世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗課件

WHOHandHygieneInitiative–HongKongExperience世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗

WHOHandHygieneInitiative1TWHFYKHDKCHMMRCQMHGHTYHTWHFYKHDKCHMMRCQMHGHTYH2Introduction介紹Part1:Reviewofscientificdata科學資料Part2:Consensus共識建議recommendationsPart3:Outcome結果測量measurementsPart4:Promotinghandhygieneonalargescale大規(guī)模推廣Part5:Informationtothepublic給公眾的信息743references

附註Introduction介紹743references3TheCoreGroupTheCoreGroup4

LaunchOctober13,2005

5Riyadh&

GulfWHO,GenevaHongKongLondon,UKOttawa,CanadaBrisbaneHUG,GenevaLaunchOctober13,2005Riyadh&GulfWHO,GenevaHongK6HongKongconnectedwithGeneva香港與日內瓦HongKongconnectedwithGenev7HongKonglinkedtoWHOHeadquarter,GenevaHongKong8世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗9世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗10COUNTRIESPLEDGINGANDIMPLEMENTINGPARTSOFWHOHANDHYGIENEGUIDELINES-6PILOTSITESWORLDWIDEFORGOLDSTANDARDGPSCIMPLEMENTATION-GENEVAGPSCSUPPORTTEAMANDTOOLS-GLOBALPATIENTSAFETYCHALLENGE(GPSC)PILOTSITESCOMPLEMENTARYCENTRALHUGINFECTIONCONTROLTEAM擁抱

感染

控制

隊

試點中環(huán)互補性網站日內瓦gpsc支持團隊和工具6.pilol網站全球黃金標準執(zhí)行gpsc國家承諾和執(zhí)行部分是誰的手部衛(wèi)生準則COUNTRIESPLEDGINGANDIMPLEME11WHOtoolsandresourcestoaidcountryimplementation世衛(wèi)組織的工具和資源，以協(xié)助國家執(zhí)行PilotTestSites試驗地點PledgeCountries承諾國ComplementaryTestSites互補

測試地點Regionalworkshops區(qū)域研討會WHOtechnicalandfinancialsupport世衛(wèi)組織的技術和財政支持Implementationpack,including:執(zhí)行包，其中包括：

Guidetoimplementation&sustainability實施指南與可持續(xù)性Suiteoftools(evaluation,education,promotion,technical)套裝工具（評估，教育，推廣，技術）Onsitevisits(asnecessary)

在實地考察（視需要）

Accesstoalltoolsandresources(websiteandhardcopies)獲得所有的工具和資源（網站和硬拷貝）

LimitedWHOtechnicalandfinancialsupport

世衛(wèi)組織有限公司技術和財政支持Accesstoalltoolsandresources(websiteandhardcopies)LimitedWHOTechnicalandfinancialsupportAllCountries所有國家AccesstoarangeoftoolsandresourceselectronicallyviatheGPSCwebsite通過電子網站GPSC，獲得一系列工具和資源，WHOtoolsandresourcestoaid12WHO-HandHygieneGuidelines手衛(wèi)生指南HandHygieneSinglemostimportantpracticetopreventthetransmissionofinfection預防感染傳播最重要的部份SinglemosteffectivewaytopreventHealthcare AssociatedInfections(HAI)是預防醫(yī)院感染的最有效的方法WHO-HandHygieneGuidelines13The5indications

5跡象AFTERB-FLUID后乙液BEFORECLEAN/INVASIVE前清潔/侵入AFTERPAT后干什么BEFOREPAT前英保通AFTERPAT’sOBJECT后輕拍的對象The5indications5跡象AFTERB-14Directtransitionbetween2patients直接過渡到2例Opportunity機遇AFTERcontact接觸后，(indication1)（說明1）BEFOREcontact)前后聯系(indication2（說明2）Directtransitionbetween2pa15Directtransitionbetween2patientsOpportunityDirecttransitionbetween2pa16KeyChangesNeededinHongKong關鍵的變化需要在香港1.Alcoholrubmostofthetime擦酒精的大部分時間2.Nomixingofhandwashingandalcoholrub沒有混合洗手和酒精擦3.Removalofdisinfectantdetergent去除消毒洗滌劑4.BroadProvisionofWHOformula廣泛的規(guī)定衛(wèi)生組織公式5.Implementguidelineasaevaluationcenter實施準則作為評估中心

