英文版医院感染控制PPT课件

.,1,TargetedSurveillanceforNosocomialInfections,BarbaraM.Soule,RN,MPA,CICChineseSocietyforNosocomialInfectionsJuly4-5,2004Suzhou,China,.,2,ICPractitioner(ICP)Activities,Surveillance,ProgramManagement,Education,Miscellaneous,OutbreakInvestigation,Consultation,.,3,SurveillancehasanEpidemiologicfoundation,Studythedistributionofproblemsandeventswithinadefined(targeted)populationatriskfordevelopingspecificinfectionsinordertoplan326:281,Incision,Hoursbeforeincision,Hoursafterincision,AntibioticAdministered,.,25,TimingofPerioperativeAntimicrobialProphylaxis,ClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281,.,26,2.PerformTargetedSurveillanceforThisProblem,1)Proportionofpatientswhoreceiveprophylacticantibioticswithin1hourbeforesurgicalincision#antibiotics1hour#surgerieswithantibiotics,.,27,PerformTargetedSurveillanceforThisProblem,2)Proportionofpatientswhoseantibioticswerediscontinuedwithin24hoursofthesurgeryendtime#discontinuew/I24hours#surgeriesreceivingantibiotics,.,28,PossibleSurgicalProcedurestoDetermineTimingofAntibioticProphylaxis,CABGColonsurgeryHipandkneearthroplastyAbdominalandvaginalhysterectomyVascularsurgery(e.g.,peripheralvascularsurgery),.,29,3.ToAffectChange,MultidisciplinaryTeamtolookatantibioticdeliverysystem:currentanddesiredRedesignsystemfortimelyABdeliveryMakeantibioticaccessibleEducatenursingandoperatingroomstaffandanesthesiologistsandsurgeonsRecordtimeonpatientchart,.,30,4.Dothechangeswork?,Re-measure2variablesin3monthsafterinitiationofnewimprovedprocedureMeasuresurgicalsiteinfectionrates.,.,31,TargetedSurveillanceforanInfectionOutcome,.,32,TargetedSurveillanceforOutcomes,NIRate:VAPCR-BSIUTIFoleyrelatedNon-Foleyrelated,DrivesInterventionFor:PneumoniapreventionCR-BSIpreventionFoley-care,d/cprogramPeri-care/hydration,.,33,1.IsThereanImportantProblem?,Ventilator-associatedpneumoniaisamajorinfectionriskforpatientsincreasedmortalityexcesslengthofstayexcesscost,.,34,Example:ChallengeforTargetedSurveillance,Reduceventilatorassociatedpneumonias(targetedadverseevent)by50%#VAPinfections#1000ventilatordays,.,35,ReductionofVAPwithTargetedSurveillanceandInterventions,KwanKL,BakerSP,FontecabioSA.Impactofaprogramofintensivesurveillanceandinterventionstargetingventilatedpatientsinthereductionofventilator-associatedpneumonia,anditscosteffectivenessICHE2003;24;11:859-63.,.,36,ReductionofVAPwithTargetedSurveillanceandInterventions,Inverventions:RaiseheadofbedSterilewaterfortubefeedingsIn-linesuctioncathetersfrom24-48-72-asneededCostsavings$350,000inoneyear.,.,37,1.IsThereanImportantProblem?,Catheter-relatedbloodstreaminfectionsareaseriousinfectionriskdevice-relatedmorbidityandmortalityextralengthofstayadditionalmedicalcosts,.,38,Example:ChallengeforTargetedSurveillance,.,39,2.PerformTargetedSurveillanceforThisProblem,MonitorbloodstreaminfectionsinSurgicalICUpatients.,.,40,3.AffectChangeSuccessfulinterventionsfromtargetedsurveillanceforBSI,SuccessfuleducationprogramtoreducecatheterassociatedbloodstreaminfectionsDrapesandfullPPEduringinsertionMonitoringandcareforsite,.,41,4.Dothechangeswork?,Re-measurein3months