ICU導(dǎo)管相關(guān)感染監(jiān)測

(Aversionfortrainingpurposeonly,thedatainvolvedisnotreflectingtherealsituation)Surveillanceof

DeviceRelatedInfection

inIntensiveCareUnit

NationalNosocomialInfectionsSurveillance(NNIS)system

全國院內(nèi)感染監(jiān)測系統(tǒng)Purpose目的Monitortheinfectionrates監(jiān)控感染率BenchmarkwithNNISSystem與NNIS標竿Determinetrends確定趨勢Identifyoutbreak定義暴發(fā)Facilitatecomparisons易于比較Linkmonitoredratesandpreventionefforts感染率與預(yù)防效果的聯(lián)系Reducedevicesrelatedinfectioninhospital減少醫(yī)院導(dǎo)管等裝置的感染率Device-associatedinfections導(dǎo)管相關(guān)感染Urinarycatheter-associatedUrinarytractinfection(CA-UTI)導(dǎo)尿管相關(guān)的尿路感染Centralline-associatedBloodstreaminfection(CA-BSI)中心靜脈導(dǎo)管相關(guān)的血流感染Ventilator-associatedPneumonia(VAP)呼吸機相關(guān)的肺炎Denominatordata分母資料Countat12midnightineveryday每天在午夜12點計算Totalnumberofpatients’admission所有病人Patient-days病人日Urinarycatheter-days導(dǎo)尿管日Centralline-days中心靜脈插管日Ventilator-days呼吸機日Surveillancemethods調(diào)查方法ongoingrevieweachpatientinICU.持續(xù)觀察ICU的每個病人byreviewingDoctorsprogressnotes,Nursingnotes,

Physiotherapistsnotes,XRreport,charts,MARforms,conversationswithnursesandphysicians查看醫(yī)生病程、護理記錄、理療單、X線檢查、CT/MAR。醫(yī)生護士的會話byreviewinglaboratorydata.

查看實驗室數(shù)據(jù)

Definedevice-relatedinfection定義導(dǎo)管相關(guān)感染ByusingstandardCDCdefinitionsthatincludelaboratory&clinicaldata使用CDC的標準包括實驗室和臨床資料Definitions–CA-BSIHaddevicewithin48-hrsperiodbeforeonsetofinfectionClinicalmanifestationsCommonskincontaminantfrom2bloodculturesNoapparentsourceforBSIexceptthecatheterDefinitions–CA-UTISymptomaticUTIS/SofUTI+veurineculture>=10Asymptomaticbacteriuria+veurineculture>=10NoS/SofUTICalculateDevice-associatedinfectionratesNumberofdevice-associatedinfectionforaspecificsitex1000Numberofdevice-daysVAPSurveillanceinICU

A BNo.ofVAP 6 27Patientdays 1373 4872Ventilatordays 643 2694Infectionrates 9.33(>50) 10.02(>50)DUratios 0.47[50] 0.55[75]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentileCA-BSISurveillanceinICU

A BNo.ofCA-BSI 0 8Patientdays 1373 4872CVCdays 402 3216 Infectionrates 0(10) 2.49(25)DUratios 0.26[>10] 0.66[50]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentileCA-UTISurveillanceinICU A BNo.ofUTI 23 12Patientdays 1373 4872UrinaryCathdays 1148 4711Infectionrates 20.03(>90)2.55(25)DUratios 0.84[50] 0.97[.90]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentilePathogensIsolated–CA-UTI

No.ofinfection 23No.ofisolate 28GM-vemicroorganism 92.9% E.Coli(50%),Klebsiella(14.3%),P