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Hand hygiene and infection control

The basic concept of hand washing:

Handwashing is the process of removing dirt and passenger microorganisms from your hands, including mechanical decontamination and chemical decontamination. Mechanical Decontamination: Washing hands with soap or detergent only. Rubbing the skin with a mechanical rubbing method to emulsify the skin fat, suspending microorganisms on the skin surface, And then wash the process of running water; chemical decontamination: the process of washing hands with antibacterial substances

Wash hands before and after meals

As the saying goes, "sickness from the mouth", in fact, the hand is the culprit, which acts as a means of transport between germs and mouth. Regular hand washing is good hygiene practice. Especially before eating is more essential. Urine is the body's waste, contains a variety of bacteria and parasite eggs. Parasitic eggs by the hand of the most easily transmitted by the mouth into the body, leading to ascariasis, enterobiasis, taeniasis and so on. Some diseases such as bacillary dysentery, acute enteritis, acute gastritis, and the occurrence and prevalence are also not closely related to the toilet.

First, hand hygiene needs to be improved

There are many infections and hand hygiene! SARS spread through the respiratory tract and close contact, and hand hygiene can prevent the spread of the disease. The main ways for human bird flu are to contact infected birds and virus-contaminated items, including poultry feces, feathers, respiratory secretions, internal organs and poultry infected with poultry manure Eggs, blood, etc .; crowded environment, poor ventilation and poor hand hygiene is an important factor in the epidemic of meningococcal disease. Hand sneezing, or hand touching the patient or carrier use items, may not be timely disinfection may be infected; Marburg - Ebola hemorrhagic fever, mainly in close contact with the spread, is currently not considered to spread through the droplets; and hands Department of Health-related other infectious diseases: typhoid fever, dysentery, cholera, hepatitis A, hemorrhagic fever, rotavirus diarrhea ... various parasitic diseases venereal disease, genitourinary tract infections.

Second, hand hygiene control evidence and philosophy

1 x 106 (CFUs) / cm2 Armpit: 5 x 105 (CFUs) / cm2 Abdomen: 4 x 104 (CFUs) / cm2 Forearm: 1 x 104 (CFUs) / cm2 Hands of HCW: 3.9 x 104 to 4.6 x 106 (CFUs) / cm2 Hand washing outside the hospital: Public health 26 interventions, 24 related studies, 76% in developing countries, 42% in communities, 42% in schools and 15% in households. Of the 15 studies on handwashing, only handwashing interventions were effective in controlling diarrhea. Hand skin bacteria type: temporary bacteria, the original skin does not exist, mainly by contact with the skin, in the skin surface or epidermal cells on the skin, because of the host and the surrounding environment, the type and quantity of bacteria are very different. And contact with the number of items, pollution and hand-washing habits related. Resident bacteria, boarding in the skin hair follicles and sebaceous glands openings, the type and quantity often constant, and more non-pathogenic, accounting for 10 to 20% of the total bacteria often inhabit the skin deep, soap rubbing brush is not easy to remove them clean, need to use chemistry Disinfectant to kill or inhibit it. Shanghai hospital outbreak of epidemic example: in 1999, a ward in Shanghai a small area of hospitalization prevalence of scabies; in 2000 a Shanghai hospital after a medical examination of vaginal candidiasis outbreaks; 2001 Shanghai hospital pediatric heart after 18 cases of pneumonia "" "" "" "" "" "" "" "" As Compare "" GE GE GE GE GE GE GE7078. "" "GE Gyran" "" "" "" "" "" "GE Gyran" "" "" "" "GE Gyran" "" "" "" "" "" GE Gyranically "" GE GE GE GE GE7070 "" "" "" "" "GEOTOTOT GE GE GEOOTHERSON GEOOTHERSON GE GEOOTHEROTOTOTOT7070 GE GE Organism" "" "" "" "" "" " Multidrug-resistant MDR has become a cardiologist for respiratory disease. The detection rate is: sputum specimens> other specimens, respiratory ICU> other ICU, tracheal intubation patients> other indwelling catheter patients. Reasons: anti-bacterial drugs and more anti-infective cycles, infection control weaknesses. Clinical scenario: A male, 45 years old, history of branch expansion for 20 years, cough with a large number of purulent sputum with fever admission, CT showed extensive cystic bronchiectasis in both lungs; a variety of antimicrobial agents ineffective treatment, body temperature rose to 39.5; again sputum culture Pseudomonas aeruginosa +++, only moderately susceptible to carbapenems, cefoperazone / sulbactam. How to deal with? What happened in the ICU with PDR-Acinetobacter baumannii? Amikacin R Gentamicin R Ampicillin + Sulbactam R Piperacillin + Tazobactam R Cefepime R Ceftazidime R Imipenem R Ciprofloxacin R TMPco R Against Ferocious MDR Infection Are you really ready? The reason for the increase of drug-resistant bacteria: The increase of drug-resistant bacteria (antibiotic selective pressure): Due to the excessive use of antibiotics by doctors, the drug-resistant bacteria with gene mutation and resistance gene transfer were screened, and the transmission of resistant bacteria increased: Cross-parasitism of bacteria in patients causes transmission of drug-resistant strains in the hospital through contact by medical staff, especially by hand, and subsequent transmission by host patients, where resistant bacteria spread in hospitals and even in communities.

