Challenges for infection prevention20111411094311/11092… · Vasa 28. september 2011 - Holt og...
8
Vasa 28. september 2011 - Holt og Clean Clean and and unclean unclean How How hard hard can can it be? it be? Jette Holt, DK Arnold Jensen, NO Challenges Challenges for for infection infection prevention prevention More elderly patients Quicker patient treatment (pathways) Increased mobility (local, national, private and professional) Increasing microbial resistance Colonization and infection Many guidelines for the prevention of infection Focal point in the guidelines – clean and unclean Nordic Concept clarification Rent/puhdas, and urent/orent/epäpuhdas Renlighed/renslighet/renlighet/puhtas Clean/unclean/cleanliness Key concepts when we talk about infection prevention / smittskydd / vårdhygien / smittevern Quantifiable? Frequency (how often) and method (how) In In what what ways ways has has the the concept concept of of clean clean and and unclean unclean changed changed from 1850 to from 1850 to today today? “The main rule is that one has a bath before dressing up. Manual labourers, such as farmers, smallholders, craftsmen, fishermen, sailors and others working outdoors, will thus have their weekly bath on Saturday, as they will be wearing their formal clothes on Sunday. Monday morning they once again put on their working clothes, and the rest of the week then goes by as if it were one continuous shift; having a bath is thus probably the last thing on their mind.” Eilert Sundt: On personal hygiene in Norway 1869 Around Around 1850 1850 Insuffiecient knowledge about the causes of disease Miasms ‐ important to separate the sick from the healthy People rarely washed themselves and their environment Water was often scarce, at least heated water Around Around 1880 1880 Bacteriology, which won out as a scientific discipline More evidence showing that improved cleaning methods and bacteria control promote infection‐ fighting Continued resistance within specialist communities Hospitals recognised the effect of good hygiene and sterile equipment – there was a decrease in wound infections and to bear children became less risky
Transcript of Challenges for infection prevention20111411094311/11092… · Vasa 28. september 2011 - Holt og...
Vasa 28. september 2011 - Holt og Jensen 1
CleanClean and and uncleanuncleanHowHow hard hard cancan it be?it be?
Jette Holt, DKArnold Jensen, NO
ChallengesChallenges for for infectioninfection preventionpreventionMore elderly patientsQuicker patient treatment(pathways)Increased mobility (local, national, private and professional)Increasing microbial resistanceColonization and infectionMany guidelines for the preventionof infectionFocal point in the guidelines – cleanand unclean
Nordic Concept clarification
Rent/puhdas, and urent/orent/epäpuhdasRenlighed/renslighet/renlighet/puhtasClean/unclean/cleanlinessKey concepts when we talk about infectionprevention / smittskydd / vårdhygien / smittevernQuantifiable?Frequency (how often) and method (how)
In In whatwhat waysways has has thethe conceptconcept ofof cleanclean and and uncleanunclean changedchanged from 1850 to from 1850 to todaytoday??
“The main rule is that one has a bath before dressing up. Manual labourers, such as farmers, smallholders, craftsmen, fishermen, sailors and others working outdoors, will thus have their weekly bath on Saturday, as they will be wearing their formal clothes on Sunday. Monday morning they once again put on their working clothes, and the rest of the week then goes by as if it were one continuous shift; having a bath is thus probably the last thing on their mind.”Eilert Sundt: On personal hygiene in Norway 1869
AroundAround 18501850
Insuffiecient knowledge about thecauses of diseaseMiasms ‐ important to separate thesick from the healthyPeople rarely washed themselvesand their environmentWater was often scarce, at leastheated water
AroundAround 18801880
Bacteriology, which won out as a scientific disciplineMore evidence showing that improved cleaningmethods and bacteria control promote infection‐fightingContinued resistance within specialist communitiesHospitals recognised the effect of good hygiene and sterile equipment – there was a decrease in woundinfections and to bear children became less risky
Vasa 28. september 2011 - Holt og Jensen 2
AroundAround 19001900
"Hygiene Focus" got more followersCan be viewed in the context of tuberculosis, which was still a very threatening and widespread disease, combined with thecertainty that the disease was bacterial
In In thethe interwarinterwar periodperiodThe ”extended care concept” wasintroducedA sense of optimism and eagerness to promote hygieneThe importance of fresh air, light, nutritiousand healthy food, personal hygiene and taking baths was strongly emphasisedPhysical activity – played an important roleto secure stronger, healthier and cleanerchildren, ”A healthy mind in a healthybody”
Hygiene Hygiene developmentdevelopment……
Hygieia before: healthy and proper lifestyleHygiene Today: cleanlinessFrom an ethical and social philosophicalcategoryTo a professional technical‐scientificconcept and a common ideological term in everyday life
WhyWhy areare wewe so so concernedconcerned aboutaboutcleanlinesscleanliness? ?
We want to get rid of the dirt / the unclean!Dirt may be regarded as a three‐foldconcept:Aesthetics (How does it look?)Etiquette (How do we look?)Infection Control (Is there a risk oftransmission/infection?)
A A questionquestion from from thethe real worldreal world……
”Is it safe to use cold water washing powderfor the clothes that is not washable above 40 degrees from our MRSA patients ?”It says on the carton that the productwashes clean at as low as 20 degrees.
Yes? No?
WhatWhat is is dirtdirt??Dirt is something that is "out of place".(Douglas 1997)
Visible / Aesthetic dirtInvisible / Microbiological dirt
Dirt is associated with low self‐esteem, social exclusion and gossipInfection hygienic dirt associated withthe risk of transmission of infection
Vasa 28. september 2011 - Holt og Jensen 3
The Inanimate Environment Can Facilitate Transmission
~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
X represents VRE culture positive sites Out of Out of placeplace……??
