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  • LA PREVENZIONE DELLE INFEZIONI IN NEONATOLOGIA: PRESENTAZIONE DI NEONATOLOGIA: PRESENTAZIONE DI

    UN INTERVENTO DI SUCCESSO

    Silvia CattaniSilvia Cattani Dipartimento Integrato Materno InfantileDipartimento Integrato Materno Infantile

    Struttura Complessa di NeonatologiaStruttura Complessa di Neonatologia Direttore: Prof. Fabrizio FerrariDirettore: Prof. Fabrizio Ferrari

    Giulia Barozzi, Fabrizio Minopoli, Elisa Nieddu, Anna Piccolo, Giovanna Cuomo, Elisa Della Casa Patrizia Marchegiano, Elena Vecchi. Barbieri Monica, Bianchini Giliola, Scannavini Patrizia

  • La Giornata mondiale sull’igiene delle mani:

    l’esperienza della TIN di Modena

    Dipartimento Integrato Materno InfantileDipartimento Integrato Materno Infantile Struttura Complessa di NeonatologiaStruttura Complessa di Neonatologia

    Prof. Fabrizio FerrariProf. Fabrizio Ferrari

    5 maggio 2011

    Giulia Barozzi, Fabrizio Minopoli, Elisa Nieddu, Anna Piccolo, Giovanna Cuomo, Elisa Della Casa, Silvia Cattani

  • Potentially Better Practices PBP #1: Meticulous attention to hand washing, with regular monitoring,surveillance and reporting of compliance PBP #2: Improve accuracy of diagnosis PBP #3: Follow a multifactorial, standardized hub and line care

    Vermont Oxford Network Tools for Improvement Series

    Reducing Nosocomial Infections

    PBP #3: Follow a multifactorial, standardized hub and line care procedure for reducing hub colonization PBP #4: Reduce duration of lipid use PBP #5: Limit time that percutaneous lines are in place to 21 days PBP #6: Topically apply preservative-free ointment PBP #7: Reduce skin punctures PBP #8: Use maximal barrier precautions for insertion of central catheters

  • Iatrogenic complications rise in the NICU with the increased length of hospital stay

    and level of immaturity.

    J Perinatol. 2010 Oct;30 Suppl:S51-6.

    Iatrogenic complications in the neonatal intensive care unit Sekar KC. Department of Pediatrics, NeonatalDepartment of Pediatrics, Neonatal--Perinatal Medicine, Oklahoma City, USA.Perinatal Medicine, Oklahoma City, USA.

    nosocomial infections,

    50% 50%

    . .

    nosocomial infections, insertion of invasive catheters

    prolonged mechanical ventilation administration of parenteral nutrition solution

    skin damage environmental complications

    medication errors

    AdoptingAdopting newer technologies and newer technologies and preventive measurespreventive measures

    might decrease these complications and improve might decrease these complications and improve outcomes. outcomes.

    Quality improvement projectsQuality improvement projects,, targeting areas, targeting areas, are expected to build are expected to build team spiritteam spirit and and

    further improve the outcomesfurther improve the outcomes

  • Quality improvement projectsprojects

    Qualche esempio

  • J Matern Fetal Neonatal Med.2010 Sep; 23(9):1039-46.

    Reducing nosocomial infections in neonatal intensive care. Rogers E et al Neonatal Intensive Care Outcomes, Queen’s University Belfast, Northern Ireland

    Clin Perinatol 2010 Sep; 37(3):645-53

    Simple strategies to reduce healthcare associated infections in Neonatal Intensive Care Unit: line, tube and hand hygiene.

    Infect Control Hosp Epidemiol 2004; 25(3):264-6

    Cost implications of successful hand hygiene promotion. Pittet D et al Geneve, Switzerland

    infections in Neonatal Intensive Care Unit: line, tube and hand hygiene. Graham PL Division of Pediatric Infectious Disease. Columbia University College of Physicians and Surgeons, New York, USA

  • Pilot Quality Improvement initiative focussing on

    hand hygiene

    Pre and post- intervention questionnaires

    J Matern Fetal Neonatal Med.2010 Sep; 23(9):1039-46.

