnly 4% reported pocket size AHR11 (1%) reported not available in the clinical area3% reported more than one bottle at each patients bedside80% of surveyed reporting using medicated soapMost do not use AHR after hand washingSelf reporting on use of AHR correlate with reporting others pract

27、iceRecommendationsStaff are very concern about skin damageIt is important to choose a skin friendly AHREducation to convince about the skin friendly-ness of AHRMost are convinced that AHR is more convenient Promote multi-location for AHRPromote pocket size AHR for staff convenienceReplace medicated

28、soap with plain soapConduct survey for (调查)present structures e. g. sink, paper towel, hand rub 设备情况Compliance of hand hygiene practice 依从性Initiate hand hygiene program in ALL health care settings hospital, GP clinic, OAH, TCM. 在一切的卫生保健机构中开展Develop a practical protocol from the WHO guideline for loc

29、al setting 当地的方案。Research for alternative hand hygiene paradigms to enhance compliance in Hong Kong 研讨依从性4 prongs Strategy in Hong KongConscientious Approach in Hand WashingConcentrate on dirty and contaminated contactsResearch potentials 正确仔细的洗手方法集中在较脏和有污染的接触方面可研讨的内容 清洁的或日常的护理活动：处置静脉导管换输液瓶丈量血压丈量口腔温

30、度扶病人坐起静脉注射、肌肉注射口服药物便利的洗手 实 践 和 重 点有污染的或较脏的护理活动：感染或未感染的伤口污染的敷料尿液和粪便造瘘，气管切开病人较脏皮肤接触时间很长粘膜必需洗手 Finger print results of Phase 1Scanty: 150Fingerprint cultures of ICN and ward nurses after CCAs, (trained)ICHE CDC Dicennial 2000CCA roundsTotal+ finger print #Bed making 61 (Pseudo spp)Temp taking 41 (Flavo

31、 spp)BP taking 41 (Flavo spp)IV injections 1-Oral medication 51 (Pseudo spp) Total 20 * 4* 50% of these in cubicles of MRSA patients but no fingerprints grew MRSA# All were positive for skin flora and 4 mix with scanty pathogens listedFingerprint results Phase 2Ward nurses doing CCA rounds after tra

32、ining providedModify traditional functional horizontal modelResearch potentials 修正橫向方式Change to Vertical直向方式planned patient centered careResearch potentials Example: 15 acute hospitals 2126 patientsChange IV bottle Give IV injection Subcutaneous injection IM injectionGive oral medications Blood pressure Take temperature Collect sputum specimenPerform haemstix testMe