针扎之处置追踪与预防医疗品质与病人安全课件

針扎之處置針扎之處置,追蹤追蹤,與預防與預防-醫療品質與病人安全醫療品質與病人安全歐聰億歐聰億感染科感染科萬芳醫院萬芳醫院台北醫學大學台北醫學大學针扎之处置追踪与预防医疗品质与病人安全SARS 之經驗之經驗醫護人員需先保護自己醫護人員需先保護自己,才有能力才有能力救治別人救治別人.针扎之处置追踪与预防医疗品质与病人安全 Needlestick injury针扎之处置追踪与预防医疗品质与病人安全醫療品質與病人安全醫療品質與病人安全Health Care Organization Management Standards1.Quality Improvement and Patient safety2.Prevention and Control of infections3.Governance,Leadership,and Direction4.Facility Management and Safety 5.Staff Qualification and Education6.Management of Communication and Information.针扎之处置追踪与预防医疗品质与病人安全何為感染控制?What is infection control?診斷感染性疾病病源和起因微生物學循證感染控制感染傳播的控制流行病學降低傳播政策落實教育遵從行為科學人員遵從意識資料來源：Seto Wh博士，亞太感染控制學會主席针扎之处置追踪与预防医疗品质与病人安全Infection Control Concept透過以下三個方向改善感染控制：透過以下三個方向改善感染控制：To improve infection control through:l基於證實的感控最佳實務基於證實的感控最佳實務Best practice in evidence based Infection Controll避免感染傳播的創新工具避免感染傳播的創新工具 Innovative Solution to reduce spread of Infectionl持續教育宣導提昇人員遵行持續教育宣導提昇人員遵行 Human compliance through education感控理念感控理念The Infection Control Concept改善治療效果改善治療效果Improve patient outcome提高聲譽提高聲譽Enhance reputation降低成本降低成本Avoid cost符合評鑑符合評鑑Meet Accreditation為醫護人員提供安全保護為醫護人員提供安全保護Support health-careWorker safety資料來源：Seto Wh博士，亞太感染控制學會主席针扎之处置追踪与预防医疗品质与病人安全感控理念架構Infection Control Concept Cascade對感染零容忍幫助人類健康生活病患及醫護人員的安全醫療照護相關感染基於實證的感控式最佳實務持續教育宣導提昇人員遵行避免感染傳播的創新工具計畫:Plan 檢核:Check 執行:Do 行動:Action改善治療效果 降低成本 提高警覺符合評鑑 醫謢人員安全(PDCA)5 5個益處4 4個步驟3 3個方向2 2個挑戰1 1個願景 0容忍针扎之处置追踪与预防医疗品质与病人安全Patient Oriented Infection Control Commitment 收集數據 採集檢體 疾病診斷 治療 出院 注射/輸液入院病患及醫護人員安全醫護照護相關感染靜脈穿刺安全預防導管相關的血流感染採血安全醫療照護相關感染主動偵測及控制针扎之处置追踪与预防医疗品质与病人安全預防醫療照護相關感染HAI Prevention病患及醫護人員的安全 與醫療品質息息相關而醫護人員的安全,其中以針扎為最常見.(其他包括:TB,SARS,H1N1,輻射安全.)针扎之处置追踪与预防医疗品质与病人安全針扎的處置針扎的處置Hepatitis B virus Hepatitis C virusSyphilisHIV(Human immunodeficiency virus)针扎之处置追踪与预防医疗品质与病人安全被針頭刺傷或尖銳物品割傷立即擠壓傷口血管使血流出，並於流動清水下清洗傷口5分鐘含血不含血檢查尖銳物品或來源者血清的愛滋病毒抗體反應(註2)陽性陰性(註3)定期（六週、三個月、六個月）追蹤三次抗體檢驗結果，六個月後追蹤結果為陰性即可排除感染之虞。經醫師瞭解扎傷之狀況及血液交流情形，撥打1922民眾疫情通報及諮詢專線，轉針扎處理專線醫師，共同評估是否需使用抗愛滋病毒預防性用藥。帶著尖銳物或來源者的血液，立即至醫療機構(註1)或聯絡當地衛生單位人員處理。觀察，日後若出現紅腫熱痛再行就醫處理。經評估需使用抗愛滋病毒預防性用藥者，至愛滋病指定醫院由醫師開立處方(註4)。並按時服藥。經評估無需使用抗愛滋病毒預防性用藥者。檢視尖銳物一般民眾一般民眾针扎之处置追踪与预防医疗品质与病人安全醫療機構請就近前往（藥癮）愛滋病指定醫院或具備愛滋病毒快速篩檢能力之醫療機構，並通知當地衛生局協助處理利用HIV快速檢驗試劑可以在1小時內得知是否為感染者，但仍需要注意空窗期問題。另B肝、C肝、梅毒亦可能透過血液傳染，應詢問醫師是否需作任何預防感染處置措施。如已知來源者，請先取得其同意後方得檢驗；若無法取得其同意，則評估其是否為HIV感染高危險群，以做為是否預防性用藥之參考。针扎之处置追踪与预防医疗品质与病人安全若檢驗陰性但病人有危險行為（如毒癮者且共用針頭等），則仍應收集病人資料，到愛滋病指定醫院由醫師判斷是否需用藥。