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  • Sveriges Kommuner och Landsting i samarbete med

    Ren vrd r skrare vrdErfarenheter frn andra omgngen av genombrottsprojektet VRISS

    Vrdrelaterade infektioner ska

    stoppas

  • Sveriges Kommuner och LandstingUpplysningar om rapportens innehll lmnas av projektledare Sonia WallinTfn: 08-452 77 13, e-post: sonia.wallin@skl.se

    Redaktr: Agneta DahlnTfn: 08-452 75 83, e-post: agneta.dahlen@skl.se

    Diagram: Josephine Lindgren, e-post: josephine.lindgren@skl.se

    Bestllning av skriften kan gras via frbundens webbplats www.skl.seDet gr ocks att bestlla genom att ringa 020-31 32 30 eller att faxa till 020-31 32 40

    ISBN: 978-91-7164-208-0

    Upplaga 4 000Grafisk form: OrdfrrdetTryck: tta.45 Tryckeri AB, Stockholm 2007

    Omslagsbild Veijo Mehtonen, Medicinsk Bild, Karolinska Universitetssjukhuset, Solna 171 76 Stockholm. Tel: 08-517 747 30 eller 08-517 745 13.

    vriga bilderSid 1: Thomas Johansson, Fotograferna US LinkpingSid 8: Thomas CarlgrenSid 14: Stefan Nilsson, S1 bildSid 22: Veijo Mehtonen, Medicinsk Bild, Karolinska universitetssjukhuset, SolnaSid 29: Miriam Carlsson, Fotomedia, SS, BorsSid 36: Anne Karlsson, IT-enheten, Lindesbergs lasarett, LindesbergSid 44: Lennart NilssonSid 53: Pia Nordlander, bildN, Vsters

  • 1Ren vrd r skrare vrd II

    Frord

    Arbetet med att frebygga vrdrelaterade infektioner r ett av de hgst prioriterade omrdena fr kvalitets- och patientskerhetsarbete i den svenska sjukvrden. Vrdrelaterade infektioner kostar samhllet miljontals kronor varje r enbart p grund av frlngda vrdti-der och de orsakar stort lidande fr vra patienter och deras anhriga. Cirka 1 500 patienter avlider varje r i Sverige som en direkt eller indirekt fljd av en vrdre-laterad infektion.

    Det finns mnga vetenskapligt vlgjorda studier som visar att man kan minska vrdrelaterade infektioner men det krvs kvalitetsfrbttringar. Mest effektivt r infektionsregistrering, utvrdering och revision av vrdrutiner, kontinuerlig ut-bildning samt hg fljsamhet till basala hygienrutiner. Infektionsregistrering r en frutsttning fr att verifiera att frbttringsarbetet har lett till en minskning av de vrdrelaterade infektionerna.

    Smittspridning av bakterier och i synnerhet multiresistenta bakterier r ett allvarligt hot mot patienten och beskrivs ofta i media med stora bokstver.

    Det r ltt att flja, misstnka och pvisa smittspridning av bakterier med ovanliga resistensmnster. Men t.ex. MRSA r bara ett symtom p den smitt-spridning som sker dagligen i samband med vrd. Det r vi, personalen, som p vra hnder och klder br mikroorganismerna frn den ena patienten till den an-dra. Basala hygienrutiner r grundlggande i arbetet att frhindra smittspridning och vrdrelaterade infektioner

    Jag har nu haft frmnen att delta i svl VRISS I som VRISS II (vrdrelate-rade infektioner ska stoppas). Det har varit oerhrt gldjande att trffa teamen, att se deras resultat och knna av deras enorma engagemang fr att minska vrd-relaterade infektioner. Man nskar verkligen att det skulle ske en omfattande smittspridning av teamens arbete och engagemang till resten av vrden och om-vrdnaden i landet. Genombrottsprojektet har alla viktiga byggstenar som behvs enligt evidensbaserade studier fr att frebygga vrdrelaterade infektioner.

    Barbro Isaksson, ordfrande i VRISS II, verlkare, Universitetssjukhuset i Linkping

    Barbro Isaksson r ordfrande i VRISS II

  • 2 Ren vrd r skrare vrd II

    English summary

    Putting an end to healthcare-associated infections

    In recent years, patient safety has come under the national and international spot-light as one of the most important dimensions of quality of care. In 20052006, the WHO implemented a campaign called Clean care is safer care, beginning with the concept that clean hands are safer hands. Sweden turned out to be a stan-dard-bearer in this field, having started a project with this focus back in 2004.

