![User instructions (1) ,[object Object],[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Slides for education_session_low_res
Similar to Slides for education_session_low_res (20)
Recently uploaded
Recently uploaded (20)
Slides for education_session_low_res
- 1. Education Session for Trainers, Observers and Health-Care Workers
- 7. Through the promotion of best practices in hand hygiene and infection control, the First Global Patient Safety Challenge aims to reduce health care-associated infection (HCAI) worldwide
- 10. 121 countries committed to address HCAI 87% world population coverage Perspective as of 5 May 2009 Current status, August 2009
- 11. SAVE LIVES: Clean Your Hands 5 May 2009–2020 Through an annual day focused on hand hygiene improvement in health care, this initiative promotes continual, sustainable best practice in hand hygiene at the point of care in all health-care settings around the world Clean Care is Safer Care The First Global Patient Safety Challenge
- 12. Part 1 Definition, impact and burden of health care-associated infection
- 18. HCAI rates reported from developing countries WHO Guidelines on Hand Hygiene in Health Care (2009) 3.2–51.0 CR*-UTI 1.7–44.6 CR*-BSI 2.9–23.0 VAP 1.2–38.7 SSI 2.6–62.0 2.9–57.7 Neonatal ICU 18.2–90.0 4.1–38.9 18.4–77.2 Adult ICU 9.7–41.0 2.5–5.1 4.6–19.1 Hospital-wide Incidence (per 1000 device-days) Incidence (per 1000 patient-days) Incidence (%) Prevalence (%) Type of survey
- 19. Device-associated infection rates in ICUs in developing countries compared with NHSN rates * Overall (pooled mean) infection rates/1000 device-days INICC = International Nosocomial Infection Control Consortium; NHSN = National Healthcare Safety Network; PICU = paediatric intensive care unit; CLA-BSI = central line-associated bloodstream infection; VAP = ventilator-associated pneumonia; CR-UTI = catheter-related urinary tract infection. 1 Rosenthal V et al. Am J Infect Control 2008 2 NHSN report. Am J Infect Control 2008 † Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador, India, Kosova, Lebanon, Macedonia, Mexico, Morocco, Nigeria, Peru, Philippines, Turkey, Uruguay # Medical/surgical ICUs 3.1 2.3 1.5 / Adult ICU# NHSN, 2006–2007, USA 2 6.6 20.0 8.9 26,155 Adult ICU # INICC, 2002–2007, 18 developing countries† 1 5.0 2.1 2.9 / PICU NHSN, 2006–2007, USA 2 4.0 7.8 6.9 1,808 PICU INICC, 2002–2007, 18 developing countries† 1 CR-UTI* VAP* CLA-BSI* N° patients Setting Surveillance network, study period, country
- 21. Frequency and impact by type of HCAI (USA and EU) Bennett and Brachman's, Hospital Infections, 5th Edition 1,361 650 503 1,006 / / Urinary tract infection 12,034 7,904 2,920 9,969 5 27 Ventilator associated pneumonia 134,602 1,783 39,875 25,546 6.5 4.3 Surgical site infection 107,156 1,822 37,078 36,441 8.5 20 Bloodstream infection Maximum Minimum SD Mean (days) (%) Range Attributable Costs in US Dollars Average increased LOS Average attributable mortality HCAI Type
- 22. Most frequent sites of infection and their risk factors LOWER RESPIRATORY TRACT INFECTIONS Mechanical ventilation Aspiration Nasogastric tube Central nervous system depressants Antibiotics and anti-acids Prolonged health-care facilities stay Malnutrition Advanced age Surgery Immunodeficiency 13% BLOOD INFECTIONS Vascular catheter Neonatal age Critical care Severe underlying disease Neutropenia Immunodeficiency New invasive technologies Lack of training and supervision 14% SURGICAL SITE INFECTIONS Inadequate antibiotic prophylaxis Incorrect surgical skin preparation Inappropriate wound care Surgical intervention duration Type of wound Poor surgical asepsis Diabetes Nutritional state Immunodeficiency Lack of training and supervision 17% URINARY TRACT INFECTIONS Urinary catheter Urinary invasive procedures Advanced age Severe underlying disease Urolitiasis Pregnancy Diabetes 34% Most common sites of health care- associated infection and the risk factors underlying the occurrence of infections LACK OF HAND HYGIENE
- 23. Part 2 Major patterns of transmission of health care-associated germs with a particular focus on hand transmission
