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Conseil dutilisation de ce ppt Le médecin hygiéniste se chargera de présenter le ppt, le message passera sans doute mieux mais toute léquipe est la bienvenue.

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Présentation au sujet: "Conseil dutilisation de ce ppt Le médecin hygiéniste se chargera de présenter le ppt, le message passera sans doute mieux mais toute léquipe est la bienvenue."— Transcription de la présentation:

1 Conseil dutilisation de ce ppt Le médecin hygiéniste se chargera de présenter le ppt, le message passera sans doute mieux mais toute léquipe est la bienvenue Faites envoyer les invitations à la formation par le supérieur hiérarchique des médecins concernés qui sengage à être présent (chef de service, chef de département, médecin-chef) Noubliez pas de demander des points daccréditation en rubrique « éthique et économie » Ne parlez pas dhygiène des mains dans votre titre et choisissez par exemple un titre comme « Existe-t-il un moyen facile et pas cher pour prévenir les infections nosocomiales »

2 Conseil dutilisation de ce ppt Idéalement à présenter à un public exclusivement médical (vu les performances moins bonnes comparées aux autres soignants) Idéalement à présenter à des petits groupes de médecins de la même spécialité Vous trouverez les performances des médecins de votre institution dans votre « feedback » personnel de lISP 30 diapositives nous semble un maximum pour la sensibilisation des médecins mais libre à vous daller en piocher dans les autres diaporamas de formation Prévoyez éventuellement une lampe UV et de la solution hydro-alcoolique contenant de la fluorescéine, cela frappe toujours limagination même des médecins

3 After 3 National hand hygiene campaigns in Belgian hospitals What did we learn? « Vous êtes en de bonnes mains »

4

5 n=148 n=127 n=178 n=158n=168n=145 N hop 48% 53% 69% 58% 69% 68% Distribution of average HH compliance

6 A qualitative exploration of reasons for poor hand hygiene among hospital workers A qualitative study based on structured interview guidelines consisting of 9 focus groups (58 persons) and 7 individual interviews Nurse and medical students « Lack of positive role models ! » Physicians: « Lack of convincing evidence that hand hygiene prevents cross infection » Erasmus V et al ICHE 2009;30:415-19

7 Overall HH compliance by profession (all) 20%

8 Evolution of HH compliance among nurses en physicians 54% 72% 59% 73% 64% 74% 36% 51% 40% 51% 45% 53%

9 HH Compliance by type of contact indications among Medical Doctors (all camp) 1.Before contact with patient 2.Before clean/invasive action 1.After contact with patient 2.After biological liquids exposure 3.After contact with patient environment 31% 48% 41% 58%

10 Role model Pittet, D et al. Ann Intern Med 2004;141:1-8 Physicians Nbr of opportunities HH compliance % Odds ratio

11 Role model Lankford M. et al Emerging Infectious disease 2003: 9:

12 A qualitative exploration of reasons for poor hand hygiene among hospital workers A qualitative study based on structured interview guidelines consisting of 9 focus groups (58 persons) and 7 individual interviews Nurse and medical students « Lack of positive role models ! » Physicians: « Lack of convincing evidence that hand hygiene prevents cross infection » Erasmus V et al ICHE 2009;30:415-19

13 Maternal mortality rates, first and second obstetrics clinics, General Hospital of Vienna First Second Intervention May 15, 1847 Percentage Semmelweis IP 1861

14 Why did he fail? Correct intervention but didnt apply the basic principle for behaviour change May not explain how death is transmitted! Too few knowledge! Autocratic decision: mandatory hand washing policy based on his observations Intervention not based on education Very agressive handdisinfection solution His supervisor didnt accept his conclusions, ventilation system is responsable for death according to the popular miasmatic theory of disease He didnt publish his findings until 14 years after his observations Best M, Neuhauser D Qual Saf Health Care 2004;13 :