KeyChangesNeededinHongKon17Timeconstraint=majorobstacle

forhandhygiene

時間限制=主要障礙對于手部衛(wèi)生handwashinghandantisepsis洗手1to1.5minalcohol-basedhandrub酒精擦手15to20secTimeconstraint=majorobstac18?Handwashingwithsoapandwaterwhenhandsarevisiblydirty手有可見贓物?Adoptionofalcohol-basedhandrubisthegoldstandardinallotherclinicalsituations,wheneverpossible酒精液擦手?Handwashingwithsoapandwat19Disinfectantsoap消毒肥皂Disinfectantsoap消毒肥皂20KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenterKeyChangesNeededinHongKon21Howmuchdoyoupayforit?Answer:1.5xthepriceinBostonNairobi,Kenya,Africa,January2005Howmuchdoyoupayforit?Na22FormulationI

Toproducefinalconcentrationsofethanol80%(V/V),glycerol1.45%,hydrogenperoxide0.125%:Pourina1000ml+1.0mlgraduatedflask:?Ethanol95%V/V842.0ml?Humectant-likesubstance:glycerol14.5ml?Hydrogenperoxide3%41.7mlTopupto1000.0mlwithdistilledorboiledwater.FormulationII

Toproducefinalconcentrationsofisopropylalcohol75%(V/V),glycerol1.45%,hydrogenperoxide0.125%:Pourina1000ml+1.0mlgraduatedflask:?Isopropylalcohol(withapurityof99,8%)751.5ml?Humectant-likesubstance:glycerol14.5ml?Hydrogenperoxide3%41.7mlTopupto1000.0mlwithdistilledorboiledwater.WHOformulationFormulationIWHOformulation23配方I

如果產品的最終濃度為：酒精80%(V/V),甘油1.45%,二氧化氫0.125%，則需要將下類物質倒入一支1000毫升有刻度的燒瓶中:?乙醇95%V/V842.0ml?保濕劑物質:甘油14.5ml?二氧化氫3%41.7ml用蒸餾水或開水添到1000.0毫升配方II

如果產品的最終濃度為：

異丙醇75%(V/V),甘油1.45%,二氧化氫0.125%，則需要將下類物質倒入一支1000毫升有刻度的燒瓶中:?異丙醇(純度為99,8%)751.5毫升?保濕劑物質:甘油14.5ml?二氧化氫3%41.7ml用蒸餾水或開水添到1000.0毫升.世界衛(wèi)生組織的酒精類手消毒液配方配方I世界衛(wèi)生組織的酒精類手消毒液配方24世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗25About$4HKabottleAbout$4HKabottle26世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗27KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenterKeyChangesNeededinHongKon28世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗29KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenteKeyChangesNeededinHongKon30Conductsurveyfor(調查)presentstructurese.g.sink,papertowel,handrub設施情況Complianceofhandhygienepractice依從性InitiatehandhygieneprograminALLhealthcaresettings–hospital,GPclinic,OAH,TCM..

在所有的衛(wèi)生保健機構中開展DevelopapracticalprotocolfromtheWHOguidelineforlocalsetting當地的方案。ResearchforalternativehandhygieneparadigmstoenhancecomplianceinHongKong研究依從性4prongsStrategyinHongKongConductsurveyfor(調查)4prong31

Correlate(Spearman)withwhether

Mean(%)

wardhadstaffinfected

p1.Mask 99 0.150.53N95 55 0.23 0.36Surgical 250.060.80both 19 0.04 0.882.Glove 90 0.48 0.853.Gown 81 0.05 0.854.Faceshield 61 0.09 0.725.Goggles 46 0.18 0.476.Cap 76 0.20 0.437.Shoes-cover 15 0.02 0.928.Handwash 97 0.09 0.74

Survey9.SARSPatientdurationofstay0.56 0.010

inward(m=13.3days)

