xelis higiena

giorgi gegelaSviligiorgi gegelaSvili

gudauri

3 maisi

2009 weli

xelis higienaxelis higiena

medicinaSi WeSmariti progresis

miRweva SeuZlebelia nozokomiur

infeqciebTan brZolis gareSe !infeqciebTan brZolis gareSe !

1. arsebuli mdgomareoba

2 mizezebi2. mizezebi

3. risk-faqtorebi

4 gadaWris gzebi4. gadaWris gzebi

5. ganxorcielebis etapebi

6 Sedegi6. Sedegi

1850 w daamtkica

xelis higienis

ungreli eqimi Ignaz Semmelweiss

el g e

aucilebloba.

am koncefcias

ar iziarebdaar iziarebda

profesori virxovi.

sicocxle

daamTavradaamTavra

fsiqiatriul

saavadmyofoSi

rgaurkvevel

viTarebaSi.

sikvdilis Semdegdaudges Zegli.

Pittet D. s x b m r bs b ssufTa xelebi amcirebs avadobas

Lancet ; 366 : 185-86, 2005 ; ,

nozokomiuri dainficireba k u d f c e

saavadmyofoebSi:

ganviTarebuli qveynebi:ganviTarebuli qveynebi

Cveulebrivi ganyofileba 8-12 %n ns r r p 15 40 %intensiuri Terapia 15-40 %

ganviTarebadi qveynebi: 16 - ???%

Director General,

Riyadh

and Director General,

WHO Headquarter,

Geneva

and

the

Gulf countries

DurbanDurban, South-Af iAfrica,January 2005


1.1. msoflios monacemebi

• yovelwliurad msoflioSi samedicino momsaxureobisas

ramdenime aseuli milioni pacienti inficirdeba

• hospitaluri infeqciebis ganviTarebis riskihospitaluri infeqciebis ganviTarebis riski

ganviTarebad qveynebSi ganviTarebulTan SedarebiT

ramdenjerme metia

z r n r b q n s n bS• zogierTi ganviTarebadi qveynis klinikebSi

hospitaluri infeqciebis gavrceleba aRemateba 25%-s

• aSS-Si yoveldRiurad 200-ze meti adamiani iRupebay veldR u d e et d Ru e

nozokomiuri infeqciebiT


1.2. saqarTvlos monacemebi

• nozokomiur infeqciebze zedamxedveloba mxoloddamsjelobiTi xasiaTis

• oficialuri monacemebiT nozokomiuri infeqciebisgavrceleba saqarTvelos arcerT klinikaSi araRemateboda 1%-sRe te d

• saqarTveloSi saavadmyofosSiga infeqciebze epid.zedamxedvelobis da kontrolis calkeulielementebi dainerga mxolod me-20 saukunis 80-ianelementebi dainerga mxolod me-20 saukunis 80-ianwlebSi

• dRemde erovnul doneze Seuswavlelia nozokomiurin q b s n n b s pr n b sinfeqciebis incidentobis da prevalentobis

maCveneblebi

xelebis higiena

N nozokomiuri infeqciebis gavrcelebaSi

ZiriTadad ,,damnaSavea” samedicinoZiriTadad ,,damnaSavea samedicino

personalis kontaminirebuli xelebi

infeqciuri kontroli SveicariaSi

nozokomiuri infeqciebis dinamika1994 19981994-1998

Pittet D et al, Lancet 2000; 356: 1307-1312 www.hopisafe.ch

xelebis higienaxelebis higiena

winaaRmdegobebi:

• samedicino personalis “drois deficiti”• samedicino personalis drois deficiti

• xelsabanebis mwiri raodenoba

• xelebis kanis alergiuli reaqciebi

• vizualurad sufTa xelebivizualurad sufTa xelebi


kanis mikroflora

rezidenturi

kanis mudmivi da

tranzitoruli

mikroflora, romelsac kanis mudmivi da

normaluri mikroflora

,

samedicino personali iZens

inficirebul

pacientebTan an

kontaminirebul garemoKkontaminirebul garemo

obieqtebTan kontaqtisas

xelebis higiena

xelebis dekontaminaciis sami done

xelebis higiena

_ xelebis dekontaminaciis sami done:

xelebis Cveulebrivi dabana _ samedicinoxelebis Cveulebrivi dabana _ samedicinopersonalis xelebis kanidan, WuWyisa datranzitoruli floris mocileba sapnisa dawylis saSualebiT

h n r nt s pt tr nz t rhigienuri antiseptika _ tranzitorulimikrofloris mocileba an ganadgureba

qirurgiuli antiseptika _ tranzitorulimikrofloris mocileba an ganadgureba dak fl c le d e drezidentuli floris Semcireba

xelebis higiena

_ sami ZiriTadi moTxovna:

xelebis higiena

sami ZiriTadi moTxovna:

Cveulebrivi dabana higienuri antiseptika qirurgiuli antiseptika

• invaziuri proc.-bis

Catarebis win

• axalSobilTan da

• fizikuri kont. win da

Semdeg

• sakvebis momzadebis da

m s w n

nebismieri

qirurgiuli Carevis

win da Semdegimunodeficitis mqone

pac. kont. win da Semdeg

• WrilobasTan,

kaTeterebTan kont. win

gacemis win

• fiziologiuri moTx.

dakmayofilebis Semdeg

• yvela SemTxvevaSi,

w d e deg

kaTeterebTan kont. win

da Semdeg

• xelTaTmanis

gamoyenebis win da

S m

yvela SemTxvevaSi,

rodesac vizualurad

binZuria

Semdeg

• sagnebTan kont. win da

Semdeg


xelebis dabanisas xSirad ele d d

gamotovebuli ubnebi:

– TiTebis daboloebebie d l e e

– TiTebsSua midamo

x s b– xelisgulebi

– cera TiTebis midamo


ar aris rekomendebuli !

beWdebisa da sxva samkaulis tareba

grZeli an xelovnuri frCxilebis gamoyeneba

frCxilebze muqi feris an naxevradgadaclili

laqi

,,manikuris” gakeTebaku g ke e

xelebis higiena

rekomendacia:

xelebis higiena

rekomendacia:

Txevadi saponiTxevadi saponi

erTjeradi dozatorebi

qaRaldis erTjeradi xelsaxocebiqaRaldis erTjeradi xelsaxocebi

xelebis Tbili wyliT dabana

sp rt s S mc ant s pt ur saSua b b sspirtis Semcveli antiseptikuri saSualebebis

gamoyeneba

mizanSewonili ar aris aeratorebis (wylismizanSewonili ar aris aeratorebis (wylis

gamafrqveveli) onkanebze dayeneba

xelebis higiena

b b n m b b b

xelebis higiena

xelebis dasabani mowyobilobebi unda ganTavsdes

moxerxebulad samedicino dawesebulebis mTelt r t r zteritoriaze

yvela palataSi an palatidan gamosasvlelSi

gansakuTrebiT im ganyofilebebSi sadacgansakuTrebiT im ganyofilebebSi, sadacsadiagnostiko da invaziuri procedurebiintensiurad tardebate u d t de

pacientebis raodenobisa da palatebisfarTobis gaTvaliswinebiT

5 ganxorcielebis etapebi5. ganxorcielebis etapebi

5.1. • nacionalur doneze infeqciuri kontrolis strategiisnacionalur doneze infeqciuri kontrolis strategiis

SemuSaveba

• samedicino dawesebulebebSi infeqciuri kontrolis

m t t b s S qmn r r nq n r bkomitetebis Seqmna da realuri funqcionireba

• infeqciuri kontrolis sakiTxebze samedicino

personalis ganswavlae l g w vl

• klinikebSi infeqciuri kontrolis sakuTari programebis

SemuSaveba da danergva

6 Sedeginozokomiuri infeqciebis Semcireba

samedicino momsaxurebis xarisxis gaumjobeseba

6. Sedegi:

ed c u e g u j e e

klinikebSi avadobis da letalobis maCveneblebis

Semcireba

p n h sp z s b s S m r bpacientTa hospitalizaciis vadebis Semcireba

pacientTa inficirebis riskis Semcireba

nozokomiuri infeqciebis risk-faqtorebis zemoqmedebisnozokomiuri infeqciebis risk faqtorebis zemoqmedebis

