2018.5.30

WHO-PDCA

http://www.ntuh.gov.tw/ifc/hhc

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http://www.who.int/gpsc/5may/tools/training_education/en/index.html

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http://www.who.int/gpsc/5may/tools/training_education/en/index.html

Care activity Care activity Care activity Care activity

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10646944

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106455 CDC 1065

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2016555

WHO-See Your Hands-hand hygiene supports safe surgical care

201632530201746944

CDC 20175

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3.0 0 60 180 minutes

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99.0

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Time After Disinfection

Baseline

Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

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en.wikipedia.org

1.Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

2. WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft ), 2006

60%80%

(MRSA)

(MDRAB)(VRE)

(HIV, HBV, HCV, influenza)

(Clostridium difficile)

Q:

1.

2.

17

0

2

4

6

Baseline 2 weeks

Alcohol rub Soap and water

15

20

25

30

Baseline 2 weeks

Alcohol rub Soap and water

Boyce J, Infect Control Hosp Epidemiol 2000;21(7):438-441.

Q: ?

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2.

3.

4.

Q1: A1: Q2:? A2: Q3: A3: Q4:()? A4:() Q5:()? A5:

n

94 65.2 16.9 16.9

(Hibiscrub) 725 64.6 18.3 16.7

94 73.0 13.5 13.5

725 68.7 20.7 10.5

94 65.2 18.0 16.9

725 54.3 18.1 27.5

n=170

n=473

n=82

4.7 13.5 5.1

(Hibiscrub) 4.7 22.0 11.5

13.0 33.9 21.8

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Stulz N.52.1

73.6

Hibiscrub

MDRAB

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4.

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25

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(1)

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~~WHY??

water-binding

28

29

conjunctivitis

Clin Exp Allergy 1997;27:167-174

Pediatr Emerg Care 1996 ;12:6-9

Int Arch Allergy Immunol. 2011 Jun 29;156(3):234-246.

natural rubber latex (NRL) medical gloves

stronger,

more flexible

better accepted by clinicians

powder-free gloves has been associated with reductions in

protein content and associated allergies.

The use of low-protein, low-allergenic, powder-free gloves is

associated with a significant decrease in the prevalence of

type I allergic reactions to NRL among healthcare workers.

http://www.youtube.com/watch?v=EwjDShmfFHM&feature=related

?

1.

2.

3.

4.(

)

1.() 2.

(Transmission-based Precaution)

(Standard Precautions)

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Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

2007

Guideline for Isolation Precautions in Hospitals. Am J Infect Control 1996;24:24-52

33

PPE

PPE PPE

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/

()

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Standard Precautions

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007

201426-37

()N95

(Personal Protective Equipment ,PPE)

(HCW)

Guideline for Isolation Precautions :Preventing Transmission of Infectious Agents in Healthcare Settings 2007 CDC

Avian Influenza, including Influenza A(H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care

Facilities. 10 May 2007

PPE?

()

(N95P100)

PPE

:

:

:

()

(IB)

(IC)

(IB)

(II)

IB

WHO Guidelines on Hand Hygiene in Health Care 2009.

1.

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3.

4.

5.TPN

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WHO Guidelines on Hand Hygiene in Health Care 2009.

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5.TPN

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IV

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135 ()

32(24.4%),7

86(63.7%)11

JAMA. 1993;270:350-353

Vinyl latex

glove leaks 26/61 6/70 P

PPE

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N95 0.3m95

6m90

6m80

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()

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N95

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N951

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(fit check)

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http://solutions.3m.com/wps/portal/3M/en_US/Health/Safety/Products/Catalog/?PC_7_RJH9U5230GE3E02LES9MG812H2_nid=8G2B3GV59

PbeF3RH7CD92Ngl

N95

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(fit check)

():

():

N95

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()

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CDC.(October 14,2009).Questions and Answers Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza among Healthcare Personnel. Available at

http://www.cdc.gov/h1n1flu/guidelines_infection_control_qa.htm.

(Fit Test)

hood method

the PortaCount Plus with N95

companion

From Taiwan CDC

:

The eye protection chosen for specific work situations (e. g., goggles or face shield)depends upon the circumstances of exposure(2007, CDC Guideline)

()

( )

**()

PPE

--

N95

N95

(Droplet Precautions)

()

1.(100cm)

2.

()

():

(Contact Precautions)

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