32

Correlate(Spearman)

withwhether

Mean%

wardhadstaffinfected*

p1.Mask 100 N95 41 0.11 0.63Surgical 200.100.66both 39 0.25 0.302.Glove91 0.29 0.223.Gown 99 0.15 0.534.Faceshield 69 0.12 0.625.Goggles 46 0.13 0.606.Cap 92 0.27 0.247.Shoes-cover7 0.22 0.358.Handwash(b) 65 0.00 0.99Handwash(a) 78 0.030.90ObservePractices*34infectedstaff Correlate(Sp33ObjectiveToexploretheextendofalcoholhandrub(AHR)useinHKTofindoutthereasonsofpreferenceandnon-preferenceTofindoutthehandhygieneperformanceindifferencestaffgroupTocorrelateworkloadandcomplianceObjective34MethodInfectioncontrolcourseparticipantstosurveyhealthcarestaffusingastructuredquestionnaireWardsarerandomlyselectedfromdifferentspecialtiesStafftypesarestratifiedtoincludefront-linehealthcareworkerssuchasdoctors,nurses,andhealthcareassistantsStaffarethenrandomlyselectedfromthedutyrosterofAm&PmshiftsMethod35ResultsHospitalsinvolved = 14Staffsurveyed = 1285Specialties = 13Results3680%14%5%2%Hospitalssurveyed=1480%14%5%2%Hospitalssurveyed=37%Specialtiessurveyed–distributionby%%Specialtiessurveyed–distri38STAFFTYPETYPESOFSTAFFSURVEYED75%15%10%n=1285STAFFTYPETYPESOFSTAFFSURVE39HandhygieneperformedinlastworkingshiftHandhygieneopportunitiesHandhygieneperformedinlast40HandhygieneperformedHCANursesDoctors1-20 55%21-39 37%40->60 8%1-20 24%21-39 52%40->60 24%1-20 28%21-39 64%40->60 18%

p=0.000p=0.001

p=0.000HandhygieneperformedHCANurs41StaffreporttheirabilitiestocopeCopingabilitya,b,cdifferssignificantlyp=0.04abcStaffreporttheirabilitiest42PercentageoftimeusingAHROnly17%areusingfrequentlyPercentageoftimeusingAHROn43selfothersCorrelationbetweenselfandothersusingAHRselfothersCorrelationbetween44percentageReasonsfornotusingAHRWorryaboutskinpercentageReasonsfornotusin45percentageReasonsforusingAHRAgreeaboutefficiencypercentageReasonsforusingAH46percentagePlacementofAHRpercentagePlacementofAHR47percentage43331932NumberofsiteswithAHRpercentage43331932Numberofsi4880712Typesofsoapusage80712Typesofsoapusage49955%reportingAHRafterhandwashing955%reportingAHRafterhand50Summaryofresults50%ofsurveyedreporting>30handhygieneperformedinlastshiftDoctorshassignificantlylowerHHperformedamongthe3groupsSignificantlyhigher%ofDoctorsreported‘abletocope’Lessthan20%reportinguseAHRfrequentlyMostreportingnotusingAHRbecauseconcernofskindamageMostagreedAHRbecauseitisconvenientSummaryofresults51AHR

isnotavailableateachbedside(27%)MajorityreportedplacingAHRatnurses’stationandcubiclesOnly4%reportedpocketsizeAHR11(1%)reportednotavailableintheclinicalarea3%reportedmorethanonebottleateachpatient’sbedside80%ofsurveyedreportingusingmedicatedsoapMostdonotuseAHRafterhandwashingSelfreportingonuseofAHRcorrelatewithreportingotherspracticeAHRisnotavailableateachb52RecommendationsStaffareveryconcernaboutskindamageItisimportanttochooseaskinfriendlyAHREducationtoconvinceabouttheskinfriendly-nessofAHRMostareconvincedthatAHRismoreconvenientPromotemulti-locationforAHRPromotepocketsizeAHRforstaffconvenienceReplacemedicatedsoapwithplainsoapRecommendations53Conductsurveyfor(調查)presentstructurese.g.sink,papertowel,handrub設施情況Complianceofhandhygienepractice依從性InitiatehandhygieneprograminALLhealthcaresettings–hospital,GPclinic,OAH,TCM..

