ICU导管相关感染调查

Surveillance ofDevice 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/SRespiratory S/SChest X-R evidenceLaboratory results,Definitions CA-BSI,Had device within 48-hrs period before onset of infectionClinical manifestationsCommon skin contaminant from 2 blood culturesNo apparent source for BSI except the catheter,Definitions CA-UTI,Symptomatic UTIS/S of UTI+ve urine culture =10Asymptomatic bacteriuria+ve urine culture =10No S/S of UTI,Calculate Device-associated infection rates,Number of device-associated infection for a specific site x 1000Number of device-days,Calculate Device utilization ratios,Number of device-daysNumber of patient-days,VAP Surveillance in ICU,ABNo. of VAP627Patient days13734872Ventilator days 6432694Infection rates9.33 (50)10.02 (50)DU ratios0.47 500.55 75() NNIS device associated infection percentile NNIS device utilization percentile,CA-BSI Surveillance in ICU,ABNo. of CA-BSI 08Patient days13734872CVC days4023216Infection rates0 (10)2.49(25)DU ratios0.26 100.6650() NNIS device associated infection percentile NNIS device utilization percentile,CA-UTI Surveillance in ICU,ABNo. of UTI2312Patient days13734872Urinary Cath days11484711Infection rates20.03 (90)2.55(25)DU ratios0.84 500.97.90() NNIS device associated infection percentile NNIS device utilization percentile,Pathogens Isolated - VAP,No. of infection6No. of isolate9GM -ve microorganism66.6%Proteus, Pseudnmonas, Acinetobacter, Klebsiella, EnterobacterGM +ve microorganism33.3%-haem. Strep., MSSA, Strep. pneumoniaeFungus0%,Pathogens Isolated CA-UTI,No. of infection23No. of isolate28GM -ve microorganism 92.9%E.Coli