- 24. Major patterns of transmission of health care-associated germs (1) Examples of germs Transmission dynamics Reservoir / source Mode of transmission Staphylococcus aureus , Gram negative rods, respiratory viruses, HAV, HBV, HIV Direct physical contact between the source and the patient (person-to-person contact); e.g. transmission by shaking hands, giving the patient a bath, abdominal palpation, blood and other body fluids from a patient to the health-care worker through skin lesions Patients, health-care workers Direct contact
- 25. Major patterns of transmission of health care-associated germs (2) Examples of germs Transmission dynamics Reservoir / source Mode of transmission Salmonella spp, Pseudomonas spp, Acinetobacter spp, S. maltophilia, Respiratory Syncytial Virus Transmission of the infectious agent from the source to the patient occurs passively via an intermediate object (usually inanimate); e.g. transmission by not changing gloves between patients, sharing stethoscope Medical devices, equipment, endoscopes, objects (shared toys in paediatric wards) Indirect contact
- 26. Major patterns of transmission of health care-associated germs (3) Influenza virus, Staphylococcus aureus, Neisseria meningitidis , SARS-associated coronavirus Transmission via large particle droplets (> 5 µm) transferring the germ through the air when the source and patient are within close proximity; e.g. transmission by sneezing, talking, coughing, suctioning Patients, health-care workers Droplet Examples of germs Transmission dynamics Reservoir / source Mode of transmission
- 27. Major patterns of transmission of health care-associated germs (4) Mycobacterium tuberculosis, Legionella spp Propagation of germs contained within nuclei (< 5 µm) evaporated from droplets or within dust particles, through air, within the same room or over a long distance; e.g. breathing Patients, health-care workers, hot water, dust Airborne Examples of germs Transmission dynamics Reservoir / source Mode of transmission
- 28. Major patterns of transmission of health care-associated germs (5) Salmonella spp, HIV, HBV, Gram negative rods A contaminated inanimate vehicle acts as a vector for transmission of the microbial agent to multiple patients; e.g. drinking contaminated water, unsafe injection Food, water or medication Common vehicle Examples of germs Transmission dynamics Reservoir / source Mode of transmission
- 36. Part 3 Hand hygiene and prevention of health care-associated infection
- 40. Standard and isolation precautions (CDC, 2007) Standard Standard Standard Before and after patient contact, after contact with blood, body fluids, excretions, mucous membranes, non-intact skin, wound dressings, between a contaminated body site and a clean body site, after contact with objects in patient surroundings, after glove removal Hand hygiene Single room; door closed; negative pressure; 6–12 air changes/hour; appropriate discharge of air outdoors or air filtration Single room Single room Standard Patient room Airborne precautions Droplet precautions Contact precautions Standard precautions Features
- 41. Standard and isolation precautions (CDC, 2007) Standard Standard Standard; upon entering the room when contact with the patient or environmental surfaces is anticipated, or if the patient has diarrhoea, open wound drainage, secretions If contact with blood or body fluids is anticipated Isolation gown Standard Standard Upon entering the room; non-sterile, examination gloves Before contact with body fluids and contaminated items; non-sterile, examination gloves Gloves Airborne precautions Droplet precautions Contact precautions Standard precautions Features
- 42. Standard and isolation precautions (CDC, 2007) Fit-tested, NIOSH-approved N95 respirator when entering the room Mask upon entering the room; standard for eye protections Standard Before procedures likely to generate splashes or sprays of blood, body fluids, secretions or excretions Mask or face shield/ goggles Tuberculosis, smallpox. No recommendation on the type of mask to be used in case of measles, chickenpox. Meningitis, pertussis, influenza, mumps, rubella, diphtheria Multidrug-resistant bacteria (MRSA, VRE), Clostridium difficile , diarrhoea, RSV infection All patients, regardless of suspected or confirmed infectious status, in any setting where health-care is delivered Examples Airborne precautions Droplet precautions Contact precautions Standard precautions Features
