bundle care

預防手術感染 Bundle

蘇迎士 疾病管制局 防疫醫師

Bundle

三到五個臨床強烈支持目標

指定特定族群

多個專家系統

局部微調

要就做到最好 一個不能少

•三到五個臨床強烈支持目標

•指定特定族群

•多個專家系統

•局部微調

•要就做到最好，一個不能少～

•三到五個臨床強烈支持目標

•指定特定族群

•多個專家系統

•局部微調

•要就做到最好，一個不能少～

•三到五個臨床強烈支持目標

•指定特定族群

•多個專家系統

•局部微調

•要就做到最好，一個不能少～

•三到五個臨床強烈支持目標

•指定特定族群

•多個專家系統

•局部微調

•要就做到最好，一個不能少～

Prophylatic antibiotics

先分清楚開什麼刀～

Class 1 or Clean wound

Non traumatic

No inflammation

No Viscus opened

Infection rate 1-2%

PGMEDICALWORLD.COM

Class 2 Wounds/ Clean contaminatedClass 2 Wounds/ Clean contaminated

• Viscus opened but minimal spillageViscus opened but minimal spillage

• Infection rate < 10%Infection rate < 10%

Class 3/ Contaminated Wound Opened viscus with spillage Traumatic wounds Fresh entrance of

genitourinary or biliary tracts in presence of infected urine or bile

Class 4 Wound/ Dirty

Acute bacterial infection encountered with out pus

Traumatic wounds with retained devitalised tissue, foreign bodies of fecal contamination

Type of Wounds suitable for Antibiotic Prophylaxis

Class1 or Clean wounds with implants

Class 2 or Clean contaminated

Class 3 & Class 4 wounds

Antibioticstherapeuticapplied for longer duration

時間很重要請在一個小時內給藥

Second doseGive if surgery lasts more than 3-4 hrs

Prophylactic antibioticsdiscontinued within 24 hours

after surgery end time (48 hours for cardiac patients)

Hair remover

Hair Removal MethodShaving versus Clipping

Hair Removal Method Clean Wound Infection

Rate (%)

Shaved with razor 2.5

Clipped 1.7

Electric razor 1.4

Not shaved, not clipped 0.9

Depilatories 0.6

LLF SSI Standards 2013

The increased risk with shaving prior to the operation is associated with microscopic cuts and shaving immediately before seriously reduces the SSI risk ( 20% risk if shaved >

24hrs--CDC, 1999).

Cruce and

Forde, 1981

Appropriate hair removal

(if deemed necessary, remove using clippers or depilatory)

Blood sugar control

ImmediatePostoperativeNormothermia

Identify and Treat remote infections(Prior to elective surgical

procedures.)

•Antiseptic shower at least the night before and preferably also the morning of the scheduled surgery.

還有沒有其他bundle?

BSI bundle

打哪裡很重要

Bundle~其實是幫不得啦！

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