? ??????S??S OS ??G? ????O??O?

1
? ??????S??S OS ??G? ????O??O?

• ?.?.?????O???
• ???S??????? ?G???S
• ??S???????? ???G??? ????O??O?
• ?. ?. ?. ?. ??????

2
(No Transcript)
3
??????S ???F???????S S? ??????? ??????S?? ???
????????? ?????? (2004-2005)
????S????? 20 PC HARDWARE (?????????G??, ???????) 4
?????. ????S??? 17 PC HARDWARE (?????????G??, ???????) 4
????S????S ??F?????????S 4 ???SO???? ??????????? ???T????? (organizers, ????t? t??., ß?µß?t??) 3
???G? ???????S?. ???????G. 3 ???SO???? ??????????? ???T????? (organizers, ????t? t??., ß?µß?t??) 3
???????S S?S????S 3 S??T?S????? 3
????ST?S??? ???. 2
????/??-??F???S 2
??????? ??T???S? 2
S?s?e?? ???µa?s?? as?, s?s?. a?µ?d????s??
4
???G??S S??????S ?? ??????? ??????S??G?????

• ???????
• Guidelines for Environmental Infection Control in
  Health-Care Facilities Recommendations of CDC and
  the Healthcare Infection Control Practices
  Advisory Committee (HICPAC). MMWR 2003 52 (No.
  RR-10) 148.
• Guideline For Prevention Of Surgical Site
  Infection, CDC, HICPAC AJIC vol.
  199927(2)97-132

5

• WHO
• Practical Guidelines For Infection Control ?n
  Health Care Facilities World Health Organization
  December 2003
• Prevention Of Hospital-acquired Infections A
  Practical Guide 2nd Edition World Health
  Organization 2002
• ?GG???
• Good Practice In Infection Control Royal College
  of Nursing 2004 (www.rcn.org.uk)
• Infection control Prevention of
  healthcare-associated infection in primary and
  community care National Institute for Clinical
  Excellence 2003 (www.nice.org.uk)
• Evidence-based Guidelines For Preventing
  Healthcare-associated Infections In Primary And
  Community Care In England Department of Health
  2001

6

• ??S??????
• Infection Control Guidelines For The Prevention
  Of Transmission Of Infectious Diseases In The
  Health Care Setting Department of Health and
  Aging Australia, January 2004, (www.icg.health.gov
  .au)
• Infection Control In Victorian Public Health
  Services. Victorian Government Department of
  Human Services, Melbourne 2002 (www.infectioncontr
  ol.health.vic.gov.au)

7
???G??S S??????S ?? ??????? ??????S?? (??????)

• ???????
• Multi-society Guideline For Reprocessing Flexible
  Gastrointestinal Endoscopes, SHEA Position Paper,
  Infection Control And Hospital Epidemiology
  200324 (7) 532-537
• Guideline For The Use Of High-level Disinfectants
  and Sterilants For Reprocessing Of Flexible
  Gastrointestinal Endoscopes, Society of
  Gastroenterology Nurses and Associates 2003 (www.
  sgna.org/resources/HLD.html)
• Apic Guideline For Infection Prevention And
  Control In Flexible Endoscopy Am J Infect Control
  200028138-55

8

1. Enforcement Priorities For Single-use Devices
   Reprocessed By Third Parties And Hospitals
   Guidance for Industry and for FDA Staff. U.S.
   Department Of Health and Human Services Food and
   Drug Administration Center for Devices and
   Radiological Health, 2000 (www.
   fda.gov/cdrh/comp/guidance/1168.pdf.)
2. Apic Guideline For Selection And Use Of
   Disinfectants, Rutala W, and 1994,1995,1996 APIC
   Guidelines Committee, Am J Infect Control
   199624313-42
3. Evidence-based Clinical Practice Guideline For
   The Prevention Of Ventilator Associated
   Pneumonia, 2004 American College of Physicians
4. Guidelines For Preventing Health-care-associated
   Pneumonia, 2003 Recommendations of CDC and the
   Healthcare Infection Control Practices Advisory
   committee (www.cdc.gov)

