?NDM-1????????? ???????

1
?NDM-1????????????????

• ?????
• ???

2
????NDM-1???? ???????
3
?????????????

• ????????????????,?????????,???????????????????????
  ????
• ???????,???????????,??
• VRE?MRSA?VRSA?NDM-1???

4
(?)???NDM-1?????

• ???NDM-1?????????????????,????,???????,????????,??
  ??,????,????????

5
???????? ????????????? ??????????
?????MRSA?? ????
6
??????????????

• ????
• ?????????NDM-1?????????????,???????????,???????,??
  ????????NDM-1???????????????????????????????????24
  ????????????
• ???????? ?????5???????????????,??????????????????
  ???,??????????????,?????????,???????????,?????????
  ???

7

• ???
• ?????????????NDM-1???????????????,??NDM-1????????
  ?,????????????????????(MRSA)?????????(VRE),?????ß-
  ????(ESBL)????????????????????????,?????????????
  ???????????

8

• ???????
• ?????????????????
• ?????????
• ????????????

9
(?)????????????

• ?????????????????,??????????????????????

10
??? ?????

• ???? ??????????????????????,??????????????????

????????2006?9?1
11
???????????????????????????????2008?130?

• ???????????????????
• ????????????????
• MRSA?VRE?ESBLs????????????
• ???????????????
• (?)??????????
• (?)????????
• (?)????????????
• (?)??????????
• ?????????????
• ???????????????
• ????????????
• ?OO????????????

12
????????????
?????
???
13
?????????12???????
? ????
14
?????????12???????
15
???????
16
?????????12???????
? ????????
17
?????????12???????? ????
18
?????????12??? ????(Hospitalized Adults)
19
(?)???????????

• ????,??,???NDM-1??????????????????

20
???????

• ????????,????????
• ???????????
• ????
• ??????????
• ??????????????
• ?????????????
• ??????
• ????????????
• ???????????????????
• ????????????????,??????????,??????????

21
???????????,????????
22
??CR-BSI bundle

• ?????????????Maximal sterile barriers
• ???????Chlorhexidine skin antisepsis
• ?????????????Site choice
• ?????????HAND HYGIENE
• ??????????????
• ????Antibiotic-coated or antiseptic- impregnated
  catheter
• ??????Post-insertion care

23
?????????VAP bundle

• ??????30?Head of bed - 30
• ??????????????????Sedation Holiday/weaning
• ?????????????Peptic Ulcer Disease (PUD)
  Prophylaxis
• ???????????26??Oral care
• ???????Deep Vein Thrombosis (DVT) Prophylaxis
• ????????????(?)

24
??????????? WHO??(2002)
?????

• ?????
• ???????? ??????????
• ???????? ????
• ???????? ?????????
• 
  ?????????
• 
  ???????????

25
???????????

• ?????????,
• ??????????,??????!

26
????????????????
27
Hand hygiene Bedpans ??????

• Lots of opportunities to contaminate hands
• ???????
• Hands can contaminate environment and patients
• ?????????

Braking the Chain by Basic Hygiene
????????,??????
http//www.who.int/gpsc/5may/en/
28
Machinal Cleaning Disinfection is Safe

• Prevents Contamination ??????
• Prevents Occupational Health Risk ??????
• Common in North-West Europe ??????????
• Cleaning and Thermal Disinfection ?????????
• Saves Nursing Time ??
• Easy to use ????
• Better Result ????

29
?????????
Prof. Dr. med. H.-P. Werner, Hygiene-Institut
Mainz.
30
???????
contaminated workroom
31
???????????
??
????
A0 60 ?
????
A0 3000
A0 600
????
A0 600
??????/??
??
32
(No Transcript)
33
?????????(?????)
34
????

1? ------???????????????????,?????????????? 2?---
---????????????????????,??????????????,???????????
? 3?------??????????????????????,??????????????,?
????????
35

36
(No Transcript)
37
(No Transcript)
38
??????

• ??
• ??
• ??
• ??
• ??
• ????
• ????
• ????
• ??????

39
MRSA????
40
?????????????Care ?????????
(??)
??????!
(????)
41
The                                               
                                                  
                                                  
                                                  
                             
  
Dish is filled with CFU's of C.difficile from a
culture of a HCWs hand after working with a
C.difficile patient.
42
????????????????
43
(No Transcript)
44

Handwashing with soap
and water when hands
are visibly dirty ??????

Adoption of alcohol
-
based hand rub is the
gold standard in all
other clinical situations,
whenever possible ?????
45
(No Transcript)
46
????????????

• ????
• ???
• ??????
• ????
• ???-????
• ??????
• ??????

47
??????
48
????
49
(No Transcript)
50
?????????!

??????????.
51
??????
52
The 5 indications
???????
?????
????\???
?????
????????????
53
?????????????????????

• -??????

54
(?)???NDM-1????????????????????

• ????????????????????

55
??
56
????-????

• 1???????????,????????????,?????????????2????
  ???????,??????,??????? 3?????????????????????,??
  ????,?????????????? 4??????????????,????????????
  ???,???????????5??????????????,???????,????????,
  ????????????,??????????? 6??????,??????????????,
  ??????????????,??????

57
????-????

• 7??????,?????????,??????????????
  8????????????,?????????? ?????? ,?????
  29?????????????,???????????????,??????????????
  ????????????????,???????,??????,????,????,????????
  ?10????????VRE?????,????????????,?????????,?????
  ???????? ?????????VRE??????????,????????,?????????
  ????,????????????

58
Thank you