在所有的衛(wèi)生保健機構中開展DevelopapracticalprotocolfromtheWHOguidelineforlocalsetting當地的方案。ResearchforalternativehandhygieneparadigmstoenhancecomplianceinHongKong研究依從性4prongsStrategyinHongKongConductsurveyfor(調查)4prong54ConscientiousApproachinHandWashingConcentrateondirtyandcontaminatedcontactsResearchpotentials

ConscientiousApproachinHand55

正確認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容

清潔的或日常的護理活動：處理靜脈導管換輸液瓶測量血壓測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踐和重點有污染的或較臟的護理活動：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間很長粘膜必須洗手集中在較臟和有污染的接觸方面可研究的內容清潔的或日常的護56

FingerprintresultsofPhase1Scanty:<50cfu,Moderate:50-150cfu,Heavy>150FingerprintculturesofICNandwardnursesafterCCAs,(trained)ICHECDCDicennial2000FingerprintresultsofPhas57CCArounds

Total

+fingerprint# Bedmaking 6 1(Pseudospp)Temptaking 4 1(Flavospp)BPtaking 4 1(Flavospp)IVinjections 1 -Oralmedication 5 1(Pseudospp)

Total20* 4*50%oftheseincubiclesofMRSApatientsbut

nofingerprintsgrewMRSA#Allwerepositiveforskinfloraand4mixwithscantypathogenslistedFingerprintresultsPhase2WardnursesdoingCCAroundsaftertrainingprovidedFingerprintresultsPhase2War58Modifytraditionalfunctional‘horizontal’modelResearchpotentials

修改橫向模式Modifytraditionalfunctional59ChangetoVertical直向模式plannedpatientcenteredcareResearchpotentials

ChangetoVertical直向模式planned60Example:15acutehospitals–2126patientsChangeIVbottleGiveIVinjectionSubcutaneousinjectionIMinjectionGiveoralmedicationsBloodpressureTaketemperatureCollectsputumspecimenPerformhaemstixtestMeasureurineoutputSitpatientupBedbathTotalof20217procedures970nursingstaffAverage=20.8times/staffIfvertical=9.5time/staff

Reductionby46%CleanDirtyExample:15acutehospitals–61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量體溫收集痰液標本血紅素檢測測量尿量扶病人坐起床浴總共20217次操作970名護士平均=20.8次/人如果垂直護理=9.5次/人

降低46%干凈污染例子:15家急救醫(yī)院–2126名患者換輸液瓶總共2062UnobtrusiveobservationStaffspecificfeedbacktoaffectbehavioralchangeRadio-frequencyIdentificationResearchpotentials

RFID射頻識別

UnobtrusiveobservationStaffs63ThankYouThankYou64AverageHowisourtrackrecordonhandwashinginhealthcarefacilities?AverageComplianceofPersonnelin(依從性情況)34StudiesofHandwashingAverageHowisourtrackrecord65KeyparametersforsuccessSystemchange系統(tǒng)的改變Administrativesupport行政支持Educationofhealth-careworkers教育Monitoringandfeedbackofperformance洗手行為的監(jiān)督和反饋Changeinbehaviour行為的改變Reductionincross-transmissionandinfectionrates下降感染率KeyparametersforsuccessSyst66SkinCareSelectlessirritatingproducts選擇非刺激的手衛(wèi)生產品

ReduceskinirritationNomixingofsoaphandwashandalcoholrubs

用酒精消毒液，不要同時使用抗菌肥皂

Wearinggloveswhilehandsarestillwet

濕的手不要穿手套

Providealternatives有替代的手衛(wèi)生產品

Usemoisturizingskincareproducts皮膚護理SkinCare67WHOHandHygieneInitiative–HongKongExperience世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗

WHOHandHygieneInitiative68TWHFYKHDKCHMMRCQMHGHTYHTWHFYKHDKCHMMRCQMHGHTYH69Introduction介紹Part1:Reviewofscientificdata科學資料Part2:Consensus共識建議recommendationsPart3:Outcome結果測量measurementsPart4:Promotinghandhygieneonalargescale大規(guī)模推廣Part5:Informationtothepublic給公眾的信息743references