9

1. Guidelines For The Prevention Of Intravascular
   Catheter-related Infections Recommendations
   Relevant To Interventional Radiology, Donald L.
   Miller, MD, and Naomi P. OGrady, MD. J Vasc
   Interv Radiol 2003 14S355S358
2. Guidelines For The Prevention Of Intravascular
   Catheter-related Infections 2002 CDC MMWR Morb
   Mortal Wkly Rep 51(RR-10)1-26
3. CDC Guidelines For Infection Control In Dental
   Health-care Settings Morbidity and Mortality
   Weekly Report December 19, 2003 / Vol. 52 / No.
   RR-17
4. Computer Equipment Used In Patient Care Within O
   Multihospital System Recommendations for
   cleaning and disinfection. Neely A. et al. Am J
   Infect Control 200533 (4) 233-237

10
???G??S S??????S ?? ??????? ??????S?? (??????)

• ??????S
• Classic Creutzfeldt-Jakob Disease in Canada,
  Infection Control Guidelines, Health Canada.
  Canada Communicable Disease Report (CCDR) vol.
  28S5 2002 (www.phac-aspc.gc.ca)
• Hand Washing, Cleaning, Disinfection And
  Sterilization In Health Care, CCDR Vol 24S8 1998
  (www.phac-aspc.gc.ca)
• Reprocessing of Reusable and Single-Use Medical
  Devices. ?p????. ??e?a? ?????? 2004
• ?.?.?.
• WHO Infection Control Guidelines For
  Transmissible Spongiform Encephalopathies, World
  Health Organization Communicable Disease
  Surveillance and Control, Geneva, 1999
  (www.who.int)

11

• ?GG???
• Sterilization, Disinfection And Cleaning Of
  Medical Equipment Guidance on Decontamination
  from the Microbiology Advisory Committee (MAC) to
  Department of Health Medical Devices Agency (MAC
  Manual) 2002
• Single-use Medical Devices Implications And
  Consequences Of Reuse Medical Devices Agency
  (MDA) 2000

12
?????S??S ???S???????????? ??????S???

1. ??pa?de?s? ???s?p????
2. ?a?a??sµ?? p??ap???µa?s?
3. ?p????? ?at??????? µe??d?? ap?ste???s??
   ap???µa?s??
4. ?pa?a???s?µ?p???s? µ?a? ???s?? e??p??sµ??

13
??pa?de?s? s?et??? µe

• ???d?a??af?? ??a t?? p??µ??e?a t?? s?s?e???
• ?t?µ??? µ?t?a p??stas?a?
• S?µas?a t?? p??s?µat?? t?? ?e????
• ????d?? ?a?a??sµ?? ap???µa?s?? ap?ste???s??
• ???s? t?? d?af???? s?s?e??? ?a? s?e?asµ?t??
  (a?a??s?, ?e?µ???as?a, d????e?a eµß?pt?s?? ??p.)
• ??e???? ap?te?esµat???t?ta? t?? d?ad??as?a?
• ?a?et???sµa - f??a??
• ?????e?e? se pe??pt?s? at???µat??

14

• ?a?a??sµ??
• ? d?ad??as?a p?? ??e? s??p? t?? apa??a?? t??
  a?t??e?µ???? ap? ?p??e?µµata ?st??, ??p??, a?µa,
  e????se??, ape????se??, ??µ??? ?at????pa ??p.
• ???ap???µa?s? (Decontamination)
• ? d?ad??as?a p?? ??e? s??p? t?? e??tt?s? t??
  µ????ß?a??? f??t??? ap? t?? ep?f??e?a e???
  ???s?µ?p???µ???? ??????? ?ste ?a e??a? asfa???
  ??a t?? ?e???st?

15
??te ???eta?

• ?e???sµ? e??p??sµ?? ?a?a?t???sµ???? ?? ?aµ????
  ???d???? (?p?p?a, stat?, t?????, d?peda, p?µ??a,
  p?eß???a, ???s??e? ??p.)
• Sa? p??t? ß?µa st?? et??µas?a t?? ?at?????
  e??p??sµ?? ??a ap???µa?s? ? ap?ste???s?

??? de? p??????e? s???ast???? ?a?a??sµ?? t??
??????? ? ?p?ste???s? ? ? ?p???µa?s? de? ?a
e??a? ap?te?esµat???
16
??? ???eta?