1, nails

Nails are part of the "working platform" of hands. Artificial nails have been shown to cause bacterial colonization and infection (Pottinger J AJIC 1989). Long nails and artificial nails can easily cause damage to the gloves (Olsen RJ, JAMA 1993). Nail polish Baumgardner CS (AORN J 1983).

2, ring

Severe bacterial colonization is more prone to skin under the ring (Hoffman PN BMJ 1985). One study found that the ring was a risk factor for GNB (Hayes RA Abst 1333, 41st ICAAC, 2001), but no studies have shown that the ring is associated with infection.

Third, hand hygiene guidelines and evaluation

The simplest, most effective, the most convenient and most economical way to wash your hands, strict implementation of the correct rules of hand washing, reduce hospital infection by 20 to 30%.

1, the minister order: "hospital infection management approach"

Supporting technical specifications documents: "Endoscope disinfection technical specifications" "Stomatological disinfection technical specifications" "medical waste disposal" "antibacterial clinical application guidelines" "medical institutions hand hygiene guidelines" "hospital infection monitoring guidelines" "medical Air purification and disinfection of institutions guide "" Medical institutions isolation technology guide "" Clean Surgical Department of Infection Control Guide

2, hand hygiene facilities

General Hand Sanitation Facilities: Handwashing Mobile Handwashing Detergents Hand Disinfectant Faucet Switches Handwash Hand Towels or Hand Towels Handwashing Disinfection Facilities Handwash Non-Handy Faucets Handwash Brushes Hand Tools Disinfectant and Dispensers None Bastard clocks and watches

3, China's "Guide" to describe the general hand hygiene facilities

1, hand-washing water: mobile handwashing, water temperature to 30 ~ 40 ℃ appropriate, the appropriate water temperature can improve detergency, and increase the hand-washing and comfort. When the water temperature is too low, the sweat glands, hair follicles and sebaceous glands on the hand skin will be shut off, which will affect the bacteria removal and the quality of handwashing. At the same time, the handwashing water should be sufficient to ensure thorough and clean hand washing. 2, faucet: faucet to be located in the appropriate position in the sink, the switch is best for non-hand-touch. Taps should have hot and cold water and control handle, and can easily adjust the water temperature and water flow size. "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "") "" GE Marran "" "" Gyran GE Marian "" "GE GE GE GE GEO GEO7070 GEO" "" "" "" "" "" "" "" KM Marlick GEOFT "" " Soap should be in a clean container, the container should be regularly cleaned and disinfected or when changing the soap clean and disinfected or use a container. 4, hand disinfectant: At present, the most commonly used in hand skin disinfection of ethanol, chlorhexidine, iodophor, ethanol and chlorhexidine and benzalkonium bromide compound preparations, hand disinfectants should be in line with relevant state regulations product. 5, hand facilities: mainly in the following categories: (1) paper towels: is the best kind of dry hand method, simple, fast, no secondary pollution. (2) Dry cell phones: Use dry cell phones to avoid direct contact between the hands after cleaning and disinfection, hand towels and other dry items to reduce the risk of re-contamination, but more time-consuming, the machine itself is not easy to clean. (3) small towel: use more small towel, towel size to 30 cm × 30 cm or so, and have a certain thickness, good water absorption and solidity. Towels should be disinfected with one, and thoroughly cleaned before disinfection; easy to access places. The container containing the towel should be dry and clean; the container cover switch should be non-contact type such as foot-type. 6, Note: The number of hand hygiene facilities should be appropriate, the installation location should be convenient for medical staff to use.