附註Introduction介紹743references70TheCoreGroupTheCoreGroup71

LaunchOctober13,2005

72Riyadh&

GulfWHO,GenevaHongKongLondon,UKOttawa,CanadaBrisbaneHUG,GenevaLaunchOctober13,2005Riyadh&GulfWHO,GenevaHongK73HongKongconnectedwithGeneva香港與日內瓦HongKongconnectedwithGenev74HongKonglinkedtoWHOHeadquarter,GenevaHongKong75世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗76世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗77COUNTRIESPLEDGINGANDIMPLEMENTINGPARTSOFWHOHANDHYGIENEGUIDELINES-6PILOTSITESWORLDWIDEFORGOLDSTANDARDGPSCIMPLEMENTATION-GENEVAGPSCSUPPORTTEAMANDTOOLS-GLOBALPATIENTSAFETYCHALLENGE(GPSC)PILOTSITESCOMPLEMENTARYCENTRALHUGINFECTIONCONTROLTEAM擁抱

感染

控制

隊

試點中環(huán)互補性網站日內瓦gpsc支持團隊和工具6.pilol網站全球黃金標準執(zhí)行gpsc國家承諾和執(zhí)行部分是誰的手部衛(wèi)生準則COUNTRIESPLEDGINGANDIMPLEME78WHOtoolsandresourcestoaidcountryimplementation世衛(wèi)組織的工具和資源，以協(xié)助國家執(zhí)行PilotTestSites試驗地點PledgeCountries承諾國ComplementaryTestSites互補

測試地點Regionalworkshops區(qū)域研討會WHOtechnicalandfinancialsupport世衛(wèi)組織的技術和財政支持Implementationpack,including:執(zhí)行包，其中包括：

Guidetoimplementation&sustainability實施指南與可持續(xù)性Suiteoftools(evaluation,education,promotion,technical)套裝工具（評估，教育，推廣，技術）Onsitevisits(asnecessary)

在實地考察（視需要）

Accesstoalltoolsandresources(websiteandhardcopies)獲得所有的工具和資源（網站和硬拷貝）

LimitedWHOtechnicalandfinancialsupport

世衛(wèi)組織有限公司技術和財政支持Accesstoalltoolsandresources(websiteandhardcopies)LimitedWHOTechnicalandfinancialsupportAllCountries所有國家AccesstoarangeoftoolsandresourceselectronicallyviatheGPSCwebsite通過電子網站GPSC，獲得一系列工具和資源，WHOtoolsandresourcestoaid79WHO-HandHygieneGuidelines手衛(wèi)生指南HandHygieneSinglemostimportantpracticetopreventthetransmissionofinfection預防感染傳播最重要的部份SinglemosteffectivewaytopreventHealthcare AssociatedInfections(HAI)是預防醫(yī)院感染的最有效的方法WHO-HandHygieneGuidelines80The5indications

5跡象AFTERB-FLUID后乙液BEFORECLEAN/INVASIVE前清潔/侵入AFTERPAT后干什么BEFOREPAT前英保通AFTERPAT’sOBJECT后輕拍的對象The5indications5跡象AFTERB-81Directtransitionbetween2patients直接過渡到2例Opportunity機遇AFTERcontact接觸后，(indication1)（說明1）BEFOREcontact)前后聯系(indication2（說明2）Directtransitionbetween2pa82Directtransitionbetween2patientsOpportunityDirecttransitionbetween2pa83KeyChangesNeededinHongKong關鍵的變化需要在香港1.Alcoholrubmostofthetime擦酒精的大部分時間2.Nomixingofhandwashingandalcoholrub沒有混合洗手和酒精擦3.Removalofdisinfectantdetergent去除消毒洗滌劑4.BroadProvisionofWHOformula廣泛的規(guī)定衛(wèi)生組織公式5.Implementguidelineasaevaluationcenter實施準則作為評估中心