- 43. Simple evidence… Hand hygiene is the single most effective measure to reduce HCAIs
- 44. Ignaz Philipp Semmelweis Pioneer of hand hygiene Vienna, Austria General Hospital, 1841–1850 Fighting puerperal fever
- 45. Maternal mortality rates, first and second obstetrics clinics, General Hospital of Vienna 0 2 4 6 8 10 12 14 16 18 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 Semmelweis IP, 1861 Percentage First Second Intervention May 15, 1847
- 47. Compliance with hand hygiene in different health-care facilities <40% Pittet and Boyce. Lancet Infectious Diseases 2001 48 Hospital-wide 1999 Pittet 32 Emergency Room 1994 Meengs 40 ICU 1993 Zimakoff 40 ICU 1992 Doebbeling 29 Neonatal Unit 1992 Larson 51 Surgical ICU 1991 Pettinger 81 ICU 1990 Dubbert 32 ICU 1990 Graham 30 Neonatal ICU 1987 Donowitz 45% Hospital-wide 1983 Larson 41% 28% ICU ICU 1981 Albert 16% 30% General Wards ICU 1981 Preston Compliance Sector Year Author
- 53. Handrubbing is the solution to obstacles to improve hand hygiene compliance 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
- 56. Part 4 WHO Guidelines on Hand Hygiene in Health Care and their implementation strategy and tools
- 59. Implementation strategy and toolkit for the WHO Guidelines on Hand Hygiene in Health Care Knowledge Action
- 68. Part 5 Why, when and how you should perform hand hygiene in health care
- 71. The golden rules for hand hygiene Hand hygiene must be performed exactly where you are delivering health care to patients (at the point-of-care) During health care delivery, there are 5 moments (indications) when it is essential that you perform hand hygiene (" My 5 Moments for Hand Hygiene " approach) To clean your hands, you should prefer handrubbing with an alcohol-based formulation, if available. Why? Because it makes hand hygiene possible right at the point-of-care, it is faster, more effective, and better tolerated. You should wash your hands with soap and water when visibly soiled You must perform hand hygiene using the appropriate technique and time duration
- 72. The geographical conceptualization of the transmission risk HEALTH-CARE AREA PATIENT ZONE Critical site with infectious risk for the patient Critical site with body fluid exposure risk
- 75. H Sax, University Hospitals, Geneva 2006 1 2 3 5 Another way of visualizing the patient zone and the contacts occurring within it
- 76. OPTIMAL HAND HYGIENE AT THE POINT-OF-CARE SHOULD BE PERFORMED
- 79. Examples of hand hygiene products easily accessible at the point-of-care
- 81. Your 5 Moments for Hand Hygiene Clean your hands before touching a patient when approaching him/her! To protect the patient against harmful germs carried on your hands! Clean your hands immediately before accessing a critical site with infectious risk for the patient! To protect the patient against harmful germs, including the patient’s own, entering his/her body! Clean your hands as soon as a task involving exposure risk to body fluids has ended (and after glove removal)! To protect yourself and the health-care environment from harmful germs! Clean your hands when leaving the patient’s side, after touching a patient and his/her immediate surroundings, To protect yourself and the health-care environment from harmful germs! Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving without having touched the patient! To protect yourself and the health-care environment against germ spread!
- 82. The 5 Moments apply to any setting where health care involving direct contact with patients takes place
- 89. How to handrub To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps. This takes only 20–30 seconds!
- 90. How to handwash To effectively reduce the growth of germs on hands, handwashing must last 40–60 secs and should be performed by following all of the illustrated steps.
- 91. Hand hygiene and glove use GLOVES PLUS HAND HYGIENE = CLEAN HANDS GLOVES WITHOUT HAND HYGIENE = GERM TRANSMISSION
- 97. It is now possible to improve hand hygiene in your facility! It’s your duty, to protect patients and yourself! You can make a change! Easy infection control for everyone… simple measures save lives!
