Nosocomial Infection ----Prevention and control

1. Nosocomial Infection----Prevention and control Wang kefang（王克芳） kefangwang@126.com

2. 你知道吗？ 从2008年起，10月 15日是个____日吗? 10月 15日是“国际洗手日” 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＞

3. 3 Hand Hygiene Clean Hands are Safer Hands SAVE LIVES: Clean Your Hands

4. 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

5. 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。

6. Today’s topics • Why is hand hygiene important for health care workers(HCWs)? • When should hand hygiene be performed? • How to perform hand hygiene?

7. Hand Washing HabitsHow often do you wash your hands ……(Americans,2005 ) – Total Sample – After petting a dog or cat 42%(16%) After using the Bathroom in your home 83%(10%) Always wash my hands (Usually wash my hands) Before handling Or eating food 77%(14%) After changing a diaper 73%(4%) After coughing or sneezing 32%(23%) After handling Money 21%(18%) After using a public restroom 91%(6%)

8. Why is hand hygiene important? 1 • Germs are present on patient skin and surfaces in the patient surroundings

9. 人体不同部位皮肤细菌量 • 头皮：1 x 106 CFUs/cm2 • 腋窝：5 x 105 CFUs/cm2 • 腹部：4 x 104 CFUs/cm2 • 前臂： 1 x 104 CFUs/cm2 • HCW的手：3.9 x 104～4.6 x 106 CFUs/cm2

10. Percent of Patients with MRSA （耐甲氧西林金黄色葡萄球菌） 腋下 13-25% 40% 30-39% 手、手腕 腹股沟

11. Why is hand hygiene important? 2 • By direct and indirect contact, patient germs contaminate health-care workers' hands • Germs survive and multiply on health-care workers' hands

12. 某位护士的手印 培养24小时后

13. 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

14. Why is hand hygiene important? 3 Defective hand cleansing results in hands remaining contaminated

15. Intervention May 15, 1847 First Second Maternal Mortality Rates Hand Hygiene: Not a New Concept 18 16 14 12 10 Percentage 8 6 4 2 0 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 Semmelweis IP, 1861

16. Impact of hand hygiene promotion

17. Evidences… Hand hygiene is the single most effective measure to reduce HCAIs • Protect the patient，and Protect yourself

18. When should hand hygiene be performed?

19. Your 5 Moments for Hand Hygiene

20. UseWhatto 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

21. Time After Disinfection % log 0 60 180 minutes 99.9 3.0 99.0 2.0 Alcohol-based handrub (70% Isopropanol) Bacterial Reduction 90.0 1.0 Antimicrobial soap (4% Chlorhexidine) 0.0 0.0 Plain soap Baseline Ability of Hand Hygiene Agents to Reduce Bacteria on Hands

22. Solid Soap Contamination of 63 Hospitals × 1×104-5个/g 1×106-7个/g

23. 消毒液浸泡： 错误的手消毒方法

24. Handwashing with soap and water when hands are visibly dirty or following visible exposure to body fluids Adoption of alcohol-based handrub is the gold standard in all other clinical situations

25. How to perform hand hygiene?如何进行手卫生？

27. Right palm over left dorsum with interlaced fingers and vice versa Palm to palm fingers interlaced Palm to palm Six Steps Hand Hygiene Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa Backs of fingers to opposing palms with fingers interlocked Rotational rubbing of left thumb clasped in right palm and vice versa

28. HandwashingRub hands together for at least 15 seconds 40-60秒

29. handrubbing 20-30秒

30. 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 Handrubbing20–30 seconds

31. Hand Hygiene Scenarios • Scenario 6a6b • Scenario 7a7b • Scenario 8a8b

32. 健康在你手中 请及时清洗你的双手

33. Contents Concepts Principals of Aseptic Technique Aseptic Techniques 教学目标 解释术语：无菌区、非无菌区、无菌物品 掌握无菌技术的原则 熟练掌握无菌技术的基本操作 4 Aseptic Technique

