ssi危险因素与预防策略3m演示PPT

1、1 1 2 3M Infection Prevention Division 2 3M Infection Prevention Division Institute of Medicines To Err is Human. Washington DC: The National Academy Press,1999. SSI 3 3M Infection Prevention Division 3 CDCs National Nosocomial Infections Surveillance (NNIS) system 4 3M Infection Prevention Division

2、 4 5 3M Infection Prevention Division 5 6 3M Infection Prevention Division 6 Goal 7: Reduce the risk of health care associated infections NPSG.07.05.01: Implement best practices for preventing surgical site infections 2 2 7 9 3M Infection Prevention Division 3M Infection Prevention Division 8 10 8 1

3、0 11 3M Infection Prevention Division 11 7 9 Cushing H: Concerning the result of operations for brain tumor, JAMA 64:189-195,1915 12 3M Infection Prevention Division 12 3M Infection Prevention Division 3M Infection Prevention Division 1. Astagneau P, LHeriteau F, Daniel F et al. Reducing surgical si

4、te infection incidence through a network, results from the French ISO-RAISIN surveillance system. J. Hosp. Infect. 72, 127134 (2009). 2. Mannin J, van den Hof S, Muilwijk J et al. Trends in the incidence of surgical site infection in The Netherlands. Infect. Control Hosp. Epidemiol. 29, 11321138 (20

5、08). 3 3 13 3M Infection Prevention Division 13 Bolon Mk, et al, Clin Infect Dis 2009;48:1223-1229 14 3M Infection Prevention Division 14 Yokoe DS, et al, Emerg Infect Dis 2004;10,1924-1930 15 3M Infection Prevention Division 15 MRSA VRE CA-MRSA NDM-1 PDRAB VISA VRSA 16 Staphylococcus aureus30.0% Co

6、agulase-negative staphylococci Enterococcus spp. Escherichia coli Pseudomonas aeruginosa Enterobacter spp Klebsiella pneumoniae 13.7% 11.2% 9.6% 5.6% 4.2% 3.0% Candida spp. Klebsiella oxytoca Acinetobacter baumannii 2.0% 0.7% 0.6% N=7,025 Hidron AI, et.al., Infect Control Hosp Epidemiol 2008;29:996-

7、1011 Hidron AI et.al., Infect Control Hosp Epidemiol 2009;30:107107(ERRATUM) 17 3M Infection Prevention Division 17 18 3M Infection Prevention Division 18 无菌操作不会产生“耐药性” 4 4 19 3M Infection Prevention Division 19 189539.0% 1897 1899 1912 7.0% 3.2% 2.4% 19131.6% (would bring the profession in disreput

8、e ) George Emerson Brewer, M.D. JAMA April 24, 1915 20 3M Infection Prevention Division 20 SSI Studies in Aseptic Technique 21 3M Infection Prevention Division 21 22 3M Infection Prevention Division 22 1.Guideline For Prevention Of Surgical Site Infection, 1999 X 1 = 23 3M Infection Prevention Divis

9、ion 23 106 102 6hrs3-5 days1 day Dr. Maxwell Finland RI Med J 1960;43:499-504 1hr2hrs 24 3M Infection Prevention Division 24 5 5 25 3M Infection Prevention Division 25 26 3M Infection Prevention Division 26 SSI Rate20%7.10%3.10% 2424 “” U.S. Department of Health 188:225-230 32 3M Infection Preventio

10、n Division 32 33 3M Infection Prevention Division 33 3M Infection Prevention Division Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 358, 876880 (2001) 34 3M Infection Prevention D

11、ivision 34 35 3M Infection Prevention Division 35 36 3M Infection Prevention Division 36 Latham R,et al. Infect Control Hosp Epidemiol.2001;22:607-612 7 Ref: Christopher T. Drake, Ann. Surgery 1977. 7 37 3M Infection Prevention Division 37 38 3M Infection Prevention Division 38 39 3M Infection Preve

12、ntion Division 39 40 3M Infection Prevention Division 40 =100/g=1,000,000/g / MRSA/MRSE 41 3M Infection Prevention Division 41 42 3M Infection Prevention Division 42 细菌从何而来？ 10% 8 8 43 3M Infection Prevention Division 43 1. 2. Rabih O. Darouiche ChlorhexidineAlcohol versus PovidoneIodine for Surgica

