Key Facts and Figures -...
Transcript of Key Facts and Figures -...
Key Facts and Figures
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Romania
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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!