34. Concepts • Aseptic technique • the practices which prevent microorganisms invading human beings, sterile objects and areas from being contaminated during medical procedures and nursing interventions. Aseptic Technique

35. Principals of Aseptic Technique • Environment requirement • Staff preparation • Distinguish different areas • Item management • Aseptic concept during procedures Aseptic Technique

36. Environment requirement • The environment should be clean, spacious, and disinfected routinely. • The Operating table is clean, dry, and flat and the layout is rational • stop cleaning the surroundings 30 minutes before the procedures, and minimize moving to prevent dust from floating. Aseptic Technique

37. Staff • Wearmask and cap, trim fingernails and perform hand hygiene before aseptic procedures. • Wearsterile gown and sterile gloves if necessary. Aseptic Technique

38. Distinguish different areas • Aseptic area • refers to the sterile area which has not been contaminated. • Non-aseptic area • is a non-sterilized area or an area having been sterilized but being contaminated again. • Aseptic supply • is an aseptic item physically or chemically sterilized. Aseptic Technique

39. Item management Aseptic supply is an aseptic item physically or chemically sterilized. • Place aseptic supplies and non-aseptic supplies separately and have distinct label. • Keep aseptic supply in sterile package or container. • Label sterile packages with name, expiration date accurately and store them according to expiration date. • Valid time • A set of aseptic supply is only for a client to use once. • 7 days (May 1 to October 1) • 14 days (October 1 to the next May 1) Aseptic Technique

40. During Procedures • Keep the body away from the aseptic area during procedures. • Face sterile area during procedures. • Use sterile transfer forceps to fetchsterile items • Keep hands and arms above the waist level. Aseptic Technique

41. During Procedures • Keep the body away from the aseptic area during procedures. • Face sterile area during procedures. • Use sterile transfer forceps to fetchsterile items • Keep hands and arms above the waist level. • Keep non-aseptic supplies awayfrom aseptic supplies. Once taken out of the container, aseptic supplies can not be put back even not be used. • No one should talk, laugh, cough or sneeze over a sterile field. • When in doubt about the sterility of a package, or consider it contaminated, then re-sterilize the items. Aseptic Technique

42. Aseptic Techniques • Apply Sterile Transfer Forceps • Apply Sterile Container • Use Sterile Package • Prepare Sterile Treatment Tray • Pour Sterile Solution • Don and Remove Sterile Gloves Aseptic Technique

43. Do you know how to protect yourself and others from infection? Isolation Do you know what to do if you come in contact with blood?

44. Concepts • Isolation • Using a variety of methods, techniques, and measures to prevent pathogens transmission from patients and carriers. • 采用各种方法、技术，防止病原体从患者及携带者传播给他人的措施。 卫生部医院隔离技术规范 2009 Isolation

45. Concepts • Clean area • the area not contaminated by pathogens • such as treatment room, Nutrition pantry and pharmacy. • Potentially-contaminated area • the area that is potentially contaminated by pathogens • like office, laboratory and disinfection room. • Contaminated area • the area contaminatedby pathogens which is in contact with clients directly and indirectly • such as ward, clients’ restroom and bathroom. Isolation

46. Isolation Principle • 在标准预防(Standard Precautions)的基础上，结合疾病的传播途径制定相应的隔离预防措施(Transmission-based precautions) 。 • 隔离病室应有隔离标志，并限制人员的出入。 Airborne Precautions Droplet Precautions Contact Precautions • 传染病/可疑传染病患者应安置在单人隔离房间。 • 受条件限制的医院，同种病原体感染的患者可安置于一室 • 建筑布局合理，符合有关规定。 卫生部医院隔离技术规范 2009

47. Isolation measures ----标准预防（Standard  Precautions） ----基于传播途径的隔离 （ Transmission-based precautions）

48. A quick recap how isolation precautions evolved over time

49. HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS

50. HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS contd--