世界卫生组织全球手卫生行动-香港经验

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 1TWHFYKHDKCHMMRCQMHGHTYH2Introduction 介绍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大规模推广Part 5: Information to the public

2、 给公众的信息743 references 附註3The Core Group4Launch October 13, 20055Riyadh & GulfWHO, GenevaHong KongLondon, UKOttawa, CanadaBrisbaneHUG, GenevaLaunch October 13, 20056Hong Kong connected with Geneva香港与日内瓦7Hong Konglinked to WHO Headquarter,Geneva8910COUNTRIES PLEDGING AND IMPLEMENTING PARTS OF WHO HAND

3、 HYGIENE GUIDELINES - 6 PILOT SITES WORLDWIDE FOR GOLD STANDARD GPSC IMPLEMENTATION - GENEVA GPSC SUPPORT TEAM AND TOOLS - GLOBAL PATIENT SAFETY CHALLENGE (GPSC) PILOT SITESCOMPLEMENTARYCENTRALHUG 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网站全球黄金标准执行gpsc国家承诺和执行部分是谁的手部卫生准则11WHO tools a

4、nd 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试验地点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 & sustainability实施指南与可持续性Suite of

5、 tools (evaluation, education, promotion, technical)套装工具（评估，教育，推广，技术） On site visits (as necessary) 在实地考察（视需要） Access to all tools and resources (website and hard copies)获得所有的工具和资源（网站和硬拷贝） Limited WHO technical and financial support世卫组织有限公司技术和财政支持 Access to all tools and resources (website and hard

6、copies) Limited WHO Technical and financial supportAll Countries所有国家 Access to a range of tools and resources electronically via the GPSC website通过电子网站GPSC，获得一系列工具和资源，12WHO - Hand Hygiene Guidelines手卫生指南Hand HygieneSingle most important practice to prevent the transmission of infection 预防感染传播最重要的部份S

7、ingle most effective way to prevent Healthcare Associated Infections (HAI) 是预防医院感染的最有效的方法13The 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14Direct transition between 2 patients直接过渡到2例Opportunity机遇AFTER contact接触后，(indication 1) （说明1

8、）BEFORE contact )前后联系(indication 2（说明2 ）15Direct transition between 2 patientsOpportunity16Key Changes Needed in Hong Kong 关键的变化需要在香港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 formu

9、la 广泛的规定卫生组织公式5.Implement guideline as a evaluation center 实施准则作为评估中心17Time constraint = major obstacle for hand hygiene 时间限制=主要障碍对于手部卫生handwashinghand antisepsis 洗手1 to 1.5 minalcohol-basedhand rub 酒精擦手15 to 20 sec18Handwashing 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19Disinfectant soap消毒肥皂20Key Changes Needed in Hong KongAlcohol rub most of the timeNo mixing of hand washing and alcohol rubRemoval of disinfectant detergentBroad Provision of WHO formulaImplement guideli

11、ne as a evaluation center21How much do you pay for it ?Answer: 1.5 x the price in BostonNairobi, Kenya, Africa, January 200522Formulation 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.

12、0 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. 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: Isopro

13、pyl alcohol (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 formulation23配方 I 如果产品的最终浓度为：酒精80% (V/V), 甘油 1.45%, 二氧化氢 0.125%，则需要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

14、ml 二氧化氢 3% 41.7 ml 用蒸馏水或开水添到 1000.0毫升 配方 II 如果产品的最终浓度为： 异丙醇75% (V/V), 甘油1.45%, 二氧化氢 0.125%，则需要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2425About $4 HK a bottle2627Key Changes Needed in Hong KongAlcohol rub most of the timeNo

15、 mixing of hand washing and alcohol rubRemoval of disinfectant detergentBroad Provision of WHO formulaImplement guideline as a evaluation center2829Key Changes Needed in Hong KongAlcohol rub most of the timeNo mixing of hand washing and alcohol rubRemoval of disinfectant detergentBroad Provision of

16、WHO formulaImplement guideline as a evaluation cente30Conduct survey for (调查)present structures e. g. sink, paper towel, hand rub 设施情况Compliance of hand hygiene practice 依从性Initiate hand hygiene program in ALL health care settings hospital, GP clinic, OAH, TCM. 在所有的卫生保健机构中开展Develop a practical proto

17、col from the WHO guideline for local setting 当地的方案。Research for alternative hand hygiene paradigms to enhance compliance in Hong Kong 研究依从性4 prongs Strategy in Hong Kong31 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 b

18、oth 190.04 0.882. Glove 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) 32 Correlate (Spearman) with whether Mean % ward had

19、staff infected* p1. Mask 100 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

20、staff33ObjectiveTo explore the 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 compliance34MethodInfection control course participants to survey healthcare st

21、aff using a structured questionnaire 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 shifts35ResultsHospitals i

22、nvolved=14Staff surveyed=1285Specialties=133680%14%5%2%Hospitals surveyed =1437%Specialties surveyed distribution by %38STAFF TYPETYPES OF STAFF SURVEYED75%15%10%n=128539Hand hygiene performed in last working shiftHand hygiene opportunities40Hand hygiene performed HCANursesDoctors1-2055%21-3937%40-6

23、08%1-2024%21-3952%40-6024%1-2028%21-3964%40-6018% p=0.000 p=0.001 p=0.000 41Staff report their abilities to copeCoping abilitya, b, c differs significantly p=0.04abc42Percentage of time using AHROnly 17% are using frequently43selfothersCorrelation between self and others using AHR44percentageReasons

24、 for not using AHRWorry about skin45percentageReasons for using AHRAgree about efficiency46percentagePlacement of AHR47percentage43331932Number of sites with AHR4880712Types of soap usage49955% reporting AHR after hand washing50Summary of results50% of surveyed reporting 30 hand hygiene performed in

25、 last shiftDoctors has significantly lower HH performed among the 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 convenient51AHR is not available at each

26、 bed side (27%)Majority reported placing AHR at nurses station and 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 washingS

27、elf reporting on use of AHR correlate with reporting others practice52RecommendationsStaff 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

28、 AHRPromote pocket size AHR for staff convenienceReplace medicated soap with plain soap53Conduct survey for (调查)present structures e. g. sink, paper towel, hand rub 设施情况Compliance of hand hygiene practice 依从性Initiate hand hygiene program in ALL health care settings hospital, GP clinic, OAH, TCM. 在所有

29、的卫生保健机构中开展Develop a practical protocol from the WHO guideline for local setting 当地的方案。Research for alternative hand hygiene paradigms to enhance compliance in Hong Kong 研究依从性4 prongs Strategy in Hong Kong54Conscientious Approach in Hand WashingConcentrate on dirty and contaminated contactsResearch p

30、otentials 55 正确认真的洗手方法集中在较脏和有污染的接触方面可研究的内容 清洁的或日常的护理活动：处理静脉导管换输液瓶测量血压测量口腔温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须洗手56 Finger print results of Phase 1Scanty: 150Fingerprint cultures of ICN and ward nurses after CCAs, (trained)ICHE CDC Dicennial 200057

31、CCA roundsTotal+ finger print #Bed making 61 (Pseudo spp)Temp taking 41 (Flavo 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 pat

32、hogens listedFingerprint results Phase 2Ward nurses doing CCA rounds after training provided58Modify traditional functional horizontal modelResearch potentials 修改橫向模式59Change to Vertical直向模式planned patient centered careResearch potentials 60Example: 15 acute hospitals 2126 patientsChange IV bottle Give IV injection Subcutaneous injection IM injectionGive oral medications Blood pressure Take temperature Collect sputum specimenPerform haemstix testMeasur