bundle care
DESCRIPTION
Education slide for the HCW about the bundle care~TRANSCRIPT
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!
謝謝您的聆聽