英文医院感染控制实用教案

1、会计学1英文医院英文医院(yyun)感染控制感染控制第一页，共43页。2Consultation第1页/共43页第二页，共43页。3Surveillance has an Epidemiologic foundationStudy the distribution of problems and events within a defined (targeted) population at risk for developing specific infections in order to plan & implement interventions.第2页/共43页第三页，共43

2、页。43 Key Surveillance Methods Hospital-wide Traditional SurveillanceAll infections complete- time consumingLimits time for interventions Periodic SurveillanceSelected infections or populations periodically over timeMiss some infections Targeted Surveillance第3页/共43页第四页，共43页。5Adapted from Pottinger et

3、 al & Gaynes et al.第4页/共43页第五页，共43页。第5页/共43页第六页，共43页。7NNIS SystemAURICUHRNSurgicalPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/Pediatric)High Risk Nursery (NICU)Risk adjustedSSIs byProcedures第6页/共43页第七页，共43页。8Your HospitalVAPICUBSISSIVentilator-Associated PneumoniaMedical /Surg

4、ical ICUsIntensive CareUnit(Pediatric)Primary BloodStream InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures第7页/共43页第八页，共43页。9第8页/共43页第九页，共43页。10第9页/共43页第十页，共43页。11第10页/共43页第十一页，共43页。12第11页/共43页第十二页，共43页。13第12页/共43页第十三页，共43页。14第13页/共43页第十四页，共43页。15第14页/共43页第十五页，共43页。16第15页/共43页第十六页，共43页。17第

5、16页/共43页第十七页，共43页。18第17页/共43页第十八页，共43页。191.Is there an important problem? What, why? Multidisciplinary Teams 2. Describe and understand the problem? Targeted Surveillance 3. How to affect change?Multidisciplinary TeamsEducationFeedbackNew protocolsNew products4. Do the changes work? Remeasure Adapte

6、d from: Richards C, et al. Emerg Infect Dis 2001第18页/共43页第十九页，共43页。20NLMIgnaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis第19页/共43页第二十页，共43页。21NLM Archives第20页/共43页第二十一页，共43页。22第21页/共43页第二十二页，共43页。23第22页/共43页第二十三页，共43页。24012345622112345678910 10# SSIs / 100 proceduresClassen

7、 DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered第23页/共43页第二十四页，共43页。25Time of administration in relation to the incision # of Patients (%) Rela

8、tive Risk of Infection 2-24 hours before 369 (13.0) 6.7 (2.9-14.7) 0-2 hours before 1708 (60.0) 1.0 0-3 hours after 282 (9.9) 2.4 (0.9-7.9) 3 hours after 488 (17.1) 5.8 (2.6-12.3) All 2847 (100) Classen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-woun

9、d infection. N Engl J Med 1992;326:281第24页/共43页第二十五页，共43页。26第25页/共43页第二十六页，共43页。27第26页/共43页第二十七页，共43页。28第27页/共43页第二十八页，共43页。29第28页/共43页第二十九页，共43页。30第29页/共43页第三十页，共43页。31第30页/共43页第三十一页，共43页。32Peri-care / hydration 第31页/共43页第三十二页，共43页。33第32页/共43页第三十三页，共43页。34第33页/共43页第三十四页，共43页。35Unit19971998Reduction

10、SICU45.1/1000VD27.9 /1000VD17.2 /1000 VDMICU22.4 /1000VD11.6 /1000 VD10.8 /1000 VDKwan KL, Baker SP, Fontecabio SA. Impact of a program ofintensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia, and its cost effectivenessICHE 2003;24

11、;11:859-63.第34页/共43页第三十五页，共43页。36第35页/共43页第三十六页，共43页。37第36页/共43页第三十七页，共43页。380510152025JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98 - MarchSICU BSI Jan 98 - March 00Rate per 1,000 line daysRate per 1,000 line daysExample: Challenge for Targeted Surveillance第37页/共43页第三十八页，共43页。39Monitor blood streaminfections in Surgical ICUpatients.第38页/共43页第三十九页，共43页。40第39页/共43页第四十页，共43页。41第40页/共43页第四十一页，共43页。420510152025JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98 - MarchSICU BSI Jan 98 - March 00BSIBSII