4, medical staff's hand wash requirements

(A) Wash hands with running water so that both hands are fully wet; (b) Apply a proper amount of soap or soap and apply evenly to the entire palm, back, fingers and fingers; (c) Carefully rub hands for at least 15 seconds Wash your hands all the skin, wash your back, fingertips and finger joints, see the specific step after rubbing. (D) Rinse thoroughly with both hands and wipe dry.

5, concrete rubbing steps

1. palms relative, fingers close together, rub each other; 2. palms opponents along the back finger rub each other, exchange; 3. palm relative, hands and fingers rub each other; 4. right hand holding the left thumb rotation rub, exchange ; 5 bend fingers so that the joints in the other palm rotation rub, exchange; 6 will be five fingers close together on the other palm rotation rub, exchange; Wrist should be cleaned when the wrist may be contaminated.

Hand wash finger (general hand hygiene)

Direct contact with the patient

2. When the hands of medical staff were significantly contaminated or contaminated with blood, body fluids and protein substances;

3. contact between different patients or from the patient's body parts of the contaminated site to move to clean parts;

4. Before and after aseptic operation: before handling clean or sterile objects;

5. After handling contaminated items;

6. wear clothes before and after isolation, after picking gloves;

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8. contact before and after the wound;

9. Nursing special patients before and after;

Hand disinfection indications (general hand hygiene)

1, before aseptic operation: diagnosis, care, treatment of immunocompromised patients before;

2, before entering the isolation wards, intensive care unit, burn ward, neonatal intensive care unit and infectious ward and other key infections before and after leaving the isolation ward;

3, after contact with non-sterile equipment and equipment;

4, both hands directly for infectious patients check, treatment, care or treatment of contaminated infectious patients;

5, after contact with infectious, bloody, body fluids and secretions: contact with infectious pathogenic microorganisms contaminated items;

6, need both hands to maintain a long time antibacterial activity, if you need to wear sterile gloves;

Hand hygiene standards: Sensory control is another important error

Class I and II areas (laminar flow clean room, laminar flow clean room, general operating room, delivery room, baby room, premature baby room, general protective isolation room, supply room aseptic area, burn ward, intensive care unit, etc. ): ≤5cfu / cm2. Ⅲ area (pediatric ward, obstetrics and gynecology examination room, injection room, dressing room, treatment room, supply clean area, emergency room, laboratory, all kinds of common wards and rooms, etc.): ≤ 10cfu / cm2. Class Ⅳ area (infectious diseases and wards) ≤ 15cfu / cm2. The hands of medical personnel working in all regions shall not detect pathogenic microorganisms.

Hand disinfection effect monitoring method?

Monitoring methods: the fingers were disinfected hands after the five fingers together, soaked in a solution containing the appropriate neutralization solution of sterile cotton swab in the finger surface from finger to finger back and forth rubbed 2 times (one hand rub the area About 30cm2), and with the rub while rotating the cotton swab, and then use a sterilizing scissors to cut off the operator's hand contact parts, one end of the cotton swab into 10ml neutralizing agent corresponding sterile eluent test tube, rapping 200 Times, take 0.5ml, do plate pouring, 37 ℃, cultured 48h, observe the number of colonies. Monitoring time: disinfection before engaging in diagnosis and treatment operations. Surveillance department: The key surveillance departments of nosocomial infection, such as operating room, delivery room, all kinds of ICU, neonatal ward, various types of transplant wards, burn wards and general protective isolation ward. Monitoring frequency: the general situation once a quarter can be, when suspected of nosocomial infection, outbreak, should be promptly monitored.