- 98. Part 6 How to observe hand hygiene practices among health-care workers Observers should carefully read the “ Hand Hygiene Technical Reference Manual” before undergoing this training session
- 102. The “My 5 Moments for Hand Hygiene” approach
- 106. Coincidence of two indications Care activity Care activity Care activity Care activity
- 109. The observer point of view Compliance with hand hygiene (1) performed hand hygiene actions (x 100) -------------------------------------------- required hand hygiene actions (opportunities) COMPLIANCE
- 110. Coincidence of two indications Care activity Care activity Care activity Care activity
- 111. The observer point of view Compliance with hand hygiene (2) = 50% ? 1 hand hygiene action x 100 ----------------------------------------- 2 indications ? X X X
- 112. The observer point of view Compliance with hand hygiene (3) = 50% 1 hand hygiene action x 100 ----------------------------------------- 2 indications = 100% 1 hand hygiene action x 100 ----------------------------------------- 1 opportunity X X ? X X X X
Editor's Notes
- Central nervous system depressants
- Hand hygiene is considered the single most important measure to prevent HCAIs and the cross-transmission of pathogens. As a transversal measure, it is the key element of standard and isolation precautions and its importance is emphasized also in the most modern “bundle” approaches for the prevention of specific site infections such as catheter-related bloodstream infection (CR-BSI), urinary tract infection (CR-UTI) , surgical site infection (SSI), and ventilator-associated pneumonia (VAP).
- Hand hygiene is considered the single most important measure to prevent HCAIs and the cross-transmission of pathogens. As a transversal measure, it is the key element of standard and isolation precautions and its importance is emphasized also in the most modern “bundle” approaches for the prevention of specific site infections such as catheter-related bloodstream infection (CR-BSI), urinary tract infection (CR-UTI) , surgical site infection (SSI), and ventilator-associated pneumonia (VAP).
- Hand hygiene is considered the single most important measure to prevent HCAIs and the cross-transmission of pathogens. As a transversal measure, it is the key element of standard and isolation precautions and its importance is emphasized also in the most modern “bundle” approaches for the prevention of specific site infections such as catheter-related bloodstream infection (CR-BSI), urinary tract infection (CR-UTI) , surgical site infection (SSI), and ventilator-associated pneumonia (VAP).
- In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics located at the University of Vienna General Hospital. He observed that maternal mortality rates, mostly due to puerperal fever, were substantially higher in one clinic (first) compared to the other (second) (16% vs 7%). He also noted that physicians and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odor on their hands despite handwashing with soap and water before entering the clinic. He hypothesized therefore that “cadaverous particles” were transmitted via the hands of students and physicians and caused the puerperal fever. As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. Following the implementation of this measure, the mortality rate dropped dramatically to 3% in the clinic most affected (first).
- After 15-30 seconds only, handrubbing is significantly more efficient than handwashing with plain soap and water, to reduce hand bacterial contamination.
- Importance of an implementation strategy and practical tools: to translate knowledge and recommendations from the Guidelines into action at the bedside, with hand hygiene practices improvement and reduction of health care-associated infections.
- health care activity may be described as a succession of tasks during which health-care workers' hands touch different types of surfaces: the patient, his/her body fluids, objects or surfaces located in the patient surroundings and patients and surfaces within the health-care area. Each contact is a potential source of contamination for health-care workers' hands. Elements or areas that are involved in hand transmission of health care-associated germs: PATIENT: the transmission risk is especially related to critical sites. Critical sites can either correspond to body sites or medical devices that have to be protected against microorganisms potentially leading to HCAI (called critical sites with infectious risk for the patient) , or body sites or medical devices that potentially lead to hand exposure to body fluids and bloodborne pathogens (called critical sites with body fluid exposure risk). Both pre-cited risks may also occur simultaneously. Critical site with infectious risk for the patient: w here there is a risk of germs being inoculated into the patient during a care activity through contact with a mucous membrane, non-intact skin or an invasive medical device. Critical site with infectious risk for the health-care worker: w here there is a risk of potential or actual exposure to a patient’s blood or another body fluid for the health-care worker. PATIENT SURROUNDINGS: space temporarely dedicated to a patient, including all inanimate surfaces that are touched by or in direct physical contact with the patient (e.g. bed rails, bedside table, bed linen, cHCAIrs, infusion tubing, monitors, knobs and buttons, and other medical equipment). health-care ZONE: all those elements beyond the patient surroundings, which make up the care environment (other patients, objects, medical equipment and people present in a health-care facility, clinic or ambulatory setting). Therefore, focusing on a single patient, two virtual geographical areas can be identified from the “transmission risk point of view”, the patient zone (including the patient and his/her surroundings) and the health-care zone ( containing all surfaces outside the patient zone, i.e. all other patients and their surroundings and the health-care facility environment). Sax H, et al. “My 5 Moments for Hand Hygiene”: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007
- Point of care - refers to the place where three elements occur together: the patient, the health-care worker, and care or treatment involving patient contact. The concept refers to a hand hygiene product (e.g. alcohol-based handrub) which should be easily accessible to health-care workers by being as close as possible, e.g. within an arm’s reach (as resources permit) to where patient contact is taking place. Point of care products should be accessible without leaving the zone of care/treatment. This enables health-care workers to quickly and easily fulfill the 5 Moments for hand hygiene. The product must be capable of being used at the required moment, without leaving the zone of activity.
