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101 5 5

(Healthcare associated-infections,HAIs)
(World
Health Organization, WHO)
5%-10% 20
2002
99,000

(WHO) 2005
2009
(The First Global Patient Safety
Challenge) (Save LivesClean Your
Hands
2010 5 5

(WHO)

1
98 10 2
WHO

3
(WHO)2009
Hand Hygiene GuidelineGuide to Implementation

2005 Clean Care is


Safer Care2009
Save Lives:Clean Your Hands)

WHO 2010
3
WHO

3

WHO 20
5

2004

2004 2007
8.9%

WHO 2005

WHO

..9
..9
13

15
15
5 16
....21
....23
....26

5 ..33
....33
5 ....33
5 ....49

..52
....52
....56

..67
........67
....69
..70
WHO .....77

(Healthcare-associated infections, HAIs)

(World Health Organization , WHO)


(Guide to Implementation)
(Hand Hygiene Technical Reference Manual)

(WHO Guide to Implementation[1])

9
(System change)


SARS


WHO


WHO
(patient zone)
(alcohol-based handrubs at the point of care)









()






(Training and education)



10



(user-centered)


Q&A

(Evaluation and feedback)









11











(Reminders in the workplace)





(Institutional safety climate)






12





()

(WHO)

Facility preparedness 2

Baseline evaluation 3

Implementation 3

Follow-up evaluation 2

Review and planning 2

(WHO Guide to Implementation[1])

(Facility preparedness)

()

(Baseline evaluation)

13

(Implementation)

(Follow-up evaluation)

(Review and Planning)



14

(Patient zone)





1.
monitor
2.Alarm




(health-care area)

15





(point of care)


(Opportunity)(Indication)(Action)
()(Opportunity)


()(Indication)






1.2./
3.4.5.

()(Action)


()(Opportunity)(Indication)(Action)

16

()
1.
2.
3.
4.

WHO 5
5
2
3

() 1(Before touching a patient)


17

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2.

() 2/(Before clean/aseptic procedure)


/







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IV flush

18


airways/
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1.
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19
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WHO


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WHO



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15

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IV pump



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pathogens)(Clostridium difficile)

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4% Chlorhexidine ) (
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29
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35


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( 3+4)

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( 32)

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)




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( 41)

41


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42

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43




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44


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( 3)
()


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1
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45
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Xylocaine
2% Xylocaine


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( 3)

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46

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( 4)

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X

()

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:

48
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( 3+4)

49
()

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( 4)

()

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( 3+4)

50
5



( 1)

( 1+4)



( 1)

( 4)



( 1)

()


( 4)

51


( 2)


()




1.
2.



()


( 1+2)




( 3+4)


( 1)




( 4)

52

( 1)





( 4)


( 1+2)





( 3+4)


( 2)







( 1)





( 4)

53

( 1)


( 4)

54

(Electroconvul-sive Therapy ECT)


( 1+2) ( 1)

( 2)




( 3+4)
( 3+4)

CPR

( 3 4)


55

2009 WHO
(WHO multimodal hand hygiene improvement strategy) :

1.WHO


2.

56


1 4
3.

1.


2.
3.

observation
biasobserver bias
selection
bias

1.

2.

3. 12~15
)

57

IndicatorMeasurementIndicate

?
??
99-100

()

58
99-100


1.
4 (1)

15

(2)
15

2.
(1)


(2)

(3)

(4)

(5)
%

100%

3.
(1) /

(2)

(3)

(4)
%

100%

59

4.
(1)


(2) 2

(3) /


(4)

(5)

(6)
A %

(+)
100%
+

B %
2
100%



C %

100%


60

1.
2 (1) Indication
/

Opportunities
(2)

Opportunities
Performed actions
(3)

(4)
%
Performed actions
100%
Opportunities
2.
(1)
(
)

(2)

(3)
%

100%

1.
1 (1)



(2)
100
(3)
%

100 100%

61

1.
(1) TNIS
4

(2) 12
(3) %

100%

2.
(1)



12 1 4
4
(2)
(3)
%

100%
(4 )
3.
(1)
Staphylococcus aureusAcinetobacter baumannii
Enterococci( Enterococcus spp.Enterococcus faecium
Enterococcus faecalis)
OxacillinImipenem Vancomycin (S
Non-S) 12 1 3
3
Enterococci
Enterococcus spp.

Enterococcus faecium
Enterococcus faecalis

(2) (S Non-S)

(3)
%

100%
(3 )

62

4. ( MSSA MRSA)
(1) 48
(Staphylococcus aureus)
14
(2)
( MSSA MRSA)
(3) 12

(4)
( MSSA MRSA)%

100%
12


1.
5 (1)

15

(2)
15

2.
(1)


(2)

(3)

(4)

(5)
%

100%

63

3.
(1) /

(2)

(3)

(4)
%

100%

4.
(1)

(2)

(3)

(4)
%
()
100%

5.
(1)


(2)

(3)

(4)
%

100%

64

1.
2 (1) Indication
/

Opportunities
(2)

OpportunitiesPerformed
actions
(3)

(4)
%
Performed actions
100%
Opportunities
2.
(1)


(2)

(3)
%

100%

1.
1 (1)



(2)
100
(3)
%

100 100%

65

1.
(1)
(1)

(2) 15

IOMInstitute of Medicine
To err is human

WHO

//

// ~
(%)
// ~
(%)
// ~
(%)
// ~

(%)
// ~
(%)
// / // ~
/

(%)

66

/ //
5
//
// / //
/
(%)
// / //
/
(%)

X 2


(%)
X /

(%)
5
(%)



(%)
1

X /


(%)

67

/

/

* WHO Guidelines on Hand Hygiene in Health CareHand hygiene as a quality

indicator for patient safetyP166-167

68



1.

