WHO手卫生指南证据的‘问’和‘答’——持续更新

樵夫

Q: How significant is the problem of infections in health care across the world?

问：在世界范围内，医疗机构内的感染问题有多重要？

A: The problem is huge: it is estimated that there are over 1.4 million cases of HAI at any given time, although this is likely to be a gross underestimation, due to the lack of proper surveillance.

Across all settings, patients can acquire bloodstream infections, surgical site infections, urinary tract infections, chest/respiratory infections or gastrointestinal infections.

Health-care workers are often the conduit for the spread of such infections to other patients in their care. It should also be noted here that many patients may carry microbes without any obvious signs or symptoms of an infection (colonized or sub clinically-infected). This clearly reinforces the need for hand hygiene, irrespective of the type of patient being cared for.

答：问题是巨大的，据估计，任何时候都有1,400,000例医院感染存在，但由于缺乏适当的监测，可能存在总数上的低估。
在所有的医疗机构内，病人都可能获得血流感染、手术部位的感染、泌尿道插管相关感染、胸部/肺部或下呼吸道的感染。
这些感染通常通过医务人员的诊疗活动进行传播。需要注意的是，许多病人可能携带了病原菌而没有明显的感染症状或体征（定植或亚临床感染）。因此，不管给何种病人进行诊治活动，都需要加强手卫生。

樵夫

Q: How important are clean hands in the overall patient safety agenda?
问：在病人安全议程中，清洁双手有多重要？
A: Hand hygiene contributes significantly to keeping patients safe. It is a simple, low-cost action to prevent the spread of many of the microbes that cause health care-associated infections (HAI). While hand hygiene is not the only measure to counter HAI, compliance with it alone can dramatically enhance patient safety, because there is much scientific evidence showing that microbes causing HAI are most frequently spread between patients on the hands of health-care workers.
In addition, health-care facilities which readily embrace strategies for improving hand hygiene also prove more open to a closer scrutiny of their infection control practices in general. Therefore, the knock-on impact of focusing on hand hygiene can lead to an overall improvement in patient safety across an entire organization.
Finally, the selection of hand hygiene as the first pillar to promote the Global Patient Safety Challenge of the WHO World Alliance for Patient Safety signifies its importance in the patient safety agenda.

答：手卫生在保证病人安全上有明显的作用，它是阻止许多微生物引起医院感染发生的简单、便宜的行为。尽管手卫生并不是预防医院感染的唯一措施，单独提高手卫生的依从性能够显著的提高病人的医疗安全，因为有大量的科学证据表明由微生物引起的医院感染最常见的传播途径是通过医务人员的手传播。
另外，那些容易拥有改善手卫生策略的医疗机构，也能常规对他们的感染控制措施进行严格的审查。因此，集中精力搞好手卫生能改善整个医疗机构的病人的医疗安全。
最后，作为WHO全球患者安全联盟发起全球患者安全挑战的第一个活动，手卫生表明了它在病人安全中的重要性。

绿茵场

非常好的内容，:victory:
辛苦 qiao 版 啦！:handshake :lol

樵夫

Q: WHY IS HAND HYGIENE COMPLIANCE STILL LOW AFTER ALL THE EFFORTS IN RECENT DECADES?
问：为什么经过多年的努力手卫生的依从性仍然很低？
A: In recent years many parts of the world have seen major improvements in hand hygiene. However, there is still not enough access to clean water, not enough sinks or towels, not enough awareness of the central role played by hand hygiene, and not enough investment in a multifaceted approach to tackle the abysmally low levels of compliance.
There are many factors which contribute to low compliance and these are listed on page 170 of the WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft).
Whatever the reasons, even in resource-rich settings, compliance can be as low as zero percent, with compliance levels most frequently well below 40%.