- First the following principles are to be remained: in no way does glove use modify hand hygiene indications or replace HH by rubbing or washing. There is no relation between indications for HH and indications for gloves, only some gestural implication to be managed
- When gloves must be done for a contact that bound a type of indication “before”, then HH action is expected immediately before glove donning and gloved hands should touch exclusively surfaces that require glove use When gloves must be removed after a contact that bound a type of indication “after”, then HH action is expected immediately after glove discard
- When gloves must be done for a contact that bound a type of indication “before”, then HH action is expected immediately before glove donning and gloved hands should touch exclusively surfaces that require glove use When gloves must be removed after a contact that bound a type of indication “after”, then HH action is expected immediately after glove discard
- Moreover, if an indication for hand hygiene applies when gloves are on, then gloves must be removed to perform hand hygiene as required, and changed if needed
- Bonne chance pour la restitution des résultats! L’équipe de swisshandhygiene
- - Indications for hand hygiene are the reasons to perform it whereas the opportunity corresponds to the number of time HH action is necessary. Reasons may be single or multiple at one time and from the observer point of view each indication must be formally detected and recorded at a give time. That means indications are not exclusive and multiple (one at least) indications may define one opportunity for HH
- An example that illustrates the coincidence of two indications defining one opportunity is when a health-care worker moves from one patient to another, which would normally imply different indications depending on the point of view of each patient: indication 4 (“after contact with patient A”) applies when the health-care workers leaves patient A to attend to patient B; and indication 1 (“before contact with patient B”) applies before the contact between the health-care worker and patient B.
- All indication combinations forming one opportunity may be observed and acceptable but one that should never been recorded: the combination of “after patient contact&quot; & &quot;after contact with patient surroundings”. The former involves the exclusion of any patient contact.
- An example that illustrates the coincidence of two indications defining one opportunity is when a health-care worker moves from one patient to another, which would normally imply different indications depending on the point of view of each patient: indication 4 (“after contact with patient A”) applies when the health-care workers leaves patient A to attend to patient B; and indication 1 (“before contact with patient B”) applies before the contact between the health-care worker and patient B.
- The example of indication overlapping illustrates the need for numerous detailed distinctions in order to calculate reliable results related to hand hygiene compliance. If indications are incorrectly mistaken for opportunities, then one performed hand hygiene action is counted for two indications. In this case it results in a false compliance of 50% because the denominator is not correct.
- The example of indication overlapping illustrates the need for numerous detailed distinctions in order to calculate reliable results related to hand hygiene compliance. If indications are incorrectly mistaken for opportunities, then one performed hand hygiene action is counted for two indications. In this case it results in a false compliance of 50% because the denominator is not correct.
- Before observing, the header information should be completed (date & period, location, start time of the session). After observing data should be complemented and checked. Period & session numbers may be completed at the data entry moment by the survey co-ordinator or the data manager.
- Determining the scope of observations should prevent most of selection bias of a direct method: why are observations conducted, where they should be made, who should be targeted? How many observations should be provided? In the Hand Hygiene Technical Reference Manual instructions and explanations are given to calculate the number of opportunities to be observed. Whatever large is the scope of observations, their results should represent an objective overview of health-care activities.