    Reducing nosocomial infections in neonatal intensive care. Rogers E et al Neonatal Intensive Care Outcomes, Queen’s University Belfast, Northern IrelandNeonatal Intensive Care Outcomes, Queen’s University Belfast, Northern Ireland

    ↓↓↓↓ LCBSI

    . .

    statistically significant

    •Increase in use of alcohol-based gel

    •Increased knowledge of hand hygiene

    ↓↓↓↓ LCBSI ↓↓↓↓ VAP

    LCBSI: line associated laboratory confirmed bloodstream infection VAP: ventilator associated pneumonia

  • hand hygiene: cornestone for prevention of HAI

    Education and training

    of health care personnel

    Clin Perinatol 2010 Sep; 37(3):645-53

    Simple strategies to reduce healthcare associated infections in Neonatal Intensive Care Unit: line, tube and hand hygiene. Graham PL Division of Pediatric Infectious Disease. Columbia University, New York, USADivision of Pediatric Infectious Disease. Columbia University, New York, USA

    . .

    of health care personnel

    Prevention of Infection related to •Central venous catheters •Urinary tract catheters

  • Cost effectiveness of providing alcohol-based foam and

    the campaign itself

    Infect Control Hosp Epidemiol 2004; 25(3):264-6

    Cost implications of successful hand hygiene promotion. Pittet D et al Geneve, Switzerland

    . .

    < 1% of a cost of a nosocomial infection

  • OMS: 13 OTTOBRE 2005 “ GLOBAL PATIENT SAFETY CHALLENGE”

    “ Clean Care is Safer Care”

    • 250 STATI PARTECIPANTI ( agenzie internazionali, agenzie governative, istituzioni mediche)

    • Linea guida “ Clean Hands are Safer Hands”

  • Promoting “clean care is safer care” isPromoting “clean care is safer care” isPromoting “clean care is safer care” isPromoting “clean care is safer care” is not a choice.not a choice.not a choice.not a choice.

    It is our duty to patients, their family It is our duty to patients, their family It is our duty to patients, their family It is our duty to patients, their family and health care workers.and health care workers.and health care workers.and health care workers.

    Let us move forward together.Let us move forward together.Let us move forward together.Let us move forward together. Each of us can make a small Each of us can make a small Each of us can make a small Each of us can make a small Each of us can make a small Each of us can make a small Each of us can make a small Each of us can make a small

    difference; significant improvements difference; significant improvements difference; significant improvements difference; significant improvements requires an effort from all of usrequires an effort from all of usrequires an effort from all of usrequires an effort from all of us

    Professor Didier Pittet

    Leader of the Global Patient Safety Challange

  • Dipartimento Integrato Materno Infantile Struttura Complessa di Neonatologia

    Area Igiene Ospedaliera

    PROGETTO IGIENE MANI PROGETTO IGIENE MANI IN NEONATOLOGIA

    2007-2009 A cura di:

    Neonatologia Prof. F. Ferrari, D.ssa Elisa Della Casa, D.ssa Silvia Cattani, Giovanna Cuomo, Giulia Barozzi, Emilia Capuano, Elisa Nieddu.

    Igiene Ospedaliera D.ssa Patrizia Marchegiano, D.ssa Elena Vecchi. Barbieri Monica, Bianchini Giliola, Scannavini Patrizia

    Responsabile generale: Dr.ssa S. Cattani Responsabile operativo: G. Bianchini

    Hanno collaborato: Farmacia:

    Dr.ssa B. Petocchi

  • Una storia che inizia da Una storia che inizia da lontano…lontano…

    2003:2003: prima epidemia da prima epidemia da Serratia Serratia marcescensmarcescens

    Cohorting Personale dedicato

    Screening settimanali Tamponi ambientale/personale Incontri informativi/formativi

    Comunicazione ai genitori Chiusura del reparto

  • Epidemie

    Germi sentinella

    Cohorting Personale dedicato

    Screening settimanali Tamponi ambientale

    Incontri informativi/formativi Comunicazione ai genitori

    Reparto chiuso

  • ……………………una maggiore una maggiore consapevolezzaconsapevolezza

    Se l’ infezione è correlata

    all’assistenza sanitaria

    Allora l’epidemia non accade…

    ...è provocata e … prevenibile

    all’assistenza sanitaria

  • 20072007

    Area igiene

    ospedaliera TIN

    Progetto “igiene

    2007

    igiene ospedaliera

    TIN “igiene mani””””

  • “Il lavaggio delle mani è la procedura singola più importante

    per la prevenzione delle infezioni associate all’assistenza”associate all’assistenza”

    CDC

  • Il progetto...Il progetto... (2007(2007--2009)2009)

    1)1) Fase zero: Misurazione della situazione Fase zero: Misurazione della situazione esistente esistente . Questionario di autovalutazione . Questionario di autovalutazione . Osservazione dei comportamenti . Osservazione dei comportamenti

    2)2) Fase di implementazione di tipo Fase di implementazione di tipo formativo/informativoformativo/informativoformativo/informativoformativo/informativo

    3)3) Fase 1 : misurazione dei risultati Fase 1 : misurazione dei risultati raggiunti raggiunti . Qu

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