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WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge. Clean Care is Safer Care [Pehme köide]

  • Formaat: Paperback / softback, 270 pages, Figures; Tables, black and white
  • Ilmumisaeg: 06-Aug-2009
  • Kirjastus: World Health Organization
  • ISBN-10: 9241597909
  • ISBN-13: 9789241597906
Teised raamatud teemal:
  • Formaat: Paperback / softback, 270 pages, Figures; Tables, black and white
  • Ilmumisaeg: 06-Aug-2009
  • Kirjastus: World Health Organization
  • ISBN-10: 9241597909
  • ISBN-13: 9789241597906
Teised raamatud teemal:
The WHO Guidelines on Hand Hygiene in Health Care provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs. The present Guidelines are intended to be implemented in any situation in which health care is delivered either to a patient or to a specific group in a population. Therefore, this concept applies to all settings where health care is permanently or occasionally performed, such as home care by birth attendants. Definitions of health-care settings are proposed in Appendix 1. These Guidelines and the associated WHO Multimodal Hand Hygiene Improvement Strategy and an Implementation Toolkit (http://www.who.int/gpsc/en/) are designed to offer health-care facilities in Member States a conceptual framework and practical tools for the application of recommendations in practice at the bedside. While ensuring consistency with the Guidelines recommendations, individual adaptation according to local regulations, settings, needs, and resources is desirable.

This extensive review includes in one document sufficient technical information to support training materials and help plan implementation strategies. The document comprises six parts.
Introduction v
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE
1(150)
Definition of terms
2(2)
Guideline preparation process
4(2)
Preparation of the Advanced Draft
Pilot testing the Advanced Draft
Finalization of the WHO Guidelines on Hand Hygiene in Health Care
The burden of health care-associated infection
6(3)
Health care-associated infection in developed countries
Burden of health-care associated infection in developing countries
Historical perspective on hand hygiene in health care
9(1)
Normal bacterial flora on hands
10(1)
Physiology of normal skin
11(1)
Transmission of pathogens by hands
12(10)
Organisms present on patient skin or in the inanimate environment
Organism transfer to health-care workers' hands
Organism survival on hands
Defective hand cleansing, resulting in hands remaining contaminated
Cross-transmission of organisms by contaminated hands
Models of hand transmission
22(2)
Experimental models
Mathematical models
Relationship between hand hygiene and the acquisition of health care-associated pathogens
24(1)
Methods to evaluate the antimicrobial efficacy of handrub and handwash agents and formulations for surgical hand preparation
25(5)
Current methods
Shortcomings of traditional test methods
The need for better methods
Review of preparations used for hand hygiene
30(19)
Water
Plain (non-antimicrobial) soap
Alcohols
Chlorhexidine
Chloroxylenol
Hexachlorophene
Iodine and iodophors
Quaternary ammonium compounds
Triclosan
Other agents
Activity of antiseptic agents against spore-forming bacteria
Reduced susceptibility of microrganisms to antiseptics
Relative efficacy of plain soap, antiseptic soaps and detergents, and alcohols
WHO-recommended handrub formulation
49(5)
General remarks
Lessons learnt from local production of the WHO-recommended handrub formulations in different settings worldwide
Surgical hand preparation: state-of-the-art
54(7)
Evidence for surgical hand preparation
Objective of surgical hand preparation
Selection of products for surgical hand preparation
Surgical hand antisepsis using medicated soap
Surgical hand preparation with alcohol-based handrubs
Surgical hand scrub with medicated soap or surgical hand preparation with alcohol-based formulations
Skin reactions related to hand hygiene
61(3)
Frequency and pathophysiology of irritant contact dermatitis
Allergic contact dermatitis related to hand hygiene products
Methods to reduce adverse effects of agents
Factors to consider when selecting hand hygiene products
64(2)
Pilot testing
Selection factors
Hand hygiene practices among health-care workers and adherence to recommendations
66(12)
Hand hygiene practices among health-care workers
Observed adherence to hand cleansing
Factors affecting adherence
Religious and cultural aspects of hand hygiene
78(7)
