Microsoft Power Point - 1 Clean-care-safer-care Stefanus

8/8/2019 Microsoft Power Point - 1 Clean-care-safer-care Stefanus

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World Health Organisation


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Simple measuressave lives

The focus is onpreventing infection

associated withhealth care

www.who.int/patientsafety/events


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"Clean Care is Safer Care" Initiative

Objectives

Global Awareness- raising

Country commitment and campaigns

Development and Implementation of the WHOGuidelines on Hand Hygiene in Health Care


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Health care-acquired infection: the scale

At any time, over 1.4 million people worldwide are suffering frominfections acquired in hospital.

Between 5% and 10% of patients admitted to modern hospitals in thedeveloped world acquire one or more infections.

The risk of health care-associated infection in developing countries is 2 to20 times higher than in developed countries.

In some developing countries, the proportion of patients affected by ahealth care acquired infection can exceed 25%.

In the United States, 1 out of every 136 hospital patients becomesseriously ill as a result of acquiring an infection in hospital; this isequivalent to 2 million cases and about 80 000 deaths a year.

In England, more than 100 000 cases of health care-associated infectionlead to over 5000 deaths directly attributed to infection each year.

A NZ study of hospital-acquired infection estimatedprevalance rate of 9.5% (Graves 2003)


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Health care-acquired infection: the cost

Added to the considerable human misery caused by healthcare- associated infections is their economic impact.

In the USA, the risks of acquiring these infections haverisen steadily over the last decades with accompanyingextra costs estimated at US$ 45005700 million a year.

In England, health care- associated infections are estimatedto cost 1 billion annually to the National Health Service.

Predicted annual cost for hospital acquired- infection in NZ

up to $136.61M


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Elements of the Global Safety Challenge

Blood Safety

Injection practices and immunisation

Environmental hygiene and waste management

Clinical procedures safety

Hand hygiene


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BLOOD SAFETY

Between 5%-10% of HIV infections

world-wide transmitted throughtransfusion of contaminated blood andblood products in the past

Between 1990-92 in NZ at least 600patients were put at risk and

transmission of Hepatitis C occurred (toan unknown number) throughtransfusion of contaminated blood

Currently the risk of bacterialcontamination from transfusionexceeds the risk of HIV, HBV and HCV

transmission in developed countries

Haemo-vigilance data from around theworld shows errors in proceduresleading to ABO incompatibility is themost common serious hazard of

transfusion

Actions: Promotion of optimal

hand hygiene associated with

procedures for collection,

processing and use of blood

products

Comprehensive haemo-vigilance

programmes

Focuspreventing transfusion-transmitted infection


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Injection practices and immunisation

One injury from a needle used on aninfected patient carries 30% risk of

transmitting Hep B, 1.8% risk oftransmitting Hep C and 0.3% risk oftransmitting HIV

In some countries up to 90% of

people seeking primary care receiveinjections of which 70% areunnecessary or could be replacedwith oral formulations

Actions

Raising awareness of risks ofunsafe injection practices andadoption of safe injection practice

Safe disposal of sharps andeffective management of sharpswaste

Promote use of auto-disable(single use) syringes inimmunisation

Vaccination of healthcare

workforce

Focussafe injection that does not harm the recipient,

does not expose the provider to any avoidable

risks, and does not result in any waste that is

dangerous.


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Environmental hygiene and waste

management

Focusachieve safe environment needed for healthcare andthe safe disposal of waste generated

1.8 million people die every yearfrom diarrhoeal diseases

Most legionella cases arenosocomial and concern healthcarefacilities worldwide

ActionHygiene education andpromotion of hand washing canlead to a reduction of cases bymore than 50%

Safe disposal waste, particularlyneedles, syringes and body fluidsHealthcare processes thatprevent the transmission by thefaecal-oral routeEnvironments that are low risk tohealth from micro organisms thatgrow in the environmentAdequate cleaning of facilities

and equipment


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Health care-associated infection

Health care-associated infection is one of the leadingcauses of premature mortality in some countries.

International studies show 5% -10% of patients acquireinfection

In intensive care, health care-associated infection affectsabout 30% of patients and the attributable mortality mayreach 44%.