Semcireba

xarjTefeqturoba

adamianuri da materialur-teqnikuri resursebis ekonomia

samedicino personalis janmrTeloba

samedicino momsaxureobaSi xelebis

higienis gzamkvlevihigienis gzamkvlevi

gzamkvlevis mizani:g kvlev

samedicino personalis,

administraciis warmomadgenlebisaWHO GUIDELINES ON HAND HYGIENE IN HEALTH CARE(ADVANCED DRAFT): A SUMMARY

administraciis warmomadgenlebisa

da xelmZRanelebis uzrunvelyofa:

• xelebis higienis rekomendaciebisA SUMMARY • xelebis higienis rekomendaciebis

sruli mimoxilviT;

• yovelmxrivi informaciiT

x n b s z z rs bdaxelovnebis gzaze arsebuli

winaaRmdegobebis gadasalaxavad.

25

gzamkvlevisgzamkvlevis

ZiriTadi rekomendaciebi

• vizualurad WuWyiani xelebis dabana sapniTa da wyliT

• sp rt s S m ant s pt ur saSua b b s qr s• spirtis Semcveli antiseptikuri saSualebebis oqros

standartis miReba

• mravalmxrivi strategiis Semadgeneli nawilebia:l d l l

• ganaTleba

• lideroba

• pacientTa monawileoba• pacientTa monawileoba

26

xelebis higienis

ganxorcielebisganxorcielebis

SesaZlo barierebi

• individualur da dawesebulebis doneze araaqtiurid v du lu d d we e ule d e e qt u

monawileoba xelebis higienis xelis SewyobaSi

• xelebis higienis modelis arasakmarisi magaliTebi

w s b b S x b s h n s r s m r s• dawesebulebaSi xelebis higienis arasakmarisi

prioritetuloba

• administraciuli sanqciebis ukmarisoba im pirTa mimarT,d t c ul qc e uk ,

romlebic ar asruleben xelebis higienas/waxaliseba,

romlebic asruleben

• dawesebulebaSi arasakmarisi usafrTxo garemo• dawesebulebaSi arasakmarisi usafrTxo garemo

27

xelebis higienis

rekomedebuli meTodebis

ganxorcielebaze

moqmedi faqtorebimoqmedi faqtorebi

• intensiuri Terapiis ganyofilebaSi muSaoba

• mTeli kviris ganmavlobaSi muSaoba (dasvenebis dReebis garda)

• xalaTis da xelTaTmanebis iSviaTi cvla

• avtomaturi xelsabanebis da Camrecxebis simcire

• jvaredini gadacemis maRal riskTan dakavSirebuli qmedebebi

• personalis araSesabamisi kompleqtacia

• pacientebis samedicino momsaxureobis dros xelebis higienis

xSiri Catarebis aucilebloba

• eqTnis asistentis statusi (eqTnis magivrad) eq te t t tu eq g v d

• eqimis statusi (eqTnis magivrad)

28

faqtorebi, romlebic

ganapirobeben xelebis

higienis cud ganxorcielebas

• xelebis sawmendi saSualebebi iwveven kanis gaRizianebas da simSralesele w e d u le e wveve k g R e d le

• niJarebis da xelsabanebis arasakmarisi raodenoba an maTi araxelsayreliganlageba

• sapnis da xelsaxocebis arasakmarisi raodenoba

• xSirad datvirTuli samuSao grafiki an arasakmarisi dro pacientisxSirad datvirTuli samuSao grafiki an arasakmarisi dro, pacientissaWiroebebis prioritetuloba

• xelebis higienis Setakeba urTirTobasTan samedicino personali-pacienti

• pacientebisagan dainficirebis dabali riski

x m n b s t r b n rwm n m s r m x m n b s m n b• xelTaTmanebis tareba an rwmena imisa, rom xelTaTmanebis gamoyenebiTSeiZleba ugulvebelyoT xelebis higiena

