ICU 导管相关感染调查PPT参考幻灯片.ppt

SurveillanceofDeviceRelatedInfectioninIntensiveCareUnitICU导管相关感染监测 Aversionfortrainingpurposeonly thedatainvolvedisnotreflectingtherealsituation 1 NationalNosocomialInfectionsSurveillance NNIS system全国院内感染监测系统 2 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 3 Populationatrisk危险人群 AllpatientshasbeenadmittedinICUfor 48hours 入ICU48小时的病人Followpatientsfor48hoursafterdischargefromICU 病人转出ICU需继续跟踪48小时 4 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 5 Denominatordata分母资料 Countat12midnightineveryday每天在午夜12点计算 Totalnumberofpatients admission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 6 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 7 8 9 10 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 11 Definitions VAP Haddevicewithin48 hrsperiodbeforeonsetofinfectionSystemicS SRespiratoryS SChestX RevidenceLaboratoryresults 12 Definitions CA BSI Haddevicewithin48 hrsperiodbeforeonsetofinfectionClinicalmanifestationsCommonskincontaminantfrom2bloodculturesNoapparentsourceforBSIexceptthecatheter 13 Definitions CA UTI SymptomaticUTIS SofUTI veurineculture 10Asymptomaticbacteriuria veurineculture 10NoS SofUTI 14 CalculateDevice associatedinfectionrates Numberofdevice associatedinfectionforaspecificsitex1000Numberofdevice days 15 CalculateDeviceutilizationratios Numberofdevice daysNumberofpatient days 16 VAPSurveillanceinICU ABNo ofVAP627Patientdays13734872Ventilatordays6432694Infectionrates9 33 50 10 02 50 DUratios0 47 50 0 55 75 NNISdeviceassociatedinfectionpercentile NNISdeviceutilizationpercentile 17 CA BSISurveillanceinICU ABNo ofCA BSI08Patientdays13734872CVCdays4023216Infectionrates0 10 2 49 25 DUratios0 26 10 0 66 50 NNISdeviceassociatedinfectionpercentile NNISdeviceutilizationpercentile 18 CA UTISurveillanceinICU ABNo ofUTI2312Patientdays13734872UrinaryCathdays11484711Infectionrates20 03 90 2 55 25 DUratios0 84 50 0 97 90 NNISdeviceassociatedinfectionpercentile NNISdeviceutilizationpercentile 19 PathogensIsolated VAP No ofinfection6No ofisolate9GM vemicroorganism66 6 Proteus Pseudnmonas Acinetobacter Klebsiella EnterobacterGM vemicroorganism33 3 haem Strep MSSA Strep pneumoniaeFungus0 20 PathogensIsolated CA UTI No ofinfection23No ofisolate28GM vemicroorganism92 9 E