The infection rate associated with vascular devicesamong neonates is 3 to 20 times higher in developingthan in developed countries

NZ study estimated prevalance rate of 9.5% (Graves2003)

During the SARS pandemic, the proportion of infected

health-care workers ranged from approximately 20% to60% of cases worldwide.

FocusPreventing infection associated with

health care

ActionIncreasing good

hand hygienepractice

Use of an alcohol-

based hand rub


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Clinical procedures safety

Surgical site infection accounts forabout 14% of possible adverseevents threatening patient safety inhospitals in developed countries.

Surgical site infection occurs in at

least 2% to 5% of the 27 millionpatients undergoing surgicalprocedures every year.

Surgical site infection accounts forabout 25% of health care-associated infections.

In the United States, surgical siteinfection prolongs hospital stay byan average of 7.4 days at anaverage cost of US$ 400 to US$2600 per wound infection.

FocusPreventing surgical site infections

ActionCorrect surgical hand preparationEnvironmental hygiene

Surgical training experience

and supervisionBest practice wound care

Appropriate antibiotic

prophylaxis and treatment


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Hand Hygiene

Clean Handsare

Safer Hands


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Guidelines on Hand Hygiene

in Health Care

WHO GUIDELINES ON HANDHYGIENE IN HEALTH CARE(ADVANCED DRAFT):A SUMMARY

Objective of the Guidelines:

To provide health-care workers,administrators and health

authorities with:

a thorough review of hand

hygiene

in-depth information tohelp them overcome

obstacles to improvement


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Guidelines main recommendations

Hand washing with soap and water when hands

are visibly dirty

Adoption of alcohol-based hand rub as the goldstandard

Use multiple strategies including

education

leadership

patient participation


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Perceived barriers to appropriate

hand hygiene

Lack of active participation in hand hygiene promotion

at individual or institutional level

Lack of role model for hand hygiene

Lack of institutional priority for hand hygieneLack of administrative sanction ofnoncompliers/rewarding of compliers

Lack of institutional safety climate


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Factors influencing poor adherence to

recommended hand hygiene practicesWorking in intensive care

Working during the week (vs. week- end)

Wearing gowns/gloves

Automated sink

Activities with high risk of cross- transmission

Understaffing or overcrowding

High number of opportunities for hand hygiene per hour

of careNursing assistant status (rather than a nurse)

Physician status (rather than a nurse)


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Self-reported factors for poor adherence

Hand-washing agents cause irritations and dryness

Sinks are inconveniently located or shortage of sinks

Lack of soap, paper, towel

Often too busy or insufficient time, patient needs take priorityHand hygiene interferes with health-care workerpatient relationship

Low risk of acquiring infection from patients

Wearing of gloves or belief that glove use obviates the need for hand hygiene

Lack of knowledge of guidelines and protocols

Not thinking about it, forgetfulness

No role model from colleagues or superiors

Scepticism about the value of hand hygiene

Disagreement with the recommendations

Lack of scientific information of definitive impact of improved hand hygiene

on health care-associated infection rates


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Risk factors associated with poor

adherence to hand hygiene

Individual level:

lack of education or experience

lack of knowledge of guidelines

being a refractory noncomplier

skin irritation by hand hygiene agents.

Team level:

lack of education or lack of performance feedback

working in critical care or in high workload conditions

downsizing or understaffing

lack of encouragement or role modelling from key staff


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Risk factors associated with poor

adherence to hand hygieneOrganisational level:

lack of written guidelines

lack of suitable hand hygiene agents

lack of skin-care promotion or agents

lack of culture or tradition of compliance

lack of administrative leadership, sanctions, rewards or support.

System level:

lack of awareness and commitment regarding the importance of healthcare-associated infection

lack of specific regulations and policies on prevention of health care-associated infection

lack of guidelines on hand hygiene in health care

lack of promotion of national or regional campaigns to improve handhygiene


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Clean Care is Safer Care

Risks to consumers are minimised when there is:

Leadership and commitment

Well designed processes and systems

Clean hygienic environment

Safer practices

Concerted and coordinated actions

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Microsoft Power Point - 1 Clean-care-safer-care Stefanus

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