Key Facts and Figures - casaromana.orgcasaromana.org/spitalulsfconstantin/Spitalul_SfConstantin_Brasov... · Aprilie 2011 Septembrie 2011 Ianuarie 2-12 Mai 2012 Septembrie 2012 Noiembrie

Key Facts and Figures

17th of May, 2013 “Sf. Constantin” Hospital, Brasov,

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• Construction works started: 2010

• Opening date: 10th of March, 2011

• Size: 8000 sqm

• Capacity: 88 beds, 3 operating rooms

• Adjacent facilities: integrated pharmacy, collaboration with the medical campus “Regina Maria” (radiological unit MRI, CT scan, etc., laboratory, inter-clinic consultations), professional laundry, inside restaurant, parking

• “St. Constantin” Foundation, that supports the costs of the investigations and surgery interventions for the patients without possibilities, humanitarian projects

Key Strengths


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• Full time medical team with international education and experience

• Continuous training and specialization of medical staff (doctors & nurses)

• State-of-the-art medical technology. Facilities designed to meet international quality norms and standards.

• Operating rooms validated in compliance with ISO 14 644 for Cleanrooms and associated controlled environments.

• Certified for the Quality Management System according to SR EN ISO 9001:2008 issued by TUV Thüringen (2011)

• International support and partnerships with leading healthcare establishments

• Downstream integration with pharmaceutical supplier (ROPHARMA SA – shareholder) provides fast and reliable access to medication

Major Advantages


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• Correct implementation of the medical good

practices in the field of the hands and hospital

hygiene since the inauguration of the hospital

• Procedures adopted as an internal code

Specialities


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• General surgery

• Medical oncology

• Urology

• ENT for children and

adults

• Neurosurgery

• Orthopedics

• Plastic surgery

• ICU

• SPCNI and infectious

diseases

Number of Employees


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2

17

79

145

170

180 185

Ianuarie 2010 Decembrie 2010 Martie 2011 Iunie 2011 Decembrie 2011 Februarie 2012 Februarie 2013

Hospitalized Patients

8

69 71 96

181 172 187

272

194

277 263 215 234 250

195 201 221 212 209 252

178 210

237

20

54 89

146

186 198 216

218

183

224 231 299 270

341

299 257

249 244 265 208

163

268 238

4 1

21 1

4

34

21 19 33 36

32

23

33 50

Continuous hospitalization One day hospitalisation - oncology One day hospitalisation - ESWL


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Discharged Patients

28

1,920

3,065

5,195

7,180

8,182

9,582

-

2,000

4,000

6,000

8,000

10,000

12,000

Aprilie 2011 Septembrie 2011 Ianuarie 2-12 Mai 2012 Septembrie 2012 Noiembrie 2012 Februarie 2013


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Surgery Patients

Year

GENER

AL

SURGE

RY ENT

NEURO

SURGER

Y

UROLO

GY

ORTOP

EDICS

PLASTI

C

SURGE

RY

2011 299 169 76 111 5

2012 663 290 149 199 45 58

2013-30

April 304 139 67 90 29 32 TOTAL ALL

INTERVENTIONS

TOTAL 1.266 598 292 400 79 90 2.725


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Collaboration


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Organized

Academic symposiums


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• Liver transplant symposium • Prof. Dr. Yaman Tokat, Florence Nightingale Hospital, General Surgery Dept., Hepatobiliary and Organ Transplant Center,

Istanbul, Turkey

• Dr. Isabelle Morard, Hepatologist, Deputy Chief of the Department of Hepatology, Liver Transplant Unit University Hospital Geneva

• Prof. Dr. Irinel Popescu, President of the Academy of Health Sciences, Director of the Center of General Surgery and Liver Transplantation Dan Setlacec, Fundeni Institute Bucharest, Romania

• Diagnosis and rehabilitation of hearing deficiencies symposium: • Prof. Dr. Georg M. Sprinzl, ENT Clinic, Medical University Innsbruck, Austria

