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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. arsebuli mdgomareoba
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. arsebuli mdgomareoba
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
xelebis higienaxelebis higiena
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 higienaxelebis higiena
xelebis dabanisas xSirad ele d d
gamotovebuli ubnebi:
– TiTebis daboloebebie d l e e
– TiTebsSua midamo
x s b– xelisgulebi
– cera TiTebis midamo
xelebis higienaxelebis higiena
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
xelebis higienaxelebis higiena
sufTa xelebi
usafrTxo xelebiau f ele
41