2.


3.

4.

5.
6.

1.
2.

3.

69

1.
2.

1.

2.
3.

4. ICUER

1.
(1)
(2)

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(4)

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2.
(1)
(2)
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3.

70
(1)
(2)

(3) 5

(4) 5

1.

2.
3.

()









National Patient Safety Foundation( NPSF) 2002
(Patient Safety Awareness Week PSAW)2009

71
One Partnership,One Team()


Learn how to become more involved in
care
Communicate and partner with
your providers
Reach out to the community
2007 (WHO)Clean Care is
Safer Care
ASK MESPEAK UP

ASK ME

PDCA

72
(WHO)

FOCUS-PDCA(

Finding Plan

Organize Do

Clarity Check

Understanding Action

Selection

FOCUS-PDCA

Finding

6W1H

1.What?

2.Where

3.When

4.Whom

73
5.Which

6.Who

7.How

Organize ()

1.

2.

3.

4.

whom

Clarity

74

1. 90%

2.

90%

(1)

(2)

(3)

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75

Selection

1.

2.

(1)

(2)

(3)

A.

B.

C.

D.

76

Plan

6W1H

Do

77
Check

baseline rate

Action

1.

2.

3.

4.

5.

78
WHO
WHO


5 27








/



WHO







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( 6 )















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27
6 5 5
5 6 5

80
100 500
4 125
126-250 251-375
376-500

5 20
5
12



WHO 5


WHO 5

5

5 WHO 5 5
5

81
5

Facility preparedness 2
Baseline evaluation 3
Implementation 3
Follow-up evaluation 2
Review and planning 2

82

WHO

83










()

(1)/
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1
(1)
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6
84

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85

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86

1
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3.5
3.6
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3.10()
3.11()

1313233
3.43.53.6
NA
2
3/
4

87


() (/) (/)

W11
W12
W13
W15
W21
W22
W23
W25
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W32
W33
W35
W41
W42
W43
W45
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W52
W53
W55
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W62
W63
W65
W71
W72
W73
PICU
BC
CCU
CVSI
MICU
NCU
SICU
RCC
BR
EICU

88

1.
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60
3.
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5.
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1.
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89

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()

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90

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2.
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60
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Pseudomonas aeruginosaE. coli
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8. 10-20 20-30 40-60
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91

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()

!!

92


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93






1.(
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//
()
,_________________________________
()
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94

/


/
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95

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96

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97

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()
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W12
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W22
W23
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99

(MICU)(CICU)(SICU)
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CCU
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MICU
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100

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101

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14

102

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106


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Q & A

107

()






1 2 3 4 5 6 7 8 9 10 11 12

108

()





1 2 3 4 5 6 7 8 9 10 11 12

Q&A

Q&A

OSCE

OSCE

109

()





1 2 3 4 5 6 7 8 9 10 11 12

110

()





1 2 3 4 5 6 7 8 9 10 11 12

111

()





1 2 3 4 5 6 7 8 9 10 11 12

112









() 70v/v (ethanol, ethyl alchol) 62.39% w/w

() 70v/v (isopropanol, isopropyl alcohol, 2-propyl)
( ) 70v/v (1-propanol, 1-propyl alcohol, n-propyl alcohol,
n-propanol, propanol)
() 70v/v

() (Dermal tolerance)
(
)

(dispenser)(

113

WHO

1.

0

0


5

1.1

10


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110 0
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110
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ICU 11
1.3 0
10
1.4 0
10
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10
1.6 0
/
10
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1.1-1.6 100
0

5
/100

114

2.

2.1
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5
2.1a
10


20

2.1b 0
20

2.2 WHO

2.2a WHO 0
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2.2b WHO 0
5
2.2c WHO 0
Why, How and When
5

2.2d WHO 0
5
2.3
0

15

2.4 0

15

2.5 0

10

/100

115

3.

3.1
0

10

3.2

0
3.2a
5
0
3.2b
5
3.3

3.3a 0
3-5 5
3.3b 0
3-5 5
3.3c 0
20 / 5
3.4

WHO
3.4
0
3.4a WHO 5
10
3 15
30 0
31-40 % 5
41-50 % 10
3.4b WHO
51-60 % 15

61-70 % 20
71-80 % 25
81 % 30
3.5
116

3.5a 0

3.5b
( 6 )
0
3.5b.i
7.5
0
3.5b.ii
7.5
/100

4.

4.1

0
/ 15
4.1a
/ 20
/ 25
0
/ 5
4.1b
/ 10
/ 15
0
/ 5
4.1c
/ 7.5
/ 10
0
4.2 10
2-3 15
4.3 0

10

4.4 0
10
4.5 0

15

117

/100

5.

5.1

0
5.1a
5
0
5.1b
5
5.1c 0
5
5.2

0
5.2a
10
0
5.2b
5
0
5.2c
5
5.3 0
5 5
10

5.4

0
5.4a *1
5
0
5.4b *2
5
5.5

5.5a ex 0
5
5.5b 0
10
5.6

5.6a E-learning 0
118

5
5.6b 0
5
5.6c 0
5
5.6d 0
ex 5
0
5.6e *3
5
5.6f Buddy system 0
4
* 5
/100

*1

*2 80%
WHO 5

*3

*4 Buddy system

119

WHO

80%

HCAIs. Staphylococcus aureus



bacteremia, Gram negative bacteremia,
HCAIs

NU
HCAI
HCAI


HCAI

WHO




/20
12

120

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