ICU導相關感染監(jiān)測PPT課件

1、icu導管相關感染監(jiān)測 (a version for training purpose only, the data involved is not reflecting the real situation )surveillance ofdevice related infection in intensive care unit national nosocomial infections surveillance (nnis) system全國院內感染監(jiān)測系統(tǒng)purpose目的monitor the infection rates 監(jiān)控感染率benchmark with nnis sy

2、stem 與nnis標竿determine trends 確定趨勢identify outbreak 定義暴發(fā)facilitate comparisons 易于比較link monitored rates and prevention efforts 感染率與預防效果的聯系reduce devices related infection in hospital 減少醫(yī)院導管等裝置的感染率population at risk 危險人群 all patients has been admitted in icu for 48 hours. 入icu48小時的病人follow patients fo

3、r 48 hours after discharge from icu. 病人轉出icu 需繼續(xù)跟蹤48小時device-associated infections 導管相關感染urinary catheter-associated urinary tract infection (ca-uti) 導尿管相關的尿路感染central line- associated bloodstream infection (ca-bsi) 中心靜脈導管相關的血流感染ventilator- associated pneumonia (vap) 呼吸機相關的肺炎denominator data 分母資料cou

4、nt at 12 midnight in everyday 每天在午夜12點計算total number of patients admission 所有病人patient-days 病人日urinary catheter-days 導尿管日central line-days 中心靜脈插管日ventilator-days 呼吸機日surveillance methods 調查方法調查方法on going review each patient in icu. 持續(xù)觀察icu的每個病人by reviewing doctors progress notes, nursing notes, phys

5、iotherapists notes, xr report, charts, mar forms, conversations with nurses and physicians 查看醫(yī)生病程、護理記錄、理療單、x線檢查、ct/mar。醫(yī)生護士的會話by reviewing laboratory data. 查看實驗室數據 name hosp source:_ previous icu adm:_ team:_idtransfer from:_transfer to:_hnicu adm date/time:_transfer out date/time:_hosp. adm.sex/age

6、diagnosis on icu admissiondiagnosis in icubhx:underlying diseasepremorbid statusallergy:surgical intervention (ot, ogd,etc)airway ventilator central lineurinary cathetera-lineother devicedatetypeon offsitetypeon offtypeonoffon offnettoettttt/o w/ at/o w/ mvt/o w/ cvct/o w/ uc2d t/o w/a 2d t/o w/mv2d

7、 t/o w/ cvc2d t/o w/ ucdevice related infection in icutype: vap / cr-bsi / cr-suti / cr-asbinfection date:_device on&off date: _device days:_systemic s/s:lab evidence:treatment:localise s/s:_ _name hosp source:_ previous icu adm:_ team:_idtransfer from:_transfer to:_hnicu adm date/time:_transfer

8、 out date/time:_hosp. adm.sex/agediagnosis on icu admissiondiagnosis in icubhx:underlying diseasepremorbid statusallergy:surgical intervention (ot, ogd,etc)airway ventilator central lineurinary cathetera-lineother devicedatetypeon offsitetypeon offtypeonoffon offnettoettttt/o w/ at/o w/ mvt/o w/ cvc

9、t/o w/ uc2d t/o w/a 2d t/o w/mv2d t/o w/ cvc2d t/o w/ ucdevice related infection in icutype: vap / cr-bsi / cr-suti / cr-asbinfection date:_device on&off date: _device days:_systemic s/s:lab evidence:treatment:localise s/s:_ _daily record of devices in neuro. icu patient at 12mn month/year : _da

10、teno. of pt. adm.no. of patient at 12mnno. of ventilatorno. of cvcno. of foley12345678910111213141516171819202122232425262728293031tot alname antibiotics prior icumicrobiology results 7 days prior icuidhnhosp. adm.sex/agepre-icu conditiondate temp wbcvent/fio2 cxrresp s/s remarksimsantibioticslab re

11、sultdaily record of devices in neuro. icu patient at 12mn month/year : _dateno. of pt. adm.no. of patient at 12mnno. of ventilatorno. of cvcno. of foley12345678910111213141516171819202122232425262728293031tot aldefine device-related infection 定義導管相關感染定義導管相關感染by using standard cdc definitions that in

12、clude laboratory & clinical data使用cdc的標準包括實驗室和臨床資料definitions vaphad device within 48-hrs period before onset of infection systemic s/srespiratory s/schest x-r evidencelaboratory resultsdefinitions ca-bsi had device within 48-hrs period before onset of infectionclinical manifestationscommon skin

13、 contaminant from 2 blood culturesno apparent source for bsi except the catheterdefinitions ca-uti symptomatic utis/s of uti+ve urine culture =10asymptomatic bacteriuria+ve urine culture =10no s/s of uti55calculate device-associated infection ratesnumber of device-associated infection for a specific

14、 site x 1000number of device-dayscalculate device utilization ratios number of device-daysnumber of patient-daysvap 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 nn

15、is device utilization percentileca-bsi surveillance in icu abno. of ca-bsi 08patient days13734872cvc days4023216infection rates0 (10)2.49(25)du ratios0.26 10 0.6650() nnis device associated infection percentile nnis device utilization percentileca-uti surveillance in icuabno. of uti2312patient days1

16、3734872urinary cath days11484711infection rates20.03 (90)2.55(25)du ratios0.84 500.97.90() nnis device associated infection percentile nnis device utilization percentilepathogens isolated - vapno. of infection6no. of isolate9gm -ve microorganism66.6%proteus, pseudnmonas, acinetobacter, klebsiella, enterobactergm +ve microorganism33.3%-haem. strep., mssa, strep. pneumoniaefungu