    As in other countries in the world, healthcare-associated infections are very common in Swedish healthcare. Some estimates indicate that as many as ten per-cent of all inpatients are affected. Healthcare-associated infections are also one of the most common reasons for claims made to the county councils mutual insu-rance company, LF, which compensates patients for hospital injuries.

    With this in mind, the Federation of Swedish County Councils and LF ini-tiated a national project in 2004 to combat healthcare-associated infections. The project went under the name VRISS and was implemented on two occasions, in 2004 and 2006. The National Board of Health and Welfare also helped arrange the second implementation of the project.

    Participants and methodsCounty councils and local authorities were invited to participate in the project with interdisciplinary teams including doctors. The teams represented a range of specialties including medicine, surgery, orthopaedics and community care of the elderly. One stated requirement was the active support of various management units. The method used was the Breakthrough Series, originally designed by the Institute for Healthcare Improvement (IHI) in Boston, Massachusetts, USA. The method aims to fill the gap between what we know and what we do, spreading best-practice methods even faster. Many ideas for changes are tested on a small scale, with the basic rule that the small changes combine to create big changes that lead towards the final goal.

  • 3Ren vrd r skrare vrd II

    ResultsThe aim of the teams was to reduce the number of healthcare-associated infec-tions. For example, halving the incidence of urinary-tract infections by cathete-rising for the right indications, introducing closed urine collection systems for catheter treatment and giving the patient extra fluids to drink. Another goal was reducing both deep and superficial infections after primary hip and knee repla-cements: Skin bacteria were reduced by the patients taking double showers using Hibiscrub three times prior to the operation; airborne particles in the surgical theatre were minimised through the 20-second rule (that all staff stand still for 20 seconds so that particles can be carried away by the ventilation system); and the routines for sterile wound changes were improved. Hospitals have also seen a drop in ventilator-associated pneumonia in patients on respirators since imple-menting measures such as raising the head of the bed 30 degrees and improving the patients oral hygiene.

    The teams have achieved excellent results in both sessions of the project; 80 percent reached their stated goals.

    Good hygiene is critical for good results. A particularly important procedural goal to avoid the spread of infection is that the staff follow basic hygiene routines. All teams in the second round of the project regularly measured compliance to basic hygiene routines and clothing regulations once a month, with the goal of 100 percent compliance. In the second project run, the average compliance was 83 percent to basic hygiene routines and 95 percent to those for clothing. A range of small changes permitted the achievement of these goals, such as setting up hooks for long-sleeved coats and making hand rub, gloves and fresh gowns more readily available.

  • 4 Ren vrd r skrare vrd II

    Innehll

    Vrdrelaterade infektioner ska stoppas ........................................................................ 5

    Stora frbttringsmjligheter .......................................................................................... 7

    Tid och std r viktigt fr framgng .............................................................................. 8

    Det ska vara ltt att gra rtt ........................................................................................ 10

    Medicinkliniken, Varbergs lasarett:

    Vi ndde vrt djrva ml .................................................................................................. 13

    Barnintensiven, Astrid Lindgrens barnsjukhus:

    Snart r vi hygiencertifierade ......................................................................................... 21

    Intensivvrdsavdelningen vid Sdra lvsborgs sjukhus, Bors lasarett:

    Projektet har gett oss mycket energi ...........................................................................28

    Lindesbergs lasarett:

    Hela sjukhuset ska med ...................................................................................................35

    Ortopedkliniken vid Pite lvdals sjukhus:

    Vi slpper inte greppet ....................................................................................................43

    Vsters stad, Tillberga Grannskapsservice:

    De boende r positiva till vrt hygientnkande ........................................................52

    Prvade frndringar fr att minska vrdrelaterade infektioner .........................61

    Deltagare i projektet ........................................................................................................77

    Bilaga 1:

    Instruktioner fr mtning av fljsamhet till basala hygienrutiner och kldregler .......................................................................82

    Fljsamhet till basala hygienrutiner..............................................................................84

    Fljsamhet till kldregler .................................................................................................86

    Bilaga 2:

    Sjlvskattningsformulr basala hygienrutiner ........................................................88

  • 5Ren vrd r skrare vrd II

    Vrdrelaterade infektioner ska stoppas

    BakgrundVrdrelaterade infektioner r inte ovanliga i svensk hlso- och sjukvrd. Vissa be-rkningar tyder p att tio procent av alla inneliggande patienter drabbas av sdana. Vrdrelaterade infektioner r ocks en a