1、Nosocomial Infection and ControlPerformanceIncentives x knowledgebarriersadapted Muir Grey:2010Good performance of clinicians Key points of my speechDefinition and registration of HAIEpidemiology profile of HAITwo arms of HAI control: hygiene % antibiotics policyRegistration of HAI and Its Significa

2、nceAim of registrationHow to avert interference Mono-factor investigationMulti-sector cooperationKey points of my speechDefinition and registration of HAIEpidemiology profile of HAITwo arms of HAI control: hygiene % antibiotics policyquestionWhat strategy is proper for HAI control?Is it feasible to

3、eliminate source of infection as a strategy of HAI control? Thinking pathway: key issue of infection control is elimination of infection source and /or stop transmission or, bothThe key strategy of HAI control1 .Baseline survey of HAI and risk assessment2 . Technology of disinfection and Q.C3 . Anti

4、biotic policy4 .Control of environment safetyThe Pareto Principle: Focusing on the Most Important DecisionsType A Problems AType B Problems BType C Problems CType D Problems DThe outcome of spreading of pathogenic strain in hospital environmentHAI: infection processColonization (it is not necessary

5、to cause infection )Infection and spreading of infection among susceptibleQuestion: can we prevent colonization and how?Overview of strategy to control HAINormal flora: a double-edged knifeNormal flora: An important defense forceOpportunistic flora: Risk of infectionInfection Pathway Blood circulati

6、on Mucus membrane Cornea Infection Respiratory tract Key points of my speechDefinition and registration of HAIEpidemiology profile of HAITwo arms of HAI control: hygiene % antibiotics policyKey points of my speechDefinition and registration of HAIEpidemiology profile of HAITwo arms of HAI control: h

7、ygiene % antibiotics policyVery low temperature ( 50C to 95C ) will kill bacteria because of 1) Dehydration of cytoplasm leading to increased concentration of electrolytes 2) Inactivation of some enzymes by removal of SH group 3) Damage of cell membraneSterilization & DisinfectionKinetics of bacteri

8、a activationThe target of disinfection protein cell membrane and virus envelop DNA cell wall othersSTERILIZATION METHODSPhysical Agents HEATDRY : Heat AirHUMID : Pressure steamPOUPINEL STOVESTERILIZERIONIC RADIATIONg RAY ELECTRONSChemicalAgents GASES ETHILENE OXYDEFORMALDEHYDEPLASMA GAS OF HYDROGEN

9、PEROXYDELQUIDS : GLUTARALDEHYDE, PERACETIC ACIDAntimicrobial agentsPhysical methodsI. Heat 1. Pasteurization (principles) 2. Dry heat 3. Moist heat a. Autoclave b. Steam c. WaterDry Heat160 170C for 2 -4 hoursDry heatAutoclaving: most popular instrument for sterilizationSteam SterilizationAutoclaves

10、Steam under pressure (moist heat)Usually 121C for 30-60 minutesDependent on agent and materialSteam SterilizationSmall Portable AutoclavesSteam SterilizationLarge Autoclaves (cage racks)Steam PenetrationSteam must be in contact with the material being sterilized to be effective.Alkaline Hydrolysis C

11、austic DigestersUsed for animal carcassesCombines an alkaline solution and heat to reduce tissue into sterile aqueous solutionLarge volume reduction in waste腐蝕消化爐Effluent DecontaminationChemical systemsGood for smaller volumes May be detrimental to environmentAdjust pH for release to sanitary sewerC

12、ontinuous Effluent DecontaminationGood for smaller volumes Doesnt handle solids Continuous Effluent DecontaminationMoves pressurized effluent through length of piping Measures temp at beginning and end of piping loop Length of piping and flow rate determine time waste is held at that tempEfficacy as

13、sessment of disinfectant cell wall cell membrane coat of virusStructure-based strategy消毒劑 種類革蘭陽性菌革蘭陰性菌分枝 桿菌芽胞真菌包膜病毒無包膜病毒酚類+醇類+甲醛+戊二醛+氧化乙烯+次氯酸鹽類+氯胺類+碘+洗必泰+重金屬類+過氧化氫+季胺類+Safety assessment of disinfectant general toxicity local toxicity speed of action detergent-resistant organics-resistant environment

14、 safety消毒劑 種類全身毒性局部毒性作用速度蛋白滅活表面活性劑滅活價格環(huán)境污染酚類+中+低+醇類+快中甲醛+慢+低+戊二醛+慢+高+氧化乙烯+慢+高+次氯酸鹽類+快+低氯胺類+快+低碘+快+高+洗必泰+中+高+重金屬類+慢+高+過氧化氫+快+中季胺類+中+中Quality controlQC of finish productProcedure controlLow cost and easy to operateEasy to identify the technical errorSampling may cover the same lot of product Reliabili

15、ty and qc assurance Re-call performanceHigh cost Key points of my speechDefinition and registration of HAIEpidemiology profile of HAITwo arms of HAI control: hygiene % antibiotics policyAnti-bacterial medicine Anti-bacteria medicineAntibiotics: Natural or semi-synthesized substance that kill and/or

16、inhibit bacteriaChemicals: Synthesized substances that kill and/or inhibit bacteria Anti-bacteria chemicalsSulfonamideQuinolonesOthers Antibiotics: R&DStandard of potential product1、efficacy2、Metabolic pathway3、Advert effects4、Feasibility of industrial productionAntibiotics: From R&D to Clinical App

17、licationSemi-synthesis: Popular approachFeasibility of marketing promotionLife span of marketing Resistance mechanism of bacteriaEnzyme destructionChemical modificationChange of PermeabilityMetabolism pathwayDeletion or change of target moleculesMechanism of resistance emergenceSelection pressureGen

18、etic recombination Incorrect use of antibioticsAntibiotic chemotherapy for non-bacteria infectionProphylaxis with antibioticsLocal application of antibioticsOver-use of wide-spectrum antibioticsToo long time of antibiotic chemotherapyAbuse of antibiotics in agriculture Bottle neck of antibiotic R%DS

19、hort life span because of over-useDifficulties in R%D 1、Proper Strain of candidate antibiotics 2、Expensive process of development 3、Long-term development & BESAdverse effectsSocial pressure from the health-care costSulphonamidesTetracyclinesPenicillinsAminoglycosidesMacrolidesGlycopeptidesStreptogra

20、minsChloramphenicolQuinolonesTrimetoprimLincosamides1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000sOxazolidinones新型抗菌藥物的研發(fā)越來越難Lipopeptides磺胺青霉素氨基糖甙類糖肽類大環(huán)內(nèi)酯四環(huán)素氯霉素潔霉素奎洛酮類鏈陽霉素甲氧芐啶酯肽類美國FDA批準(zhǔn)上市的新型抗菌藥物數(shù)量 1983-2002 (不含外用藥)Source: Nordberg P, et al. Antibacterial drug resistance background paper Priority Medicines