Importance of hand hygiene in different religions
Hand gestures in different religions and cultures
The concept of ``visibly dirty'' hands
Use of alcohol-based handrubs and alcohol prohibition by some religions
Possible solutions
Behavioural considerations
85(4)
Social sciences and health behaviour
Behavioural aspects of hand hygiene
Organizing an educational programme to promote hand hygiene
89(4)
Process for developing an educational programme when implementing guidelines
Organization of a training programme
The infection control link health-care worker
Formulating strategies for hand hygiene promotion
93(6)
Elements of promotion strategies
Developing a strategy for guideline implementation
Marketing technology for hand hygiene promotion
The WHO Multimodal Hand Hygiene Improvement Strategy
99(25)
Key elements for a successful strategy
Essential steps for implementation at heath-care setting level
WHO tools for implementation
``My five moments for hand hygiene''
Lessons learnt from the testing of the WHO Hand Hygiene Improvement Strategy in pilot and complementary sites
Impact of improved hand hygiene
124(4)
Practical issues and potential barriers to optimal hand hygiene practices
128(18)
Glove policies
Importance of hand hygiene for safe blood and blood products
Jewellery
Fingernails and artificial nails
Infrastructure required for optimal hand hygiene
Safety issues related to alcohol-based preparations
Hand hygiene research agenda
146(5)
PART II. CONSENSUS RECOMMENDATIONS
151(6)
Ranking system for evidence
Indications for hand hygiene
Hand hygiene technique
Recommendations for surgical hand preparation
Selection and handling of hand hygiene agents
Skin care
Use of gloves
Other aspects of hand hygiene
Educational and motivational programmes for health-care workers
Governmental and institutional responsibilities
For health-care administrators
For national governments
PART III. PROCESS AND OUTCOME MEASUREMENT
157(17)
Hand hygiene as a performance indicator
158(6)
Monitoring hand hygiene by direct methods
The WHO-recommended method for direct observation
Indirect monitoring of hand hygiene performance
Automated monitoring of hand hygiene
Hand hygiene as a quality indicator for patient safety
164(4)
Assessing the economic impact of hand hygiene promotion
168(6)
Need for economic evaluation
Cost-benefit and cost-effectiveness analyses
Review of the economic literature
Capturing the costs of hand hygiene at institutional level
Typical cost-savings from hand hygiene promotion programmes
Financial strategies to support national programmes
PART IV. TOWARDS A GENERAL MODEL OF CAMPAIGNING FOR BETTER HAND HYGIENE - A NATIONAL APPROACH TO HAND HYGIENE IMPROVEMENT
174(15)
Introduction
175(1)
Objectives
175(1)
Historical perspective
176(1)
Public campaigning, WHO, and the mass media
177(1)
National campaigns within health care
Benefits and barriers in national programmes
178(1)
Limitations of national programmes
179(1)
The relevance of social marketing and social movement theories
180(1)
Hand hygiene improvement campaigns outside of health care
Nationally driven hand hygiene improvement in health care
181(1)
Towards a blueprint for developing, implementing and evaluating a national hand hygiene improvement programme within health care
182(1)
Conclusion
182(7)
PART V. PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION
189(10)
Overview and terminology
190(1)
Patient empowerment and health care
190(1)
Components of the empowerment process
191(1)
Patient participation
Patient knowledge
Patient skills
Creation of a facilitating environment and positive deviance
Hand hygiene compliance and empowerment
192(2)
Patient and health-care worker empowerment
Programmes and models of hand hygiene promotion, including patient and health-care worker empowerment
194(1)
Evidence
Programmes
WHO global survey of patient experiences
195(1)
Strategy and resources for developing, implementing, and evaluating a patient/health-care worker empowerment programme in a health-care facility or community
196(3)
PART VI. COMPARISON OF NATIONAL AND SUB-NATIONAL GUIDELINES FOR HAND HYGIENE
199(7)
References
206(33)
Appendices
239(19)
Definitions of health-care settings and other related terms
240(2)
Guide to appropriate hand hygiene in connection with Clostridium difficile spread
242(4)
Hand and skin self-assessment tool
246(1)
Monitoring hand hygiene by direct methods
247(3)
Example of a spreadsheet to estimate costs
250(1)
WHO global survey of patient experiences in hand hygiene improvement
251(7)
Abbreviations 258(1)
Acknowledgements 259