齐鲁医学ICU-导管相关感染调查

1、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 )2021/10/23 星期六1National Nosocomial Infections Surveillance (NNIS) system全国院内感染监测系统2021/10/23 星期六2Purpose目的Monitor the infection rat

2、es 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2021/10/23 星期六3Population at risk 危险人群 All patients has been admitted in IC

3、U 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2021/10/23 星期六4Device-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-

4、 associated Pneumonia (VAP) 呼吸机相关的肺炎2021/10/23 星期六5Denominator 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2021/10/23 星期六6Surveillance methods 调查方法on going review eac

5、h 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 2021/10/23 星期六72021/10/23 星期六82021/10/23 星期六92021/

6、10/23 星期六10Define 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2021/10/23 星期六11Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory results2021/1

7、0/23 星期六12Definitions 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 catheter2021/10/23 星期六13Definitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture =10Asymptomatic bacter

8、iuria+ve urine culture =10No S/S of UTI552021/10/23 星期六14Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-days2021/10/23 星期六15Calculate Device utilization ratios Number of device-daysNumber of patient-days2021/10/23 星期六16VAP

9、Surveillance in ICUABNo. 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 percentile2021/10/23 星期六17CA-BSI Surveillance in ICU ABNo. of CA-BSI 08Patient days13734872CVC

10、days4023216Infection rates0 (10)2.49(25)DU ratios0.26 100.6650() NNIS device associated infection percentile NNIS device utilization percentile2021/10/23 星期六18CA-UTI Surveillance in ICUABNo. of UTI2312Patient days13734872Urinary Cath days11484711Infection rates20.03 (90)2.55(25)DU ratios0.84 500.97.

11、90() NNIS device associated infection percentile NNIS device utilization percentile2021/10/23 星期六19Pathogens Isolated - VAPNo. of infection6No. of isolate9GM -ve microorganism66.6%Proteus, Pseudnmonas, Acinetobacter, Klebsiella, EnterobacterGM +ve microorganism33.3%-haem. Strep., MSSA, Strep. pneumoniaeFungus0%2021/10/23 星期六20Pathogens Isolated CA-UTINo. of infection23No. of isolate28GM -ve microorganism 92.9%E.Coli (50%), Klebsi