KeyChangesNeededinHongKon84Timeconstraint=majorobstacle

forhandhygiene

時間限制=主要障礙對于手部衛(wèi)生handwashinghandantisepsis洗手1to1.5minalcohol-basedhandrub酒精擦手15to20secTimeconstraint=majorobstac85?Handwashingwithsoapandwaterwhenhandsarevisiblydirty手有可見贓物?Adoptionofalcohol-basedhandrubisthegoldstandardinallotherclinicalsituations,wheneverpossible酒精液擦手?Handwashingwithsoapandwat86Disinfectantsoap消毒肥皂Disinfectantsoap消毒肥皂87KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenterKeyChangesNeededinHongKon88Howmuchdoyoupayforit?Answer:1.5xthepriceinBostonNairobi,Kenya,Africa,January2005Howmuchdoyoupayforit?Na89FormulationI

Toproducefinalconcentrationsofethanol80%(V/V),glycerol1.45%,hydrogenperoxide0.125%:Pourina1000ml+1.0mlgraduatedflask:?Ethanol95%V/V842.0ml?Humectant-likesubstance:glycerol14.5ml?Hydrogenperoxide3%41.7mlTopupto1000.0mlwithdistilledorboiledwater.FormulationII

Toproducefinalconcentrationsofisopropylalcohol75%(V/V),glycerol1.45%,hydrogenperoxide0.125%:Pourina1000ml+1.0mlgraduatedflask:?Isopropylalcohol(withapurityof99,8%)751.5ml?Humectant-likesubstance:glycerol14.5ml?Hydrogenperoxide3%41.7mlTopupto1000.0mlwithdistilledorboiledwater.WHOformulationFormulationIWHOformulation90配方I

如果產品的最終濃度為：酒精80%(V/V),甘油1.45%,二氧化氫0.125%，則需要將下類物質倒入一支1000毫升有刻度的燒瓶中:?乙醇95%V/V842.0ml?保濕劑物質:甘油14.5ml?二氧化氫3%41.7ml用蒸餾水或開水添到1000.0毫升配方II

如果產品的最終濃度為：

異丙醇75%(V/V),甘油1.45%,二氧化氫0.125%，則需要將下類物質倒入一支1000毫升有刻度的燒瓶中:?異丙醇(純度為99,8%)751.5毫升?保濕劑物質:甘油14.5ml?二氧化氫3%41.7ml用蒸餾水或開水添到1000.0毫升.世界衛(wèi)生組織的酒精類手消毒液配方配方I世界衛(wèi)生組織的酒精類手消毒液配方91世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗92About$4HKabottleAbout$4HKabottle93世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗94KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenterKeyChangesNeededinHongKon95世界衛(wèi)生組織全球手衛(wèi)生行動-香港經驗96KeyChangesNeededinHongKongAlcoholrubmostofthetimeNomixingofhandwashingandalcoholrubRemovalofdisinfectantdetergentBroadProvisionofWHOformulaImplementguidelineasaevaluationcenteKeyChangesNeededinHongKon97Conductsurveyfor(調查)presentstructurese.g.sink,papertowel,handrub設施情況Complianceofhandhygienepractice依從性InitiatehandhygieneprograminALLhealthcaresettings–hospital,GPclinic,OAH,TCM..

在所有的衛(wèi)生保健機構中開展DevelopapracticalprotocolfromtheWHOguidelineforlocalsetting當地的方案。ResearchforalternativehandhygieneparadigmstoenhancecomplianceinHongKong研究依從性4prongsStrategyinHongKongConductsurveyfor(調查)4prong98

Correlate(Spearman)withwhether

Mean(%)

wardhadstaffinfected

p1.Mask 99 0.150.53N95 55 0.23 0.36Surgical 250.060.80both 19 0.04 0.882.Glove 90 0.48 0.853.Gown 81 0.05 0.854.Faceshield 61 0.09 0.725.Goggles 46 0.18 0.476.Cap 76 0.20 0.437.Shoes-cover 15 0.02 0.928.Handwash 97 0.09 0.74

Survey9.SARSPatientdurationofstay0.56 0.010

inward(m=13.3days)

