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本帖最后由 qlg8001 于 2013-8-2 11:34 编辑
Hospitals have fretted for years over how to make sure doctors, nurses and staff keep their hands clean, but with only limited success. Now, some are turning to technology — beepers, buzzers, lights and tracking systems that remind workers to sanitize, and chart those who don't.
Health experts say poor hand cleanliness is a factor in hospital-borne infections that kill tens of thousands of Americans each year. The U.S. Centers for Disease Control and Prevention in Atlanta estimates that one of every 20 patients in U.S. hospitals gets a hospital-acquired infection each year.
"We've known for over 150 years that good hand hygiene prevents patients from getting infections," said Dr. John Jernigan, an epidemiologist for the CDC. "However, it's been a very chronic and difficult problem to get adherence levels up as high as we'd like them to be." Hospitals have tried varying ways to promote better hygiene. Signs are posted in restrooms. Some even employ monitors who keep tabs and single out offenders.
Still, experts believe hospital workers wash up, at best, about 50 percent of the time. One St. Louis-area hospital believes it can approach 100 percent adherence.
Since last year, SSM St. Mary's Health Center in the St. Louis suburb of Richmond Heights, Mo., has been the test site for a system developed by Biovigil of Ann Arbor, Mich. A flashing light on a badge turns green when hands are clean, red if they're not. It also tracks each hand-cleaning opportunity — the successes and the failures.
The failures have been few at the two units of St. Mary's where the system is being tested, the hospital said. One unit had 97 percent hand hygiene success, said Dr. Morey Gardner, the hospital's director of infection disease and prevention. The other had 99 percent success.
"The holy grail of infection prevention is in our grasp," Gardner said.
The Biovigil system is among many being tried at hospitals. A method developed by Arrowsight, based in Mount Kisco, N.Y., uses video monitoring. It is being used in intensive care units at North Shore University Hospital in Manhasset, N.Y., and the University of California San Francisco Medical Center.
Akron, Ohio-based GOJO Industries, maker of Purell hand sanitizer, has developed an electronic compliance monitoring system using wireless technology to track when soap and hand sanitizer dispensers are used. The SmartLink system gives the hospital data on high- and low-compliance areas. The company said it has installed the system at several hospitals around the country, but didn't say how many.
HyGreen's Hand Hygiene Reminder System was developed by two University of Florida doctors. The Gainesville, Fla., company now features two systems used in seven hospitals, including Veterans Administration hospitals in Chicago, Wilmington, Del., and Wilkes-Barre, Pa.
One is similar to Biovigil's green badge method. In HyGreen's, a wall-mounted hand wash sensor detects alcohol on the hands. The badge includes an active reminding system. Unclean hands create a warning buzz. If the buzz sounds three times, the worker is noted for noncompliance.
HyGreen spokeswoman Elena Fraser said that because some hospitals are moving away from alcohol-based sanitizers, HyGreen offers a second system. A touch of the sanitizer dispenser clears the worker to interact with a patient. If the worker shows up at the patient bed without hand-cleaning, the series of warning buzzes begins.
Fraser said hospital infections have dropped 66 percent at units of Miami Children's Hospital where the badge system has been implemented.
Nurses using the Biovigil system at St. Mary's near St. Louis wear a badge with changeable colored lights. A doorway sensor identifies when the nurse enters a patient's room, and the badge color changes to yellow.
The nurse washes his or her hands and places them close to the badge. A sensor in the badge detects chemical vapors from the alcohol-based solution. If hands are clean, the badge illuminates a bright green hand symbol.
If the nurse fails to sanitize, the badge stays yellow and chirps every 10 seconds for 40 seconds, then flashes red. Once the flashing red starts, the nurse has another 30 seconds to wash up, otherwise the badge turns solid red, denoting non-compliance. Either way, each instance is tracked by a computer. The hospital can track each individual's compliance.
Registered Nurse Theresa Gratton has helped lead the effort toward hand cleanliness at St. Mary's. She heard about the Biovigil system in early 2012 and convinced the hospital to give it a try.
Gratton said patients are aware of the risk of infection and frequently inquire about whether caregivers have washed their hands. She said the badge relieves their anxiety.
Bill Rogers, a 65-year-old retiree recuperating at St. Mary's from back surgery and a heart scare, agreed.
"The first thing I noticed up here was the badges," Rogers said. "It is comforting for me to know their hands are clean as soon as the badge beeps and it goes from yellow to green."
St. Mary's is expanding the Biovigil system later this year to other units of the hospital and to employees other than nurses, though details are still being worked out, Gardner said. Eventually, the system may be expanded to SSM's seven other St. Louis-area hospitals, he said.
Biovigil's chief client officer, Brent Nibarger, said customers won't buy the system but will pay a subscription fee of about $12 a month per badge.
The CDC's Jernigan said the high-tech systems can only help.