15 Impact of better handhygiene compliance on HCAI and incidence of nosocomial MRSA Pittet et al. Lancet 2000;356:

16 Impact of hand hygiene promotion YearHospital setting Increase of hand hygiene complianceReduction of HCAI ratesFollow-upReference 1989Adult ICUFrom 14% to 73% (before pt contact) HCAI rates: from 33% to 10%6 yearsConly et al 2000Hospital-wideFrom 48% to 66%HCAI prevalence: from 16.9% to 9.5%8 yearsPittet et al 2004NICUFrom 43% to 80%HCAI incidence: from 15.1 to 10.7/1000 patient-days2 yearsWon et al 2005Adult ICUsFrom 23.1% to 64.5%HCAI incidence: from 47.5 to 27.9/1000 patient-days21 monthsRosenthal et al 2005Hospital-wideFrom 62% to 81%Significant reduction in rotavirus infections4 yearsZerr et al 2007Neonatal unitFrom 42% to 55%HCAI incidence: overall from 11 to 8.2 infections/1000 patient-days) and in very low birth weight neonates from 15.5 to 8.8 infections /1000 patient-days 27 monthsPessoa-Silva et al 2007NeurosurgeryNASSI rates: from 8.3% to 3.8%2 yearsThu et al 20081) 6 pilot health-care facilities 2) all public health-care facilities in Victoria (Aus) 1) from 21% to 48% 2) from 20% to 53% MRSA bacteraemia: 1) from 0.05 to 0.02/100 patient-discharges per month; 2) from 0.03 to 0.01/100 patient-discharges per month 1) 2 years 2) 1 year Grayson et al 2008NICUNAHCAI incidence: from 4.1 to 1.2/1000 patient-days18 monthsCapretti et al

17 Compliance: 21% 42% MRSA bacteraemia: 57% reduction Med J Aust Nov 21;183(10):

18 Compliance: 40% 53% HCAIs: / 1,000 PD Pediatrics Nov;114(5):e

19 Compliance: 43% 80% HCAIs: / 1,000 PD Infect Control Hosp Epidemiol Sep;25(9):742-6.

20 Compliance: 23% 64.5% HCAIs: / 1,000 PD Am J Infect Control Sep;33(7):392-7.

21 Compliance: 42% 55% HCAIs: / 1,000 PD Pediatrics Aug;120(2):382-90

22 Compliance: 20% 53% MRSA bacteraemia: / 100 discharges per month Med J Aust Jun 2;188(11):

23 Compliance: 19% 24% HCAIs: / 1,000 PD Crit Care Med Feb;32(2):

24 Relation between handhygiene compliance and MRSA prevalence Girou E ICHE 2006 Oct;27(10):

25 Jarlier, V. et al. Arch Intern Med 2010;170: Changes in the use of alcohol-based hand-rub solutions (in liters per 1000 HDs) from 1993 to 2007

26 Change in MRSA incidence per 1000 HDs in ACHs and RLTCHs from 1996 to 2006 Jarlier, V. et al. Arch Intern Med 2010;170:

27 Evolution de l'incidence moyenne globale min. 5 participations : Antibiotic use management teams MRSA new guidelines 1st Camp d Camp d Camp 2009 National surveillance MRSA, Bea Jans

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29 Factors related with the performance of a proper hand hygiene technique OBJETIVE: To identify factors related with the performance of a proper hand hygiene technique in a hand hygiene campaign. METHODS: We developed two cross-sectional studies on 15 hospital units. The outcome variable was complied HH with proper technique and the exposures variables were care factors (unit, professional group, etc) and other factors related with the HH campaign (training on hand washing). Statistical analysis: The strength of association was measured using odds ratios (OR) with their 95% confidence interval (CI). Adjusting for confounders was performed using multiple logistic regression. RESULTS: 12% of the observed 1241 hand hygiene were performed with proper technique. The strongest associated factors were ICUS (OR: 4.07 (CI 95% ( )), surgical wards (OR: 3.24 (CI 95% ( ), procedures with high risk of contamination (OR: 2,56 CI 95% ( )), and physicians (OR: 2.52 CI 95% ( )). Training increased by 21% the probability of hand hygiene with proper technique for every 10% increase in trained health care workers (OR: 1.21 CI 95% ( ). CONCLUSIONS: Hand Washing Training was associated with proper technique especially in surgical services and physicians Dierssen-Sotos T, Med Clin (Barc) Aug 9.

30 Before rub After rub Efficacy of hand rub disinfection

31 Thank you for your attention!


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