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1、120072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )1 1手部卫生与感染手部卫生与感染 吴安华(dr_) 中南大学湘雅医院感染控制中心 湖南省医院感染管理质量控制中心 卫生部医院感染监控管理培训基地20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )2 2The title of the Global Patient Safety Challenge for The title of the Global Patient Safety Challenge for 2005 to 2006 is “Cl
2、ean Care is Safer Care“.2005 to 2006 is “Clean Care is Safer Care“.Countries will be invited to adopt this challenge for their own health care systems with the following main principles: formally assessing the scale and nature of health care-associated infection within the health care system; adopti
3、ng an internationally recognized approach to surveillance of the problems so that current baseline incidence of infection can be established and change can be monitored; conducting an analysis of the root causes of the problem with particular emphasis on “systems thinking”; developing solutions to i
4、mprove safety and reduce risk by focusing on five action areas in particular: clean hands 清洁手 clean practices 清洁操作 clean products 清洁产品 clean environment 清洁环境 clean equipment 清洁设备 relying on evidence-based best practice in all aspects of addressing the challenge; fully engaging patients and service u
5、sers as well as health care professionals in improvement and action plans; ensuring the sustainability of all action beyond the initial two-year Challenge period. 20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )3 3IgnazIgnaz SemmelweisSemmelweis, , 18151815- -18651865 1840s: General Hospital of Vie
6、nna Divided into two clinics, alternating admissions every 24 hours: First Clinic: Doctors and medical students Second Clinic: Midwives0246810121416Maternal mortality, 1842First ClinicSecond Clinic手卫生手卫生: : 不是新概念不是新概念Maternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1
7、841-18500246810121416181841184218431844184519461847184818491850Maternal Mortality (%)MDsMidwivesSemmelweis Hand Hygiene Intervention Hand antisepsis reduces the frequency of patient infections Adapted from: Hosp Epidemiol Infect Control, 2ndEdition, 1999.20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医
8、院) )5 5皮肤正常菌群皮肤正常菌群 Nail flora: skin flora + dust containing fungi Neither profuse sweating nor washing significantly modifies normal skin flora Soap or disinfectant (hexachlorophene) diminish microbial population 30 second scrubbing Soap: physically removes organisms Disinfectants: bactericidal But
9、 flora rapidly replenished from sebaceous and sweat glands Pathogenic organisms eliminated (?) Re-exposure needed to colonize Nosocomial infections dramatically diminished or eliminated20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )6 6Humans sheds # 300,000,000 squames/day (4 to 25 mm) able to car
10、ry bacteriaSkin Hand FloraSkin Hand Flora RESIDENT FLORA Survives on the skin more than 24 hours Not easily removed, hours of scrubbing Complete sterilization impossible Low virulence Staphylococci, diphteroides mostly Gram + very few Gram -TRANSIENT FLORA Survive on skin less than 24 hours Easily r
11、emoved with soap and water Acquired during contacts with contaminated areas mouth, nose, perineal area, genitals, anal area Catheter, bedpan, urinal, patient care casual contact May have high virulence Enterobacteria, Gram - bacilli, Pseudomonas.220072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )7 7定
12、植与感染定植与感染定植与感染定植与感染, , , ,差别在哪里差别在哪里差别在哪里差别在哪里? ? ? ? People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized If an infection develops, it is usually from bacteria that colonize patients Bacteria that colonize patients can be transmitted from o
13、ne patient to another by the hands of healthcare workers Bacteria can be transmitted even if the patient is not infected InfectedColonized20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )8 8在手和环境表面发现VRE? Up to 41% of healthcare workers hands sampled (after patient care and before hand hygiene) were
14、positive for VRE1? VRE were recovered from a number of environmental surfaces in patient rooms? VRE survived on a countertop for up to 7 days21Hayden MK, Clin Infect Diseases 2000;31:1058-1065.2 Noskin G, Infect Control and Hosp Epidemi 1995;16:577-581.20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院)
15、 )9 9手卫生的最重要的理由? 1. 去污2. 防止医院感染3. 防止细菌从医院到家庭4. 防止细菌从家庭到医院20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )1010What you cannot see can What you cannot see can cause cause foodbornefoodborne illness.illness.Hepatitis A Norovirus (Norwalk virus) Shigella spp. Shiga toxin-producing Escherichia coli Salm
16、onella Typhi Staphylococcus aureus手卫生不良传播手卫生不良传播手卫生不良传播手卫生不良传播 的食源性疾病的食源性疾病的食源性疾病的食源性疾病20072007- -3 3- -2020吴安华吴安华( (中南大学湘雅医院中南大学湘雅医院) )1111不是每个医务人员都知道手上有哪些细菌护士、医师和其他医务人员做一个简单的操作都可能 增加手上的细菌100-1000个，如护士、医师和其他医务人员做一个简单的操作都可能 增加手上的细菌100-1000个，如把病人从床上扶起来把病人从床上扶起来测量血压或脉搏测量血压或脉搏接触病人的手接触病人的手给病人翻身给病人翻身接触病人衣服或床单接触病人衣服或