答：近年来，世界许多地方的手卫生都有明显的改善。然而，仍然没有足够的设施净化水，没有足够的洗手池和擦手毛巾，没有意识到手卫生扮演的重要角色，没有足够的投入来从多方面改善依从性低的问题。
低依从性有许多原因，并列在WHO手卫生指南的170页
不管什么原因，即使在资源富裕的地方，依从性也可能低至0，而大多数依从性低于40%。

樵夫

Q: What sort of microbes can spread during lapses in hand hygiene?
问：通过手卫生可降低哪些病原微生物的传播？
The following are examples of the types of microbes that can be spread on the hands of health-care staff:
Staphylococcus aureus (including MRSA)
Streptococcus pyogenes (Group A Strep)
Vancomycin-resistant Enterococcus (VRE)
Klebsiella
Enterobacter
Pseudomonas
Clostridium difficile
Candida
Rotavirus
Adenovirus
Hepatitis A virus
Norovirus
Wounds will contain large numbers of microbes. Areas around the perineum can be heavily loaded with microbes, but even the armpit, trunk and hands can be frequently covered in huge numbers. Microbes such as Staphylococcus aureus and Klebsiella can be present on intact skin in numbers ranging from 100 to 1000,000 per square cm.
It is easy to understand that the hands of staff can become contaminated even after seemingly ‘clean’ procedures such as;
Taking a pulse
Taking blood pressure readings
Taking a temperature
Touching a patient’s hand, shoulder or groin.
Furthermore, several studies have presented dramatic evidence that microbes have an impressive ability to survive on the hands, sometimes for hours, if hands are not cleaned.. All of the studies clearly demonstrate that contaminated hands can be vehicles for the spread of microbes.

答：通过医务人员的手传播的病原菌主要有金黄色葡萄球菌（包括MRSA）、化脓性链球菌（A群链球菌）、VRE、克雷伯菌属、肠杆菌属、假单胞菌属、艰难梭菌、假丝酵母菌、轮状病毒、腺病毒、甲肝病毒、诺如病毒等。伤口含有大量的微生物。会阴周围也定植有大量的微生物，但即使是腋窝，躯干和手通常也含有大量的细菌。金黄色葡萄球菌和克雷伯菌等微生物在完整的皮肤表面的存在量可达到100~1000,000/cm2。
很容易理解为什么医务人员的手即使在进行清洁的操作时也会被污染，如把脉、测血压、测体温、查体等。而且，有研究表明，如果不洗手的话细菌在手上有很强的存活力，通常数小时。所有这些研究都清楚地表明污染了的手是传播微生物的载体。

1995薰衣草

非常感谢！我们在推广手卫生时可以用到！

jiesi

好，非常好！已下载学习。谢谢！

兰兔

下班都会洗手，采血会戴手套，手机会戴塑料套，但检查前不洗手现象比比皆是，是不董还......手项目管理小组该如何有效工作，请赐教

wenwen65

手卫生工作如此重要,可接触病人前后不吸手还大有人在,:funk: 可见我们的院感管理工作还得努力了!

落花生

我国手卫生设施方面还存在差异。

altrmyy

多谢！手卫生非常重要，但是要想提高医务人员手卫生的依从性却有非常艰巨的路要走

gongjiewen

洗手人人都知道，但为什么做不到，就是一个观念问题。

感控一家人

12#
发表于 2009-4-3 15:15 | 只看该作者
洗手人人都知道，但为什么做不到，就是一个观念问题。


           相当有同感

思索

非常重要，但是要想提高医务人员手卫生的依从性却非常艰巨 ，学习了，谢谢！

esuoting

非常实用的内容！该问答是否来源于WHO手卫生指南？

402511765

很好的学习机会，谢谢老师了！

米奇朋克

樵夫 发表于 2009-1-15 21:05

                               
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Q: WHY IS HAND HYGIENE COMPLIANCE STILL LOW AFTER ALL THE EFFORTS IN RECENT DECADES?
问：为什么经过 ...

手卫生依从性不高是医疗机构普遍存在的问题，SIFIC在这方面可以考虑发动一场全国范围的促进活动，当然不能轰轰烈烈搞几个月就结束，需要制定周密计划，分周期、分步骤推进。

月光依旧

多好的问答，英文中文。让我这个“硕士前”给我们的博士后们培训时增加点底气。他们多认国外的。感谢老师！

南京南京

月光依旧 发表于 2012-3-28 17:52

                               
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多好的问答，英文中文。让我这个“硕士前”给我们的博士后们培训时增加点底气。他们多认国外的。感谢老师！

“硕士前”，第一次听到这个名词，看了博士后才明白啥意思，呵呵

57092238

很好的内容，望老师不断更新！期待中！