99

Correlate(Spearman)

withwhether

Mean%

wardhadstaffinfected*

p1.Mask 100 N95 41 0.11 0.63Surgical 200.100.66both 39 0.25 0.302.Glove91 0.29 0.223.Gown 99 0.15 0.534.Faceshield 69 0.12 0.625.Goggles 46 0.13 0.606.Cap 92 0.27 0.247.Shoes-cover7 0.22 0.358.Handwash(b) 65 0.00 0.99Handwash(a) 78 0.030.90ObservePractices*34infectedstaff Correlate(Sp100ObjectiveToexploretheextendofalcoholhandrub(AHR)useinHKTofindoutthereasonsofpreferenceandnon-preferenceTofindoutthehandhygieneperformanceindifferencestaffgroupTocorrelateworkloadandcomplianceObjective101MethodInfectioncontrolcourseparticipantstosurveyhealthcarestaffusingastructuredquestionnaireWardsarerandomlyselectedfromdifferentspecialtiesStafftypesarestratifiedtoincludefront-linehealthcareworkerssuchasdoctors,nurses,andhealthcareassistantsStaffarethenrandomlyselectedfromthedutyrosterofAm&PmshiftsMethod102ResultsHospitalsinvolved = 14Staffsurveyed = 1285Specialties = 13Results10380%14%5%2%Hospitalssurveyed=1480%14%5%2%Hospitalssurveyed=104%Specialtiessurveyed–distributionby%%Specialtiessurveyed–distri105STAFFTYPETYPESOFSTAFFSURVEYED75%15%10%n=1285STAFFTYPETYPESOFSTAFFSURVE106HandhygieneperformedinlastworkingshiftHandhygieneopportunitiesHandhygieneperformedinlast107HandhygieneperformedHCANursesDoctors1-20 55%21-39 37%40->60 8%1-20 24%21-39 52%40->60 24%1-20 28%21-39 64%40->60 18%

p=0.000p=0.001

p=0.000HandhygieneperformedHCANurs108StaffreporttheirabilitiestocopeCopingabilitya,b,cdifferssignificantlyp=0.04abcStaffreporttheirabilitiest109PercentageoftimeusingAHROnly17%areusingfrequentlyPercentageoftimeusingAHROn110selfothersCorrelationbetweenselfandothersusingAHRselfothersCorrelationbetween111percentageReasonsfornotusingAHRWorryaboutskinpercentageReasonsfornotusin112percentageReasonsforusingAHRAgreeaboutefficiencypercentageReasonsforusingAH113percentagePlacementofAHRpercentagePlacementofAHR114percentage43331932NumberofsiteswithAHRpercentage43331932Numberofsi11580712Typesofsoapusage80712Typesofsoapusage116955%reportingAHRafterhandwashing955%reportingAHRafterhand117Summaryofresults50%ofsurveyedreporting>30handhygieneperformedinlastshiftDoctorshassignificantlylowerHHperformedamongthe3groupsSignificantlyhigher%ofDoctorsreported‘abletocope’Lessthan20%reportinguseAHRfrequentlyMostreportingnotusingAHRbecauseconcernofskindamageMostagreedAHRbecauseitisconvenientSummaryofresults118AHR

isnotavailableateachbedside(27%)MajorityreportedplacingAHRatnurses’stationandcubiclesOnly4%reportedpocketsizeAHR11(1%)reportednotavailableintheclinicalarea3%reportedmorethanonebottleateachpatient’sbedside80%ofsurveyedreportingusingmedicatedsoapMostdonotuseAHRafterhandwashingSelfreportingonuseofAHRcorrelatewithreportingotherspracticeAHRisnotavailableateachb119RecommendationsStaffareveryconcernaboutskindamageItisimportanttochooseaskinfriendlyAHREducationtoconvinceabouttheskinfriendly-nessofAHRMostareconvincedthatAHRismoreconvenientPromotemulti-locationforAHRPromotepocketsizeAHRforstaffconvenienceReplacemedicatedsoapwithplainsoapRecommendations120Conductsurveyfor(調查)presentstructurese.g.sink,papertowel,handrub設施情況Complianceofhandhygienepractice依從性InitiatehandhygieneprograminALLhealthcaresettings–hospital,GPclinic,OAH,TCM..

在所有的衛(wèi)生保健機構中開展DevelopapracticalprotocolfromtheWHOguidelineforlocalset