AccumulationAccumulation of ...?of ...? Rent / Rent / PuhdasPuhdas is is ……Etymologically ‘hreinn’ is an adaptation of ‘krinein’(which means ‘to disassemble’)The opposite of uncleanA momentary stateSomething we do and something we are ...Something we define
Invisible clean and invisible unclean (microbiology)Visibly clean and visibly dirty (microbiology and aesthetics)
Clean Unclean
To separate To separate cleanclean and and uncleanunclean.. .. Religious notions of clean and Religious notions of clean and unclean foodunclean food
Vasa 28. september 2011 - Holt og Jensen 4
SystematicSystematic messmess ?????? Waste Waste intointo cleanclean bags and bags and cleancleanpatientpatient in in cleanclean bed...?bed...?
CleanClean as a as a methodmethod
To make / keep cleanCleaningWhen is clean clean enough?
How often do you change the linens?Weekly? Every 14 days? Every 3 weeks? Once a month?
At what temperaure do you do your linens?40 degrees? 60 degrees? 80 degrees? 90 degrees?
How often do you clean your toilet?Every day? Twice a week? Once a week?
CleanClean as a as a romanceromance ……http://http://www.youtube.comwww.youtube.com/watch?v=ZqDzKad2Q3M/watch?v=ZqDzKad2Q3M ((CleaningCleaning: Target : Target WomenWomen –– 3:23)3:23)
Clean is a momentary stateUnclean is a much more stable conditionWhat is unclean and clean is relativeVaries from culture to cultureFrom person to person
Clean and unclean, as somethingphysical
WhenWhen doesdoes uncleanunclean becomebecome a a risk? ... risk? ...
Is this anaesthetic problem oran infection preventionproblem ?
Yes? No?
Vasa 28. september 2011 - Holt og Jensen 5
Yes, now it is an infection prevention problem
The most unclean place in a room is …
1. Door handle2. Patient bedside table3. The floor
Clean and unclean, as something you feel ....
The clean and uncleanClosely related to the individual and to the communityThe Good ones and the GoodThe Bad ones and the BadFeelings ... ..
Vasa 28. september 2011 - Holt og Jensen 6
CleanClean as as wellwell‐‐beingbeingStaying clean ‐ when are you clean enough?
How often do you take a bath/shower?Every day? Every other day? Once a week?
How often do you change your underwear?Every day? Every other day? Once a week?
How often do you change the bed linen?Once a week? Every other week? Every third week?
How often do you change the towels?Every day? Every other day? Once a week?
Cleanliness is the way forward
Remove the Accumulation of all thingsUnclean, desinfect the surroundings and theAir, and your country will be freed from Sickness (…). Uncleanliness is the Enemy ofgood Health, Happiness and a long life.
Translated from Jørgensen (1994)
PeterPeter……..Is homelessHangs out with his dog and other homeless peopleIs hospitalized with a colonized leg woundHas a plastic bag and now asks you to find his wallet in the bottom of the bagHe keeps in his bag his clothes, personal documents, toilet gear and treasuresWill you put on your gloves before you reach for his wallet in his bag?
Yes No
ChristinaChristina……....Is a mid‐level manager of a major companyLives in a villa with her family and pet dogIs hospitalized with a colonized leg woundHas a Mulberry bag, and now asks you to find her purse at the bottom of the bagShe keeps in her bag her clothes, personal documents, toilet gear and valuablesWill you put on your gloves before reaching for the purse in her bag?YesYes NoNo
Emotions affect the notion of clean.
"We know this but ..." A 2002 pilot study focusing on hand hygiene
Clean as a part of one's personality
Clean does not entail anything evil, cunningor selfishA pure heart and cleanliness: innocenceA clear criminal record, a clear conscience, unsoiled, unmixed
Vasa 28. september 2011 - Holt og Jensen 7
Language is normative
Something that is in accordance with norms or rulesCleanliness is normative…..
Clean as a school of thought…A clean mind and bodyThe clean and the uncleanThe royalty, the nobility, the bourgeoisie, the peasants
Dette er dansk/norsk idiomer sommister sin betydning i en engelsk oversettelse
Sayings – DK, N, S, FiGøre rent bord (bringe tingene i orden) ‐ Aloittaapuhtaalata pöydältä. Have rent mel i posen ‐ Puhtaat jauhot pussissa.Holde sin sti ren ‐ Lakaise ensin oman rapunedusta.Rene linjer ‐ Puhdas linja.Tale rent/tale rent ud af posen ‐ Puhu suupuhtaaksi.Renlighet är halva "måltiden” ‐ Puhtaus on puoliruokaa.
Key issues concerning clean and unclean
Is it safe to place bedpans and tooth mugs in the same dishwasher?Is it safe to use the same medical equipment on both humans and animals?Is it safe for staff to use the same toilets as visitors?Is it safe for caregivers to use the same toilets as patients?Is it a risk for you if builders use your toilet when working in your house?
Summary
Clean and unclean are important conceptsThey affect our:Behaviorchoice of actionsour relationships with one otherthey also affect the spread of infection
We challenge You!
Compose an infection prevention proverb!
It must contain the words clean and unclean (in a nordic language)It must either rhyme or contribute to better compliance ‐ take your pick!Place it in the box at the entranceHave fun!
The end (is near….)!
Vasa 28. september 2011 - Holt og Jensen 8
Anbefalt litteraturPurity and Danger: An Analysis ofthe Concepts of Pollution and Taboo. Mary Douglas, 1978.Rent og urent – en analyse av forestillinger omkring urenhet og tabu. Mary Douglas, norsk utgave 1997.
Against Disease – The impact ofHygiene and Cleanliness onHealth. 2007, SDA.
http://www.againstdisease.com/documents/SDA_Against_Disease_final_cover_11808.pdf
