世界衛(wèi)生組織全球手衛(wèi)生行動(dòng)-香港經(jīng)驗(yàn)(文件)
【正文】 surveyed reporting using medicated soap ?Most do not use AHR after hand washing ?Self reporting on use of AHR correlate with reporting others practice Remendations ? Staff are very concern about skin damage ? It is important to choose a skin friendly AHR ? Education to convince about the skin friendlyness of AHR ? Most are convinced that AHR is more convenient ? Promote multilocation for AHR ? Promote pocket size AHR for staff convenience ? Replace medicated soap with plain soap 1. Conduct survey for (調(diào)查 ) ? present structures e. g. sink, paper towel, hand rub 設(shè)施情況 ? Compliance of hand hygiene practice 依從性 2. Initiate hand hygiene program in ALL health care settings –hospital, GP clinic, OAH, TCM.. 在所有的衛(wèi)生保健機(jī)構(gòu)中開展 3. Develop a practical protocol from the WHO guideline for local setting 當(dāng)?shù)氐姆桨浮? 4. Research for alternative hand hygiene paradigms to enhance pliance in Hong Kong 研究依從性 4 prongs Strategy in Hong Kong Conscientious Approach in Hand Washing Concentrate on dirty and contaminated contacts Research potentials 正確認(rèn)真的洗手方法 集中在較臟和有污染的接觸方面 可研究的內(nèi)容 清潔的或日常的護(hù)理活動(dòng)： 處理靜脈導(dǎo)管 換輸液瓶 測(cè)量血壓 測(cè)量口腔溫度 扶病人坐起 靜脈注射、肌肉注射 口服藥物 便利的洗手 實(shí) 踐 和 重 點(diǎn) 有污染的或較臟的護(hù)理活動(dòng)： 感染或未感染的傷口 污染的敷料 尿液和糞便 造瘺，氣管切開 病人較臟 皮膚接觸時(shí)間很長 粘膜 必須洗手 F i n g e rprint M o de ra t e he a vy M RS A F i n g e rprint S c a nt y M RS A T o ta l I CN s n=28 0 3 ( 11%) 3 ( 1 1 % ) W a rd s t a ff (c o nt ro l s ) n=154 33 (21 %) 21 (14%) 54 (35% ) Finger print results of Phase 1 Scanty: 50 cfu, Moderate: 50 150 cfu, Heavy 150 Fingerprint cultures of ICN and ward nurses after CCAs, (trained) ICHE CDC Dicennial 2023 CCA rounds Total + finger print Bed making 6 1 (Pseudo spp) Temp taking 4 1 (Flavo spp) BP taking 4 1 (Flavo spp) IV injections 1 Oral medication 5 1 (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 listed Fingerprint results Phase 2 Ward nurses doing CCA rounds after training provided Modify traditional functional ‘horizontal’ model Research potentials 修改橫向模式 Change to Vertical直向模式planned patient centered care Research potentials Example: 15 acute hospitals – 2126 patients ?Change IV bottle ?Give IV injection ?Subcutaneous injection ?IM injection ?Give oral medications ?Blood pressure ?Take temperature ?Collect sputum specimen ?Perform haemstix test ?Measure urine output ?Sit patient up ?Bed bath Total of 20237 procedures 970 nursing staff Average = times / staff If vertical = time / staff Reduction by 46% Clean Dirty 例子 : 15家急救醫(yī)院 – 2126名患者 ?換輸液瓶 ?靜脈注射 ?皮下注射 ?肌肉注射 ?口服藥物 ?血壓 ?測(cè)量體溫 ?收集痰液標(biāo)本 ?血紅素檢測(cè) ?測(cè)量尿量 ?扶病人坐起 ?床浴 總共 20237次操作 970名護(hù)士 平均 = /人 如果垂直護(hù)理 = /人 降低 46% 干凈 污染 Unobtrusive observation Staff specific feedback to affect behavioral change Radiofrequency Identification Research potentials RFID 射頻識(shí)別 Thank You 01020304050607080901 4 710 13 16 19 22 25 28 31 34StudyPercent ComplianceAverage How is our track record on handwashing in healthcare f
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