Hand hygiene and hand washing

When you need to wash your hands: After touching your face, away from your ward, hospital or clinic, after taking off your gloves after touching blood, body fluids, secretions, excretions, mucous membranes, damaged skin, and contaminated objects and the environment , Before and after touching the patient, if there is no obvious pollution, alcohol hand rub instead of handwashing.

The advantages of hand washing

The only way to remove hand contamination is to use less common soap and water to stimulate the skin on the hand than other antimicrobial products.

Disadvantages of hand washing

Personnel poor compliance, hand skin irritation than alcohol wipe poor results, take a long time, need soap, water and towels dry. Other issues such as drip and other maintenance: wash, dry, repeated bottling.

Compliance research on hand washing

"You must wash your hands before touching all the patients 'mucous membranes or the damaged skin." The study found compliance <40%. Gloves must be worn before touching all patients' mucous membranes or the damaged skin. Observe the findings: 80-90% compliance.

1, the factors that affect the medical staff to wash their hands

GE GEOTorOVIOTOTOTOT GEOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOT GEASTSAST "" "" "" "" "" "" "" "" "" "" "KM" GE GE GE GE GE70 GEO70 "" "" KM Organ GE GEOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTOTHOTOTOT GEran "" "" "" "" "" "KM Marran" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" " Suspected of the lack of supply of handwash value, or irritation from the hands of the hand washing equipment, hand dry lack of technical manuals for handwashing, or supervisory management.

2, hand hygiene

It requires the work of all personnel involved, through the observation and establishment of compliance baseline, analysis of epidemiological data, the research results are fed back to all staff. Reward and punishment: assessment of performance.

3, under what circumstances must wash their hands

When the hand has obvious stains or looks like there is dirt when no other good method of choice is available.

4, the advantages of antibacterial products to wash their hands

Chlorhexidine, chlorinated meta-xylenol, for most microorganisms with a long-lasting antimicrobial effect, but with hexachlorophenol, triclosan antibacterial effect is relatively poor, but for skin irritation than iodophor, a bit similar Rubbing a single alcohol in hand, but better than ordinary hand-washing products (soap or soap).

5, under what circumstances need antibacterial products to wash their hands

When hands can be contaminated with microbial contaminants while alcohol can not be used, while alcohol and long-lasting antimicrobial actives can not be used for surgical disinfection.

Fourth, hand hygiene and alcohol rub hand

1, the advantages of alcohol rubbing hands

It is more effective than handwashing and handwashing with antibacterial products, less damaging than the handwashing of the hands, less waste than handwashing and gloves, less time consuming, fast acting, and less need for water and towels.

2, under what circumstances rubbed alcohol hand

"" "GE GE Organism" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "" "GE Organism" "" "" "" "" "" "GE GE GE GE GE GE" "" "".

3, the shortcomings of alcohol rubbing hands

Adding emollients to alcohol is costly: very important, religious restrictions restrict the use of alcohol, are flammable, may not be compatible with some lotions and antimicrobial handwashing products, and alcohol lacks long lasting activity.

Hand hygiene and gloves

1, the advantages of wearing gloves

Reduce the pathogen migration to the hand or from the hands of migrating out of the best way, if the normative to wear gloves and replacement, cost-effective, gloves, types, uses and more diverse materials to reduce the risk of two-way transmission of pathogens, significantly reduced needle needles The chance of breaking the skin to protect against infection of blood-borne diseases.

2, the disadvantage of wearing gloves

High cost, use is not standardized, there is no timely replacement of gloves and so on. Medical staff think gloves are just for

 

 

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