ICU_导管相关感染调查.ppt

surveillance of device related infection in intensive care unit icu导管相关感染监测,(a version for training purpose only, the data involved is not reflecting the real situation ),national nosocomial infections surveillance (nnis) system 全国院内感染监测系统,purpose目的,monitor the infection rates 监控感染率 benchmark with nnis system 与nnis标竿 determine trends 确定趋势 identify outbreak 定义暴发 facilitate comparisons 易于比较 link monitored rates and prevention efforts 感染率与预防效果的联系 reduce devices related infection in hospital 减少医院导管等装置的感染率,population at risk 危险人群,all patients has been admitted in icu for 48 hours. 入icu48小时的病人 follow patients for 48 hours after discharge from icu. 病人转出icu 需继续跟踪48小时,device-associated infections 导管相关感染,urinary catheter-associated urinary tract infection (ca-uti) 导尿管相关的尿路感染 central line- associated bloodstream infection (ca-bsi) 中心静脉导管相关的血流感染 ventilator- associated pneumonia (vap) 呼吸机相关的肺炎,denominator data 分母资料,count at 12 midnight in everyday 每天在午夜12点计算,total number of patients admission 所有病人 patient-days 病人日 urinary catheter-days 导尿管日 central line-days 中心静脉插管日 ventilator-days 呼吸机日,surveillance methods 调查方法,on going review each patient in icu. 持续观察icu的每个病人 by reviewing doctors progress notes, nursing notes, physiotherapists notes, xr report, charts, mar forms, conversations with nurses and physicians 查看医生病程、护理记录、理疗单、x线检查、ct/mar。医生护士的会话 by reviewing laboratory data. 查看实验室数据,define device-related infection 定义导管相关感染,by using standard cdc definitions that include laboratory & clinical data 使用cdc的标准包括实验室和临床资料,definitions vap,had device within 48-hrs period before onset of infection systemic s/s respiratory s/s chest x-r evidence laboratory results,definitions ca-bsi,had device within 48-hrs period before onset of infection clinical manifestations common skin contaminant from 2 blood cultures no apparent source for bsi except the catheter,definitions ca-uti,symptomatic uti s/s of uti +ve urine culture =10 asymptomatic bacteriuria +ve urine culture =10 no s/s of uti,calculate device-associated infection rates,number of device-associated infection for a specific site x 1000 number of device-days,calculate device utilization ratios,number of device-days number of patient-days,vap surveillance in icu,a b no. of vap 6 27 patient days 1373 4872 ventilator days 643 2694 infection rates 9.33 (50) 10.02 (50) du ratios 0.47 50 0.55 75 () nnis device associated infection percentile nnis device utilization percentile,ca-bsi surveillance in icu,a b no. of ca-bsi 0 8 patient days 1373 4872 cvc days 402 3216 infection rates 0 (10) 2.49(25) du ratios 0.26 10 0.6650 () nnis device associated infection percentile nnis device utilization percentile,ca-uti surveillance in icu,a b no. of uti 23 12 patient days 1373 4872 urinary cath days 1148 4711 infection rates 20.03 (90)2.55(25) du ratios 0.84 50 0.97.90 () nnis device associated infection percentile nnis device utilization percentile,pathogens isolated - vap,no. of infection 6 no. of isolate 9 gm -ve microorganism 66.6% proteus, pseudnmonas, acinetobacter, klebsiella, enterobacter gm +ve microorganism 33.3% -haem. strep., mssa, strep. pneumoniae fungus 0%,pathogens isolated ca-uti,no. of infection 23 no. of isolate 28 gm -ve microorganism 92.9% e.coli