If I had U$ which IPC intervention would I Choose?! Carlos Starling Belo Horizonte Brazil

Transcrição

1 If I had U$ which IPC intervention would I Choose?! Carlos Starling Belo Horizonte Brazil cstarling@task.com.br

2 Disclosure No conflict with this topic 2

3 BMC road bike price U$ 6.000

4 Conseqüência das infecções hospitalares no Brasil: óbito Obs.: considerando internações/ano

5 Nosocomial Infection Costs Auto e ano de publicação País Infecção ou microorganismo Custos (US$) Navarrete-Navarro 1999 México Global (IH) Leroyer 1997 França Global (IH) Diaz-Molina 1993 Espanha Global (IH) Li 1990 China Global (IH) Starling 2003 Brasil Global (IH) 5,548 Pittet 1994a USA Corrente sanguínea Stone PW 2003 Global Corrente sanguínea Digiovine 1999 USA Corrente sanguínea Jarvis USA Corrente sanguínea Abramson 1999 USA Corrente sanguínea Starling 2003 Brasil Corrente sanguínea Saint 2002 USA Corrente sanguínea Cosgrove 2002 USA Enterobacter spp Stone PW 2003 Global MRSA Rubin 1999 USA MRSA Abramson 1999 USA MRSA (sepse) Kotilainen 1997 USA Pneumonia Starling 2003 Brasil Pneumonia Jarvis USA Pneumonia Pittet 1994b França Pneumonia Kappstein 1992 Alemanha Pneunonia Haley 1987 USA Pneunonia Whitehouse 2002 USA Sítio cirúrgico Starling 2003 Brasil Sítio cirúrgico Jarvis USA Sítio cirúrgico Starling 2003 Brasil Trato urinário Saint 2002 USA Trato urinário 676 Tambyah 2002 USA Trato urinário 589 Jarvis USA Trato urinário 576

6 Average Length of Stay related with NI Auto e ano de publicação País Infecção ou microorganismo Dias extras de internação Li 1990 China Global (IH) 24 Diaz 1993 Espanha Global (IH) 14 Navarrete-Navarro 1999 México Global (IH) 10 Leroyer 1997 França Global (IH) 5 Diaz-Molina 1993 Espanha Global (IH) 4 Pittet 1994a USA Corrente sanguínea 24 Bates 2003 USA Corrente sanguínea 11 Digiovine 1999 USA Corrente sanguínea 10 Cosgrove 2002 USA Enterobacter spp 9 Abramson 1999 USA MRSA (sepse) 12 Bercault 2001 France Pneumonia 15 Merchant 1998 Índia Pneumonia 6 Kappstein 1992 Alemanha Pneunonia 10 Haley 1987 USA Pneunonia 6

7 NI costs in a Brazilian General Hospital Obs.: considerando internações por ano STARLING et al, 2003.

8 Cost Benefit of NIC Costs of NIC by years of life saved = US$2.000 to US$ Cost efectivines of colesterol reduction in a person > 40 years old = US$ by years of life saved Mamography in Womens from 50 to 60 years = US$ by years of life saved Fraser UJ, AJIC, 30:77-85, 2002

9 Hand Hygiene X Nosocomial Infection Ignaz P. Semmelweis (Topics - Nosocomial Infections) BOYCE,J.M; PITTET,D. Guideline for hand hygiene in health-care settings,mmwr,v.51,rr-16,october

10 Hand Hygiene Compliance Unfortunately, despite all the effort made by the professionals in infection control, compliance with hand hygiene practices is still unacceptably low usually less than 50% (Pittet, 2001; WHO, 2009). In developing countries handwashing compliance is worst, about 30% (Wu et al., 2016) In Brazil, this rate of adhesion is 27%, varying between 12% before contact with the patient and 45% after this contact (Erasmus et al., 2010; Bathke et al., 2013). Comissão Executiva de Controle de Infecções Hospitalares 10

11 Hand Hygiene Educational Program Comissão Executiva de Controle de Infecções Hospitalares 11

12 How to change this reality? Continuous education of healthcare workers with multimodal strategy and direct observation can produce long-lasting improvement in hand hygiene compliance (Arise et al., 2016; Arntz et al., 2016) Consecutive campaigns with immediate feedback methods also can achieve and sustain a durable high hand hygiene compliance rate (Fonguh et al., 2016) In this context, novel education strategies, more interactive, as the use of robot to personalize health education, can improve hand washing adherence (Blanson et al., 2013; Sheridan, 2016). Comissão Executiva de Controle de Infecções Hospitalares 12

13 The objective of our study a) How to adapt a robot as MeccaNoid G15KS ( ) to be an instrument of health training and continuous education of healthcare workers? b) What is the effectiveness of the use of a humanoid robot on the compliance with hand hygiene? Comissão Executiva de Controle de Infecções Hospitalares 13

14 ADAPTING THE TOY ROBOT Comissão Executiva de Controle de Infecções Hospitalares 14

15 ADAPTING THE TOY ROBOT Comissão Executiva de Controle de Infecções Hospitalares 15

16 OZIRES in Action Comissão Executiva de Controle de Infecções Hospitalares 16

17 OZIRES in Action Comissão Executiva de Controle de Infecções Hospitalares 17

18 Comissão Executiva de Controle de Infecções Hospitalares 18

19 Results Comissão Executiva de Controle de Infecções Hospitalares 19

20 How much cost Ozires? Comissão Executiva de Controle de Infecções Hospitalares 20

21 Conclusion It is really possible to use a toy robot, after few adaptations, as a great instrument of health training and continuous education of healthcare workers with less than US$ 4.000,00 The education approach based on Ozires, it is not necessary to withdraw the healthcare worker from his work area, as an ICU, which can be a novel education strategy, more interactive, that can really personalize health education. Comissão Executiva de Controle de Infecções Hospitalares 21

22 Conclusion We found very promising results in our pilot study. After the insertion of Ozires in the three ICUs enrolled in this study, the mean hand hygiene rate increased from 36%, between January and July, to 65% in August-November/ 2016 Innovation is difficult to define, but, for sure to use a robot to engage medical and nurses in short term courses is a technological innovations in teaching and learning in healthcare facilities Comissão Executiva de Controle de Infecções Hospitalares 22

23 The Future Several others Robots are being created We are linking Ozires with your virtual old cousin Watson(IBM) in order to give him a real artificial intelligence Real time EPI surveillance, ATM Stewardship and other basic and advanced IC activities What will be the ICP in the near future??? Comissão Executiva de Controle de Infecções Hospitalares 23

24 ICP in the future more time and money(?) to have fun... Comissão Executiva de Controle de Infecções Hospitalares 24