預防性藥物要越早使用越好，最好是6小時內，超過48小時以上效果差。皮膚傷口接觸到愛滋病毒陽性血液(例如被針頭刺穿)後受到傳染的危險性約為0.3%，黏膜接觸後受傳染的危險性約為0.09%。接觸到HbsAg(+),HbeAg(-)危險性約為1-6%，兩者均陽性危險性約為22-31%。接觸到HCV(+)危險性約為1.8%。针扎之处置追踪与预防医疗品质与病人安全HIV PEPBasic:AZT 200mg tid+3TC 150mg bidfor 4 weeksExpanded:basic regimens(2 NRTI)+PI(protease inhibitor)or+NNRTI 针扎之处置追踪与预防医疗品质与病人安全Timing of PEP initiationInitiate as soon as possible针扎之处置追踪与预防医疗品质与病人安全Postexposure testing1.In patients with basic regimens:FU HIV serology at 1.5,3,&6 mons2.In patients with expanded regimens:FU HIV serology to 12 mons3.HIV testing in any suspected acuteretroviral syndrome4.Direct viral assays is not recommended for routine use针扎之处置追踪与预防医疗品质与病人安全Hepatitis B ExposureExposure person Source:HBs Ag(-)Unvaccinated Initiate HB vaccineVaccinated No rx necessary针扎之处置追踪与预防医疗品质与病人安全Hepatitis B ExposureExposure person Source:HBs Ag(+)Unvaccinated HBIG+vaccineVaccinated If anti-HBS(+),follow up If anti-HBS(-),HBIG+vaccine针扎之处置追踪与预防医疗品质与病人安全Hepatitis C ExposureNo specific treatment at present.Follow up 1,3,6,12 months针扎之处置追踪与预防医疗品质与病人安全Syphilis exposureIf the patients serology:TPHA 160,Benzathine penicillin 1 vial IM st.Follow up 1,3,6 months.针扎之处置追踪与预防医疗品质与病人安全Prevention 针扎之处置追踪与预防医疗品质与病人安全防止針扎的五大作為Develop an institution-wide culture of safety in the work environmentPromote reporting of sharps injuries and injury hazardsAnalyze sharps injury data for prevention planningSelect/evaluate sharps injury prevention devicesEducate and train healthcare personnel针扎之处置追踪与预防医疗品质与病人安全感控理念架構Infection Control Concept Cascade對感染零容忍幫助人類健康生活病患及醫護人員的安全醫療照護相關感染基於實證的感控式最佳實務持續教育宣導提昇人員遵行避免感染傳播的創新工具計畫:Plan 檢核:Check 執行:Do 行動:Action改善治療效果 降低成本 提高警覺符合評鑑 醫謢人員安全(PDCA)5 5個益處4 4個步驟3 3個方向2 2個挑戰1 1個願景 0容忍针扎之处置追踪与预防医疗品质与病人安全ER與CCU全面使用安全針具後之針扎狀況使用安全針具零回套針扎來源:中部某醫學中心資料针扎之处置追踪与预防医疗品质与病人安全ER危險針具扎傷分析來源:中部某醫學中心資料针扎之处置追踪与预防医疗品质与病人安全 Sharps container针扎之处置追踪与预防医疗品质与病人安全Single dose,protective system针扎之处置追踪与预防医疗品质与病人安全安全針具/器動脈採血針安全性靜脈留置針無針式輸液套接頭一般注射針頭针扎之处置追踪与预防医疗品质与病人安全SummarySharps injuries are an important concernIncreased risk of disease transmissionHigh costs to personnel and healthcare systemMost sharps injuries are preventableNeedlestick Safety and Prevention Act requires prevention efforts be undertakenValuable in development of sharps injury prevention programPotential to enhance current prevention 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