英文版醫(yī)院感染控制課件教程文件

英文版醫(yī)院感染控制課件

SurveillancehasanEpidemiologicfoundationStudythedistributionofproblemsandeventswithinadefined(targeted)populationatriskfordevelopingspecificinfectionsinorder

toplan&implementinterventions.23KeySurveillanceMethods

Hospital-wideTraditionalSurveillance Allinfections–complete-timeconsuming LimitstimeforinterventionsPeriodicSurveillance

Selectedinfectionsorpopulationsperiodicallyovertime Misssomeinfections

TargetedSurveillance3Advantages/DisadvantagesAdaptedfromPottingeretal&Gaynesetal.4TargetedSurveillanceCDC’sNationalNosocomialInfectionsSurveillance(NNIS)SystemTargets:NNISSystemAURICUHRNSurgicalPatientAntimicrobialUseandResistanceIntensiveCareUnit(Adult/Pediatric)HighRiskNursery(NICU)RiskadjustedSSIsbyProcedures6YourHospitalSurveillanceSystemTargets:YourHospitalVAPICUBSISSIVentilator-AssociatedPneumoniaMedical/SurgicalICUsIntensiveCareUnit(Pediatric)PrimaryBloodStreamInfectionsPrimaryOrthopedicNeurosurgicalorCABGProcedures7Whichinfectiontotarget?

FocusonpatientsathighriskforHAIPatientcareareasICU’s,cardio-thoracicsurgery,cancerwardSpecificpopulationsneonates,transplantpatients,hemodialysisptsProcedures/DevicesCTsurgery,centralvascularlines,ventilatorsOrganismsofepidemiologicimportance

–MRSA,VRSA8TargetedSurveillancefor

OutcomesPrimaryBloodstreaminfectionsVentilator-associatedpneumonia,SurgicalsiteinfectionsMRSA,VREinfectionsVascularaccessinfectionsinhemodialysispatientsSharpsinjuriesinhealthcareproviders.9TargetedSurveillanceforProcessesHepatitisBimmunityratesinpersonnelPersonnelcompliancewithprotocols-isolationprecautions,Sterilizationqualityassurancetesting,EffectiveenvironmentalcleaningAntimicrobialprescribingandadministration10Howtoimplementtargetedsurveillance

11StepOne

ICPandMDreviewMicrobiologyreportsdailyReviewpastsurveillancedataperiodicallyDevelopalistofthepotentialinfectionsorpopulationsfortargetedsurveillance

12StepTwoInfectioncontrolteamselectsnosocomialinfectionstotargetbasedononeormoreofthefollowingcriteria:

13CriteriaforSelectingProcessesorOutcomesforTargetedSurveillance

ICprogramobjectivesFrequencyorlevelofriskofinfectiouscomplicationsfor area patientpopulation procedure serviceMorbidity,Mortality,CostPossibilityforprevention14StepThree

ICPperformschartreviewsontheinfection-relatedprocessesoroutcomesidentifiedinStepTwousingstandardized,consistent,approveddefinitions.ConsistentintensityandthoroughnessofsurveillanceovertimeSamedefinitionsovertime

15TargetedSurveillance:

AMeanstoanEndCollectonlynecessarydataArriveatmeaningfulinformation16SoYouCan:DevelopmeaningfulinterventionsDOsomethingtoreduceinfectionsImprovepatientcare!17TheCycleforSuccessThroughTargetedSurveillanceIsthereanimportantproblem?

What,why?

Multidisciplinary Teams

2.Describeandunderstandtheproblem?TargetedSurveillance

3.Howtoaffectchange?

Multidisciplinary Teams

Education Feedback Newprotocols Newproducts4.Dothechangeswork?

Remeasure

Adaptedfrom:RichardsC,etal.EmergInfectDis200118NLMIgnazSemmelweisTargetedSurveillanceAndInterventionForPuerperalSepsis19TargetedSurveillanceforaProcessTimingofAntibioticProphylaxisforSurgicalSiteInfectionNLMArchives201.IsThereanImportantProblem?Inappropriatesurgicalprophylaxisisamajorinfectionriskexposespatienttounnecessarytoxicityincreasesantimicrobialresistanceexcessdosesorinappropriatespectrumantibioticsdonotreducetheincidenceofsurgicalwoundinfection21“Ideal”ProphylaxisIdealantibioticforprophylaxisactiveagainstpathogensmostlikelytocontaminatewoundadequateconcentrationsduringpotentialcontaminationadministeredforashorttimetoreducecomplications,resistance,andcost22TargetedProcessSurveillance

TimingofPerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281IncisionHoursbeforeincisionHoursafterincisionAntibioticAdministered23Timingof

PerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281242.PerformTargetedSurveillanceforThisProblem

1)Proportionofpatientswhoreceiveprophylacticantibioticswithin1hourbeforesurgicalincision

#antibiotics1hour#surgerieswithantibiotics25PerformTargetedSurveillanceforThisProblem

2)Proportionofpatientswhoseantibioticswerediscontinuedwithin24hoursofthesurgeryendtime

#discontinuew/I24hours#surgeriesreceivingantibiotics26PossibleSurgicalProcedurestoDetermineTimingofAntibioticProphylaxisCABGColonsurgeryHipandkneearthroplastyAbdominalandvaginalhysterectomyVascularsurgery(e.g.,peripheralvascularsurgery)273.ToAffectChangeMultidisciplinaryTeamtolookatantibioticdeliverysystem:currentanddesiredRedesignsystemfortimelyABdeliveryMakeantibioticaccessibleEducatenursingandoperatingroomstaffandanesthesiologistsandsurgeonsRecordtimeonpatientchart284.Dothechangeswork?Re-measure2variablesin3monthsafterinitiationofnewimprovedprocedureMeasuresurgicalsiteinfectionrates.29TargetedSurveillanceforanInfection

Outcome30TargetedSurveillanceforOutcomesNIRate:VAP CR-BSIUTI Foleyrelated Non-Foleyrelated

DrivesInterventionFor:PneumoniapreventionCR-BSIpreventionFoley-care,d/cprogramPeri-care/hydration311.IsThereanImportantProblem?Ventilator-associatedpneumoniaisamajorinfectionriskforpatientsincreasedmortalityexcesslengthofstayexcesscost32Example:ChallengeforTargetedSurveillanceReduceventilatorassociatedpneumonias(targetedadverseevent)by50%

#VAPinfections#1000ventilatordays33ReductionofVAPwithTargetedSurveillanceandInterventionsKwanKL,BakerSP,FontecabioSA.Impactofaprogramofintensivesurveillanceandinterventionstargetingventilatedpatientsinthereductionofventilator-associatedpneumonia,anditscosteffectivenessICHE2003;24;11:859-63.34ReductionofVAPwithTargetedSurveillanceandInterventionsInverventions:RaiseheadofbedSterilewaterfortubefeedingsIn-linesuctioncathetersfrom24-48-72-asneededCostsavings$350,000inoneyear.351.IsThereanImportantProblem?Catheter-relatedbloodstreaminfectionsareaseriousinfectionriskdevice-relatedmorbidityandmortalityextralengthofstayadditionalmedicalcosts360510152025JanAprilJulyOctJanAprilJulyOctJan'98'99'00SICUBSIJan'98-MarchSICUBSIJan'98-March

‘00Rateper1,000linedaysRateper1,000linedaysExample:ChallengeforTargetedSurveillance372.P