• Dr. Silviu Albu, Chairman of the Romanian Society of Otolaryngology

• Dr. Astrid Wolf- Magele, Medical University Innsbruck, Austria

• “Transplantation rénale: historique, prise en charge et donneurs vivants”

presided by Mrs. Dr. Karine Hadaya, the Service of Kidney Transplantation from the Nephrology Service of the Cantonal

Hospital of Genève

• The international Conference “European standards of hospital

hygiene” organized in collaboration with the University of General Medicine Transylvania Brasov and the University

Szeged (dr. Nagy Elisabeth), 4-6 June, 2013

Organized Activity


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• Quality management system → SMC

Responsible → System Procedures (7) and

Operational Procedures (50)

• Presented and implemented

• Informed staff

SPCNI


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• 5 persons (3 doctors, 2 nurses)

• Meeting 1x/week

• 22 specific system procedures SPCNI: • Bacteriological screening

• Hand hygiene

• Pre-operatory chemoprophylaxis

• Auto-control

• Personnel hygiene

• Spaces hygiene

• Prophylaxis of the nosocomial infections

• Sterilization

• Patients circuits, waste, visitors, soft equipment,

• etc.

Bacteriological Screening


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Key points


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• Carried out before hospitalization, within the

mandatory pre-anesthesia consultation

• Screening MRSA + ESBL generally available,

priory informed patient

• Up to the current day performed on a number of

3,746 patients

• The only hospital in Romania where it is applied (experimentally applied in the National Institute of Infectious

Diseases – Bucharest for 6 months)

Information flow


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+Result

Lab doctor

ID doctor

Director of nurses

Personnel

Information chain


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Signaling Isolation

CONTACT


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=

Gloves

+

Gowns

AIR Isolation


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IMUNODEPRESSED

Patient


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Clostridium difficile

Acute diarrheal disease


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Colonised Patient = isolation

CONTACT


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• MRSA

• Patient is informed at home to

start the decolonization

protocol

• Decolonization Protocol

• All patients, regardless of

screening, using chlorhexidine

soap before surgery

• ESBL:

• Mandatory contact

isolation

• Use of sanitary tools

(sphygmomanomete,

stethoscope,

thermometer) only for

the patient - to the

extent possible

Partial +Results


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407, 11%

399, 11%

49, 1%

2884, 77%

MRSA +

ESBL +

ESBL+MRSA +

Hands hygiene


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Education Activity


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• Workshop “National standards versus European standards in applying the universal cautions in a sanitary unit with nosocomial risk”, with a participation of 32 doctors, 22-24 11.2012

• “Modern notions of hygiene-hospital” – 100 nurses, 01-04.11.2012

• Course of “Maintenance and proper handling of the port-a-cath”, 02.04.2013

• Course of hand hygiene and nosocomial infections for the nurses of Brasov (12. 06.2013)

• Presentations in conferences and national congresses of the bacteriologic screening, the hands hygiene and the pre-surgery prophylaxis

• Participation in the editing of one of our colleague nurses master’s diploma paper about bacteriological screening

Training for hospital staff


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• 4 courses of hands hygiene

• Course of correct use of antibiotics – antibiotic stewardship

• “The oncologic immune-depressed patient –behavior, attitude”

• “Infection with Clostridium difficile”

• “The bacterial multi-resistance – where to?”

• Presentation of the specific operational procedures, subsequent testing

• E-learning tools available for the employees, on desktop

With what?


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Monthly

consumption for

108 employees in

direct

contact with the

patient:

55 liters

How?


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• Periodical training

• Daily supervision - “Chinese

drop”

• Presentation of the

importance of the hands

hygiene in regards of

nosocomial infections

• The reflex of using hydro-

alcoholic solution without

constraints

The five moments of hand

hygiene


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Inaintea contactului cu pacientul

Inaintea gestului aseptic

Inainte + Dupa lichide biologice / manusi

Cand?

