Surveillanceof

DeviceRelatedInfection

inIntensiveCareUnit

ICU導管相關感染監(jiān)測

(Aversionfortrainingpurposeonly,thedatainvolvedisnotreflectingtherealsituation)精選課件NationalNosocomialInfectionsSurveillance(NNIS)system

全國院內(nèi)感染監(jiān)測系統(tǒng)精選課件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

感染率與預防效果的聯(lián)系Reducedevicesrelatedinfectioninhospital

減少醫(yī)院導管等裝置的感染率精選課件Populationatrisk

危險人群AllpatientshasbeenadmittedinICUfor>48hours.

入ICU48小時的病人Followpatientsfor48hoursafterdischargefromICU.

病人轉(zhuǎn)出ICU需繼續(xù)跟蹤48小時精選課件Device-associatedinfections

導管相關感染Urinarycatheter-associatedUrinarytractinfection(CA-UTI)

導尿管相關的尿路感染Centralline-associatedBloodstreaminfection(CA-BSI)

中心靜脈導管相關的血流感染Ventilator-associatedPneumonia(VAP)

呼吸機相關的肺炎精選課件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

導尿管日Centralline-days

中心靜脈插管日Ventilator-days

呼吸機日精選課件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)

精選課件精選課件精選課件精選課件Definedevice-relatedinfection

定義導管相關感染ByusingstandardCDCdefinitionsthatincludelaboratory&clinicaldata使用CDC的標準包括實驗室和臨床資料精選課件Definitions–VAPHaddevicewithin48-hrsperiodbeforeonsetofinfection

SystemicS/SRespiratoryS/SChestX-RevidenceLaboratoryresults精選課件Definitions–CA-BSIHaddevicewithin48-hrsperiodbeforeonsetofinfectionClinicalmanifestationsCommonskincontaminantfrom2bloodculturesNoapparentsourceforBSIexceptthecatheter精選課件Definitions–CA-UTISymptomaticUTIS/SofUTI+veurineculture>=10Asymptomaticbacteriuria+veurineculture>=10NoS/SofUTI55精選課件CalculateDevice-associatedinfectionratesNumberofdevice-associatedinfectionforaspecificsitex1000Numberofdevice-days精選課件CalculateDeviceutilizationratios

Numberofdevice-daysNumberofpatient-days精選課件VAPSurveillanceinICU

A BNo.ofVAP 6 27Patientdays 1373 4872Ventilatordays 643 2694Infectionrates 9.33(>50) 10.02(>50)DUratios 0.47[50] 0.55[75]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentile精選課件CA-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[]NNISdeviceutilizationpercentile精選課件CA-UTISurveillanceinICU A BNo.ofUTI 23 12Patientdays 1373 4872UrinaryCathdays 1148 4711Infectionrates 20.03(>90)2.55(25)DUratios 0.84[50] 0.97[.90]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentile精選課件PathogensIsolated-VAP

No.ofinfection 6No.ofisolate 9GM-vemicroorganism 66.6% Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+vemicroorganism 33.3%

α-haem.Strep.,MSSA,Strep.pneumoniaeFungus 0%精選課件PathogensIsolated–CA-UTI

No.ofinfection 23No.ofisolate 28GM-vemicroorganism 92.9% E.Coli