ICU导管相关感染监测.ppt

ICU导管相关感染监测,(Aversionfortrainingpurposeonly,thedatainvolvedisnotreflectingtherealsituation),SurveillanceofDeviceRelatedInfectioninIntensiveCareUnit,NationalNosocomialInfectionsSurveillance(NNIS)system全国院内感染监测系统,Purpose目的,Monitortheinfectionrates监控感染率BenchmarkwithNNISSystem与NNIS标竿Determinetrends确定趋势Identifyoutbreak定义暴发Facilitatecomparisons易于比较Linkmonitoredratesandpreventionefforts感染率与预防效果的联系Reducedevicesrelatedinfectioninhospital减少医院导管等装置的感染率,Populationatrisk危险人群,AllpatientshasbeenadmittedinICUfor48hours.入ICU48小时的病人Followpatientsfor48hoursafterdischargefromICU.病人转出ICU需继续跟踪48小时,Device-associatedinfections导管相关感染,Urinarycatheter-associatedUrinarytractinfection(CA-UTI)导尿管相关的尿路感染Centralline-associatedBloodstreaminfection(CA-BSI)中心静脉导管相关的血流感染Ventilator-associatedPneumonia(VAP)呼吸机相关的肺炎,Denominatordata分母资料,Countat12midnightineveryday每天在午夜12点计算,Totalnumberofpatientsadmission所有病人Patient-days病人日Urinarycatheter-days导尿管日Centralline-days中心静脉插管日Ventilator-days呼吸机日,Surveillancemethods调查方法,ongoingrevieweachpatientinICU.持续观察ICU的每个病人byreviewingDoctorsprogressnotes,Nursingnotes,Physiotherapistsnotes,XRreport,charts,MARforms,conversationswithnursesandphysicians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byreviewinglaboratorydata.查看实验室数据,Definedevice-relatedinfection定义导管相关感染,ByusingstandardCDCdefinitionsthatincludelaboratory&clinicaldata使用CDC的标准包括实验室和临床资料,DefinitionsVAP,Haddevicewithin48-hrsperiodbeforeonsetofinfectionSystemicS/SRespiratoryS/SChestX-RevidenceLaboratoryresults,DefinitionsCA-BSI,Haddevicewithin48-hrsperiodbeforeonsetofinfectionClinicalmanifestationsCommonskincontaminantfrom2bloodculturesNoapparentsourceforBSIexceptthecatheter,DefinitionsCA-UTI,SymptomaticUTIS/SofUTI+veurineculture=10Asymptomaticbacteriuria+veurineculture=10NoS/SofUTI,CalculateDevice-associatedinfectionrates,Numberofdevice-associatedinfectionforaspecificsitex1000Numberofdevice-days,CalculateDeviceutilizationratios,Numberofdevice-daysNumberofpatient-days,VAPSurveillanceinICU,ABNo.ofVAP627Patientdays13734872Ventilatordays6432694Infectionrates9.33(50)10.02(50)DUratios0.47500.5575()NNISdeviceassociatedinfectionpercentileNNISdeviceutilizationpercentile,CA-BSISurveillanceinICU,ABNo.ofCA-BSI08Patientdays13734872CVCdays4023216Infectionrates0(10)2.49(25)DUratios0.26100.6650()NNISdeviceassociatedinfectionpercentileNNISdeviceutilizationpercentile,CA-UTISurveillanceinICU,ABNo.ofUTI2312Patientdays13734872UrinaryCathdays11484711Infectionrates20.03(90)2.55(25)DUratios0.84500.97.90()NNISdeviceassociatedinfectionpercentileNNISdeviceutilizationpercentile,PathogensIsolated-VAP,No.ofinfection6No.ofisolate9GM-vemicroorganism66.6%Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+vemicroorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%,PathogensIsolatedCA-UTI,No.ofinfection23No.ofisolate28GM-vemicroorganism92.9%E.Coli(50