• gzamkvlevebis da protokolebis arasakmarisi codna

• naklebi fiqri xelebis higienaze, gulmaviwyoba

• TanamSromlebisagan da xelmZRvanelobisagan aranairi mibaZvis magaliTi

• skepticizmi xelebis higienis mniSvnelobisadmi

• rekomendaciebisagan gansxvavebuli mosazrebebi

• samecnieri informaciis simcire hospitaluri infeqciebis maCveneblebze

29

• samecnieri informaciis simcire hospitaluri infeqciebis maCveneblebzexelebis higienis gavlenis Sesaxeb

arasrulfasovan xelebis

higienasTan dakavSirebulihigienasTan dakavSirebuli

risk-faqtorebi

• individualuri done:

• ganaTlebis an gamocdilebis ukmarisoba• ganaTlebis an gamocdilebis ukmarisoba

• gzamkvlevis arasaTanado codnis done

• valdebulebis Sesrulebis gauTviTcnobierebloba

• xelebis higienis saSualebebiT kanis gaRizianeba.

• jgufis done:

• ganaTlebis ukmarisoba da muSaobisas arasrulfasovanig le uk d u ulf v

ukukavSiri

• kritikuli medicinis an maRali datvirTvis ganyofilebebSi

muSaobamuSaoba

• arasakmarisi an dabali kvalifikaciis personali

• wamyvani personalis arasakmarisi mxardaWera da roli

30

arasrulfasovan xelebis higienasTan

dakavSirebuli risk-faqtorebidakavSirebuli risk faqtorebi

r n n• organizaciuli done:

• gzamkvlevebis ukmarisoba

• xelebis higienis Sesabamisi saSualebebis arasakmarisi raodenoba

n s m s s S b b s r s m r s r n b• kanis movlis saSualebebis arasakmarisi raodenoba

• ukmarisoba kulturis ar arseboba an tradiciebis mimdevroba

• administraciuli liderobis, sanqciebis, waxalisebis damxardaWeris ukmarisobamxardaWeris ukmarisoba.

• sistemis done:

• samedicino momsaxureobasTan dakavSirebuli infeqciebismniSvnelobis arasakmarisi Sefasebav el k ef e

• specifiuri regulaciebis da meToduri miTiTebebis ukmarisoba

• samedicino dawesebulebebSi xelebis higienis gzamkvlevebisukmarisoba

x b s h n s n n r r n r mp n b s• xelebis higienis nacionaluri da regionaluri kampaniebisarasakmarisi waxaliseba

31

sufTa samedicino

momsaxureoba usafrTxoamomsaxureoba usafrTxoa

• momxmareblebisaTvis riski minimaluria• momxmareblebisaTvis riski minimaluria,

roca arsebobs:

r b m b b• lideroba da movaleobebi

• kargad SemuSavebuli procesebi da

sistemebi

• higienurad sufTa garemo g e u d uf g e

• usafrTxo meTodebi

• organizebuli da koordinirebuli• organizebuli da koordinirebuli

qmedebebi

32

samedicino

da farmacevtuli personalis codnad f cevtul e l c d

“molaparake kedlebi”

samedicino da farmacevtul personalis codna

“molaparake kedlebi”molaparake kedlebi

Zinder, Niger, Africa, - January 2005

“improvizebuli”improvizebuli

drenaJebi

infeqciuri kontroli

Ria drenaJebiRia drenaJebi

dro = d

xelis higienis mTavariel g e v

problemale

s p n p r n rsaponi+

wyali

spirtxsnari

y l

1 - 1.5 wuTi 15 - 20 wami

pacientTa usafrTxoebis saqarTvelos aliansi

pirveli priziT dajildovda

2008 wlis 25-27 ivniss strasburgSi gaimarTa2008 wlis 25 27 ivniss strasburgSi gaimarTa

saerTaSoriso konferencia “jandacvis

ergonomika da pacientTa usafrTxoeba”.

konferenciis organizatorebi: evropis sabWo, k fe e c g t e ev W ,

evropis komisia, evropis parlamenti,

ergonomikis saerTaSoriso asociacia,

safrangeTis da italiis janmrTelobisf ge d t l j el

saministroebi

P SP.S.

““SviloSvilo,,

ss q m bq m beses eqimebieqimebi

meme TuTu verver momxedavenmomxedaven,,

SenSen multirezistentulimultirezistentuli

gaxdebigaxdebi””gaxdebigaxdebi


sufTa xelebi

usafrTxo xelebiau f ele

41

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xelis higiena