13、l- Site Antisepsis N Engl J Med 2010;362:18-26 Strategies to Prevent Central LineAssociated Bloodstream Infections in Acute Care Hospitals 3. Chlorhexidine gluconate preoperative skin preparation initiated a 100% reduction ofincisional Cesarean section infections while other risk factors were evalua

14、ted and corrected University of Minnesota Medical Center, Fairview, Minneapolis, MN,2008 44 3M Infection Prevention Division 44 Jan. 2010 45 3M Infection Prevention Division 45 46 3M Infection Prevention Division 46 47 3M Infection Prevention Division 47 1.French ML, Eitzen HE, Ritter MA. The plasti

15、c surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg 1976;184:46. 2. Johnston DH, Fairclough JA, Brown EM, et al. Rate of bacterial ecolonization of the skin after preparation: four methods compared. Br J Surg 1987;74:64. 3. Alexander JW, Aerni S, Plettner JP. De

16、velopment of a safe and effective one-minute preoperative skin preparation. Arch Surg 1985;120:1357. 48 3M Infection Prevention Division 48 9 CFU 9 49 49 10 110100100010000100000100000010000000 10000 Ioban 2 1000 100 CFU 50 50 Alexander JW, Aerni S, Plettner JP: Development of a safe and effective o

17、ne-minute preoperative skin preparation. Arch Surg 120:13571361, 1985. 1 51 3M Infection Prevention Division 51 3M Infection Prevention Division 52 3M Infection Prevention Division 52 3M Infection Prevention Division 1. Hsieh HF, Chiu HH, Lee FP. Surgical hand scrubs in relation to microbial counts:

18、 systematic literature review. J Adv Nurs 2006;55:68. 2. Pereira LJ, Lee GM, Wade KJ. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect 1997;36:49 53 3M Infection Prevention Division 53 1. Nelson CL. Prevention of sepsis. Clin

19、Orthop Relat Res 1987;222:66. 2. Davies RR, Noble WC. Dispersal of bacteria on desquamated skin. Lancet1962;2:1295. 3. Walter CW, Kundsin RB. The airborne component of wound contamination and infection. Arch Surg 1973;107:588. 4. BSEN 13795-1:2002 54 3M Infection Prevention Division 54 10 10 55 3M I

20、nfection Prevention Division 55 56 3M Infection Prevention Division 56 57 3M Infection Prevention Division 57 Bode LGM, etal. Preventing SSI in nasal carriers of Staph aureus. NEJM 2010;362:9-17 58 3M Infection Prevention Division 58 59 3M Infection Prevention Division 59 60 3M Infection Prevention

21、Division 60 SSI 11 11 61 3M Infection Prevention Division 61 62 3M Infection Prevention Division 62 63 3M Infection Prevention Division 63 Annals of Surgery Volume 248, Number 5, November 2008 64 3M Infection Prevention Division 64 65 3M Infection Prevention Division 65 66 3M Infection Prevention Di

22、vision 66 1. Letts RM, Doermer E. Conversation in the operating theater as a cause of airborne bacterial contamination.J Bone Joint Surg Am 1983;65:357 12 12 67 67 1.Blomgren G, Hoborn J, Nystrom B. Reduction of contamination at total hip replacement by special working clothes. J Bone Joint Surg Br

23、1990;72:985. 2. Whyte W, Bailey PV, Hamblen DL, et al. A bacteriologically occlusive clothing system for use in the operating room. J Bone Joint Surg Br 1983;65:502. 3. Charnley J, Eftekhar N.Related Penetration of gown material by organisms from the surgeons body. Lancet. 1969 Jan 25;1(7587):172-3

24、4. Moylan J A, Fitzpatrick K T, Davenport K E, Reducing wound infections. Improved gown and drape barrier performance, Arch Surg 1987, 122-152-157 3M Infection Prevention Division 68 3M Infection Prevention Division 68 1. 2. 3. Davis N, Curry A, Gambhir AK, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br 1999 Sep; 81(5): 8869. Sebold EJ, Jordan LR. Intraoperative glove perforation. A comparative analysis. Clin Orthop Relat Res 1993 Dec; 297: 2424. Doyle PM, Alvi S, Johanson R. The effectiveness of double-gloving in obstetrics and