• ?e a?t?µata µ??a??µata
• - ????t???a ?e?????????? e??a?e???
• - ????t???a ?e?µ???? ? ??µ???? ap???µa?s??
• - ????t???a ?pe?????
• ?e????a?t???
• - ????? p?? µp????? ?a ß???st??? se ????
• - ????? p?? de? µp????? ?a ß???st??? se ????

17
???a????? ?a?a??sµ??
???te??eta?

• ? ???d???? µ????s?? t?? ?e???st? ?a? ???es?? t??
  se ??µ???? ??s?e?
• ??p?p???µ??? d?ad??as?a p?? ?ata???feta?
• ?µ??
• ??pa?de?s? st? ???s? t?? s???e???µ????
  µ??a??µat??
• ????s? ?d????? ?atas?e?ast??
• ???a?a µe a????? p??pe? ?a p?????ta? ?a?
  ?e????a?t???
• ????µ??? ??st??

18
?e????a?t???? ?a?a??sµ??

• ?ta? de? ?p???e? d?a??s?µ?? e??p??sµ?? ??a
  a?t?µat? ?a?a??sµ? ?a?
• G?a e?a?s??ta ?a? pe??p???a ???a?a
• ???s??? Sta a??µ???, sta ???a?a µe a?????,
  a????se??, e???p??
• ???s? at?µ???? µ?t??? p??stas?a? (ad??ß????
  p?d??, ???t?? ???t?a, µ?s?a, p??state?t???
  p??s?p?? ??p.)

19
?p????? t?? ?at??????? µe??d?? ???eta? µe ß?s?

1. ??? ßa?µ? ep????d???t?ta? t?? ???????
2. ??? ?d???e? t?? ?atas?e?ast? t?? ???????

20
?at?ta?? a?t??e?µ???? ?at? Spaulding
?????? ???d???? (???s?µa) ??s?????ta? se ?st???, ste??e? ?????t?te? ? st? a??e?a?? s?st?µa (?p?ste???s?) ?e??/???? e??a?e?a, ?a?et??e? (a??e?a-??? ??ste??), eµf?te?µata ??p.
??s?? ???d???? (?µ????s?-µa) ?????ta? se epaf? µe ß?e????????? ? µe d??µa p?? de? e??a? a???a?? (?p?ste???s? ? ?????? ?a?µ?? ap???µa?s?) Gast??s??p?a, ??????s??p?a, a?ap?e?st??? ?????µata, ??p.
?aµ???? ???d???? (µ? ???s?µa) Se epaf? µe ????? d??µa ? ?aµµ?? epaf? µe t?? as?e?? (??s?? ? ?aµ???? ßa?µ?? ap???µa?s? ? ap??? ?a?a??sµ??) Te?µ?µet?a, p?es?-µet?a, s???aµ?de?, ?µat?sµ??, p??ta, ??µ?d??a, pat?µata ??p.
21
?????????????S ???S? ?O? ??T??O?
????????S?S-???S????OS?S
Sp???? Sp???? ????ßa?t???d?a ?a?t???a ???
?p?ste???s? ?p?ste???s? ?p?ste???s? ?p?ste???s? ?p?ste???s? ?p?ste???s?
?tµ?? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
???? ?e?µ ? ? ? ? ?
???sµa ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
?p???µa?s? ?p???µa?s? ?p???µa?s? ?p???µa?s? ?p???µa?s? ?p???µa?s?
??t?µata µ? ? ? ? ? ? ? ? ? ? ? ??
?tµ?? ??e?µ ? ? ? ? ? ? ? ? ? ? ??
??µ??? ap??
MAC Manual 2002 Medical Devices Agency
? ?aµ?? ? ????? ?? ??t??a ? ? ? ?a??
22
???S? ?????O? ???????????O?
Sp???? ?? ?a?t???a ???
??????e? ? ?? ? ? ? ??
G???ta?/d? ? ? ? ? ? ? ? ? ? ?
????f?a?/d? ? ? ? ? ? ? ? ? ? ?
????e?d ??????? ? ? ? ? ? ? ? ? ? ? ? ?
?pe?????? ??? ? ? ? ? ? ? ? ? ? ? ? ?
???se?? ?pe???\d??? ? ? ? ? ? ??
??ata tet/???? ?µµ????? ? ?? ?? ??
?pe???e?d?µ??? ?e?? ? ? ? ? ? ? ? ? ? ? ? ?
??????a µe t? d????e?a eµß?pt?s?? ??? ??t???
??p???? ?t?p?? µ???ßa?t???d??? ??????a µe t??
p????t?ta t?? d?a??µat??
MAC Manual 2002 Medical Devices Agency
23
?a?????te? p?? ep??e????? t?? ap?te?esµat???t?ta
t?? ap???µa?s?? - ap?ste???s??

