13. National Patient Safety Goals, Hospital & Critical Access Hospital, 20097c. Prevent multiple drug-resistant organisms (MDRO) infections, especially methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile-associated disease (CDAD).
7d. Prevent catheter-associated BSI (CABSI)
7e. Prevent surgical site infections (SSI)
13a. Patient involvement in their care: respiratory & hand hygiene on day of admission – pt. & family
14. 美国National Patient Safety GoalNPSG.07.03.01-Implement evidence-based practices to prevent health care-associated infections due to multi-drug resistant organisms (MDRO). These organisms are not transmitted by air. They are spread by contact via hands or contaminated environment.
MRSA
C. difficile
VRE
MDR gram negative bacteria
15. Spread of MDROs Can Be Controlled By:Good infection control practices
Meticulous hand hygiene for contact with patient and patient’s environment of Standard Precautions
Good environmental and equipment cleaning practices
HCW knowledge regarding these organisms and how they are spread
Judicious use of antibiotics
Teaching patient and family
16. FIGHTSFollow isolation practices
In-service training for staff
Gauging disinfectant efficacy
Hand hygiene
Testing environmental surfaces
Standardized cleaning procedures
34. Pathogen Survival in the EnvironmentAdapted from: Kramer A, et al. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;16(6):130. Used with permission.OrganismDuration of persistence (range)Acinetobacter spp.3 days-5 monthsClostridium difficile (spores)5 monthsEscherichia coli1.5 hours-16 monthsEnterococcus spp, including VRE5 days-4 months Influenza virus1-2 daysNorovirus8 hours-7 daysStaphylococcus aureus, including MRSA7 days-7 months
35. DecontaminationRisk of infection by used items in healthcare
1968 Earle H Spaulding
Critical items:
Items that enter sterile tissue or vascular system
Semi-critical items
Items that come in contact with mucous membranes or non intact skin
Non-critical items
Items that come in contact with intact skin
36. 手频繁接触的物体表面,是高度危险的!
37. (本页无文本内容)
38. High-touch equals high-risk: surface cleaning plus hand hygiene key to HAI preventionWith the ever increasing proliferation of superbugs, comes not only a need for new products and protocols but also a look back at fundamental interventions.
"Hand hygiene and environmental cleaning and disinfection are the two primary interventions that we can make and those are definitely back to basics," said Sue Barnes, national leader, infection prevention and control and patient safety, Kaiser Permanente Program Offices, and a member of the National APIC communications committee.Healthcare Purchasing News, June, 2009
41. Removes organic soil / visible soil
Removes potentially infectious micro organisms
Removes soil which protects m.o. during disinfection
Careful cleaning
Mechanical energy - friction, flushing, scrubbing
Chemical products - detergents or enzymes
Right Method - manual & machinal
Manual Cleaning
42. Manual CleaningNO SAFE Products!
43.
Everybody is an “EXPERT”
Difficult to monitor
Responsibilities not clear
Health-risk
Manual CleaningNO SAFE Procedure!
44. Common in Households
Not Common in Healthcare settings
Easy to use
Standardization & Validation
Better Result
Saves Nursing Time
Monitoring
Thermal Disinfection Machinal CleaningMachinal Cleaning is Safer
45. 病区的基本配置:清洗消毒机
46. 日本尿壶与便盆的消毒
47. 关注频繁手接触物体表面的去污染
48. MICRO FIBER The “cleaner” cleaning system
49. 关东病院设备科-保养与维修
50. How Can We Evaluate Environmental Cleaning
Direct observation
Culture the environment
ATP bioluminescence Tool
Fluorescent marking tool03/26/2010TSICP50
51. TESTING OF SURFACES
52. ATP bioluminescence Swab surface luciferase tagging of ATP Hand held luminometerUsed in the commercial food preparation industry to evaluate surface cleaning before reuse and as an educational tool for more than 30 years.
53. ATP is present in blood, skin cells, other bodily fluids and microbes.
ATP存在于血液,皮肤细胞,
其它体液和微生物中。
54. Dazo Solution(Initially called “GOO”)
55. (本页无文本内容)
56. Baseline Environmental Evaluation of
36 Acute Care Hospitals% of Objects CleanedHospitalsMean = 48.5 %(20,056 Objects)
57. PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 ACUTE CARE HOSPITALS%
63. Low and Intermediate Level Disinfectants Use: non-critical items that will come in contact with intact skin
Low-level disinfectant: agent that destroys all vegetative bacteria (except tubercle bacilli), lipid viruses, some non-lipid viruses, and some fungi, but not bacterial spores
Intermediate-level disinfectant: agent that destroys all vegetative bacteria, including tubercle bacilli, lipid and some non-lipid viruses, and fungi, but not bacterial spores
HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.
65. Clean/disinfect:
On a regular basis,
When spills occur,
When visibly soiled
Follow manufacturers’ instructions for proper use:
use-dilution,
dwell time,
material compatibility,
storage,
shelf-life.
1:10 Bleach recommended for C. difficileCleaning & Disinfecting Non-critical Items
66. 2019/5/22Dr.HU Bijie66主动监测培养
67. Reservoir for Spread of Antibiotic Resistant PathogensClinical InfectionsColonized (Asymptomatic) Patients
79. Impact of 4% Chlorhexidine (CHG) Whole-Body Washing on Multidrug-resistant Acinetobacter baumannii (ACBA) Skin Colonisation-Patients in a MICUAll patients daily whole-body disinfection with CHG
Of 320 patients at admission, 55(17%)ACBA-positive skin swabs
Prevalence of ACBA skin colonisation among remaining patients was 5.5% at 24h and 1% at 48h (P=0.002,OR:2.4)
ACBA-BSIs decreased from 4.6 to 0.6 per 100 patients (P<0.001;OR:7.6)
Daily whole-body CHG disinfection significantly reduced ACBA skin colonisation and BSIs
82. Antibiotic StewardshipID Division
Infectious Diseases Specialist
Department of Pharmacy
Clinical Pharmacist
Health administration
Antibiotic Utilization Review Subcommittee
Electronic antibiotic stewardship
computerized antimicrobial approval system in a hospital setting
Education and interaction
Infection control professional