Dupa contactul cu

pacientul

Dupa contact cu obiectele pacientului

Hands hygiene


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• Mandatory for the entire

personnel

– facilitated by the

existence of

small 100ml bottles

• Rings, nail polish, long or

applied nails are forbidden

• Stressing the appropriate

use of gloves

Control?


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• Monthly, by evidence of self-control

• Weekly: “black box”

• Unforeseen

• Direct observational study

Hand hygiene


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• Feed-back to HCW:

• Immediately: observational direct study

• Monthly: within the sampling of self-control proves

• Available procedures for read only on intranet

• Feed-back to hospital management:

• Whenever necessary

• Monthly

Supplementary


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• Patients have Softaman dispensers that they

are invited to use

• Visitors are invited to wear a disposable gown

and to use the Softaman solution when entering

the section

Spaces hygiene


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Partnership for excellence


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Spaces hygiene


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• High level disinfection in all medical spaces, periodically changed

• Changing flow with air positive pressure in surgical rooms (30-60 cycles/surgical hour, 15-30 cycles/hour urology, ENT, NCH)

• Therapy septic room: negative flow of the air

• Concept of clean rooms, similar to the pharmaceutical industry

• Nebulization with hydrogen peroxide and silver ions, after a well-established graphic

• Signed charts of daily cleaning

• Monthly self control AMF, sterile and non-sterile products

• Outsourced laundry for undergarments, soft equipment, including equipment for medical personnel (regular audit)

The personnel hygiene


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• Screening at hiring for MRSA, ESBL +/- decontamination

• Periodic nasal, pharyngeal screening (according to Romanian legislation)

• Eminently surgical hospital: immunity testing HBV, vaccination receptive persons

• Post-exposure prophylaxis to biological products

• Monitoring of nosocomial infections

• Washing soft-equipment, compartment locker in the locker room (outdoor clothes / hospital)

• Counseling, treatment for employees (family, .....)

Preoperative

Chemoprophylaxis


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Preoperative Chemoprophylaxis


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• Specific surgery procedures

• Differentiated by specialty

• In accordance with existing international guidelines

(mainly European)+ ECDC

• Permanent counseling with prescriber doctors (ICU)

• Monitoring, in collaboration with the pharmacy, of

the consumption of antibiotics / hospital

• Prompt communication with the bacteriology

laboratory

Patient circuit on admission

pre-surgery preparation


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• Change in civilian clothes in the wardrobe

• Entrance with hospital clothes

• Mandatory shower with chlorhexidine before surgery

• Immediate shaving before surgery

• Entering the surgery room in clean hospital shirt, respecting the patient circuit, guided by the nurse

• Adapted chemoprophylaxis before surgery

• ICU: septic / aseptic room

Multimodal intervention – Critical elements for success

• System change (use of alcohol-based hand-rubs is standard of care) √

• Education of healthcare workers √

• Monitoring and feedback of performance √

• Reminders in the work place (posters) √

• Strong administrative support √

• Leadership and culture change √


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Effectiveness of a Hospital-wide Programme to improve compliance

with hand hygiene Didier Pittet, Stéphane Hugonnet, Stéphan Harbarth, Philippe Mourouga, Valérie Sauvan, Sylvie

Touveneau, Thomas V Perneger, and members of the Infection Control Programme – THE LANCET

• Vol. 356 • October 14, 2000

Evidence of successful

implementation

of the solution worldwide


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…even in the

taxi…

Principles (1)


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• We are like a small village with small population

where everyone knows everything about

everyone and everything, anytime

Principles (2)


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Who knows?.....


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Thank you for your

attention!

Documents

Key Facts and Figures - casaromana.orgcasaromana.org/spitalulsfconstantin/Spitalul_SfConstantin_Brasov... · Aprilie 2011 Septembrie 2011 Ianuarie 2-12 Mai 2012 Septembrie 2012 Noiembrie