1. ?pa??? p??? st?? ep?f??e?a t?? ??????? ?e???,
   a??t?? ? ???a????? ??s???
2. ? f?s? t?? a?t??e?µ???? (a????, a????se??,
   ?????t?te?)
3. ? ?????? ???es?? t?? a?t??e?µ???? st? µ???d?
   ap?ste???s?? ap???µa?s??
4. ? p????t?ta t?? ap???µa?t???? st? te???? d????µa
   ???s??
5. ? ?e?µ???as?a, t? ?? ??p.
6. ? t??p?? pa?eta??sµat?? ?a? f??a??? t?? ???????

????p?? ?a?a??sµ??
?p?s??a?µ?????s? ???????
??a ta s?µe?a t?? ??????? se epaf? µe t?
ap???µa?t???

• F??s?? d????µa ap???µa?t????
• ??e???? ?????st?? ?p?te?esµat???? S?????t??s??
• (Minimum Effective Concentration)

24
?pa?a???s?µ?p???s? µ?a? ???s?? a?t??e?µ????

• ?a a?t??e?µe?a p?? ap? t?? ?atas?e?ast? t???
  p????????ta? ??a ?a ???s?µ?p??????? µ?a f??? de?
  p??pe? ?a ?a?a???s?µ?p??-???ta?

25
???ß??µata p?? ????? s??s? µe t??
epa?a???s?µ?p???s? t?? µ?a? ???s?? a?t??e?µ????
? ???µ??? t? s?µa?t???te?? p??ß??µa

1. ????p?? ?a?a??sµ?? ?a? ap???µa?s?-ap?ste???s?
   ???? ?atas?e?ast???? ?d?a?te??t?t?? (??e?e?
   ????e?, spe??e?, a???? µe µe???? µ???? ? p???
   ste???, e?d???? ep?st??se?? ??p.)
2. ??????? a?t?d??se?? ap? ??µ??? ?at????pa t??
   ap???µa?t????
3. ??????s? t?? ?????? ?atas?e??? t?? a?t??e?µ????
4. ???a???? p??ß??µata p?? ep??e????? t?? ?e?t?????a
   t?? ???????

26
S?S??S??S G?? ??T???S?? ??? ????????S? ??? ?C ???
?O? ?????????O? ??? (Neely A. et al. Am J Infect
Control 200533 (4) 233-237)

1. ? s????t?ta t?? ?a?a???t?ta?-ap???µa?s?? ?a? ta
   s?e??sµata p?? ?a ???s?µ?p??????? e??a? ta ?d?a
   µe a?t? p?? ???s?µ?p?????ta? ??a t?? ????
   e??p??sµ? st?? s???e???µ??? ????.
2. ?aµß????ta? ?p??? ?? ?d???e? t?? ?atas?e?ast??
   t?? s?s?e???

27

1. ???s? p?ast???? ?a??µµ?t?? ? e?d???
   ?atas?e?asµ???? e?a?t?µ?t?? (ad??ß?????)

28

1. ???s?µ? ?e???? (sap???? ? a?t?s?pt???) p??? ?a?
   µet? t?? epaf? µe e?a?t?µata t?? ?C
2. ???s??? st?? ????e? LCD (?a?a??sµ?? µ??? µe
   µa?a?? ßaµßa?e?? pa?? ? pa?? eµp?t?sµ??? µe
   ????p?e?µa)

29

• All health care workers are under ethical and
  legal duties to protect the health and safety of
  their patients.
• ???? ?? e??a??µe??? st? ???? t?? ??e?a? ?????
  ????? a??? ?a? ??µ??? ?a????? ?a p??state???? t??
  ??e?a ?a? asf??e?a t?? as?e??? t???
• 
  (Department Of Health - UK)

30
??????S?O