"For a health care worker, keeping their hands clean is the single most important thing they can do to protect their patients," Jernigan said. ===============================================================================================================
医院已多年担忧如何使确定的 医生 ，护士和工作人员保持双手清洁，但只有有限的成功。.现在，一些正在转向技术 - 寻呼机，蜂鸣器，灯光和跟踪系统，提醒工人进行消毒，并绘制那些谁不这样做。
卫生专家说，手清洁度不佳是一个因素，杀死数万成千上万的美国人每年在院内传播感染。 . 美国亚特兰大 疾病控制和预防中心估计，每20名患者在美国医院每年得到医院获得性感染。
为CDC的流行病学家约翰·杰尼根博士说：“我们已经知道了150多年，良好的手部卫生，防止患者免受感染，。不过，它一直得到遵守水平高，因为我们想他们是一个非常长期和困难的问题。” 尝试不同的方法，以促进更好的卫生医院。.标志张贴在厕所。有些人甚至雇用显示器保持标签和单出罪犯。
不过，专家认为，医院工作人员洗，在最好的情况下，约50％的时间。 圣路易斯地区医院认为它可以接近100％的坚持。
SSM圣玛丽健康中心在圣路易斯郊区的里士满高地，密苏里州，自去年以来，已经开发的系统测试现场由Biovigil密歇根州安阿伯，徽章上的指示灯闪烁变为绿色时，双手是干净的，红色的，如果他们不。它还跟踪每手清洗的机会 - 成功和失败。
失败已经很少在圣玛丽系统正在测试两个单位的，医院说。一个单位97％的手部卫生的成功，莫雷加德纳博士说，医院的主任，感染性疾病和预防。 其他有99％的成功率。“圣杯预防感染是在我们的掌握之中，”Gardner说。该Biovigil系统在许多医院正在尝试。的方法开发Arrowsight，总部设在纽约州克斯科山，使用视频监控。 它是被用来在重症监护病房，在北岸大学医院在Manhasset，NY，加州旧金山医疗中心和大学。
俄亥俄州阿克伦基于GOJO工业制造商普瑞洗手液，已经开发了电子监察系统使用无线技术来跟踪时使用肥皂和洗手液分配器。为系统提供了高，低遵守区域医院的数据。.该公司说，它已经安装了该系统在全国各地的医院，但没说多少。 手部卫生提醒系统是由大学的两位佛罗里达医生。 美国佛罗里达州盖恩斯维尔，公司现在拥​​有两个系统使用的七家医院，包括在特拉华州威尔明顿，芝加哥，退伍军人管理局医院，威尔克斯 - 巴里，宾夕法尼亚州
一个是到Biovigil的绿色徽章的方法类似。HyGreen，一台壁挂式洗手传感器检测酒精的手中。.徽章包括主动提醒系统。 .不干净的手创造一个警告的嗡嗡声。如果嗡嗡鸣响三次，工人指出违规。
HyGreen的发言人埃莱娜弗雷泽说，因为一些医院正在远离酒精的消毒剂，HyGreen系统提供了第二。淡淡的消毒液分配器清除与病人互动的工人。如果工人在病床无需手工清洗，该系列警告嗡嗡声开始。 弗雷泽说，在迈阿密儿童医院的徽章系统已经实施的单位，医院感染已下降了66％。
护士使用的Biovigil系统在圣路易斯附近的圣玛丽佩戴胸卡，与多变的彩色灯光。当护士进入病人的房间，和徽章的颜色变为黄色的门口传感器识别。
护士洗他或她的手和他们接近徽章的地方。的徽章中的传感器检测到化学气体的酒精为基础的解决方案。 如果手是干净的，徽章亮起明亮的绿色手形符号。
如果护士不消毒，徽章保持黄色和啁啾每10秒，40秒，然后闪烁红色。 .护士一旦闪烁的红色开始，再过30秒洗了，否则徽章变成红色常亮，表示不遵守。 无论哪种方式，每个实例由计算机跟踪。.医院可以跟踪每个人的遵守。
注册护士特蕾莎格拉顿已经帮助向手清洁圣玛丽带头努力。她听说在2012年年初的Biovigil系统，并说服了医院，给它一个尝试。
格拉顿说，患者都知道感染的风险，并经常打听看护者是否洗手。.她说，徽章，减轻他们的焦虑。
比尔·罗杰斯，一个65岁的退休休养圣玛丽从背部手术和心脏恐慌，同意。
我注意到的第一件事情，在这里的徽章，”罗杰斯说。“这是在安慰我，要知道，他们的手是干净的尽快徽章发出蜂鸣声，并从黄色变为绿色。”
圣玛丽扩大的Biovigil系统今年晚些时候给其他单位的医院和护士以外的员工，虽然细节仍在商讨中，加德纳说。最后，系统可能会扩大到SSM公司的其他七个圣路易斯地区的医院，他说。
Biovigil的首席客户官，布伦特Nibarger，说客户不会购买系统，但将支付订阅费约12美元每月徽章。
CDC的杰尼根说高科技系统只能帮助。 Jernigan said.杰尼根说：“对于一名卫生保健工作者，保持双手清洁是最重要的事情，他们可以做些什么来保护他们的病人，”。 | 
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发表于 2013-8-1 13:30
