課前預(yù)習(xí)定義病人在醫(yī)療機(jī)構(gòu)因其他疾病接受治療過(guò)程中所感染

Definition:Infectionsthatpatientsacquireduringthecourseofreceivingtreatmentforotherconditionswithinahealthcaresetting Settings:hospitals(IntensiveCareUnits,SpecialCareUnits,othersuchasambulatorysurgicalclinics,dialysiscenters 1.7million1outof20patients(5%)acquirean99,000deathsassociatedwith$26-33billioninexcesshealthcare

EstimatesofHealthcare-associatedInfectionsinUSHospitalsAnnually數(shù)

Billion$

Urinarytractinfections

Procedure-relatedinfectionsSurgicalsite Healthcare-associatedInfectionsinNon-hospitalSettingsLong-termcare1.7millionbedswith2.5millionresidents/yearnationally nsHealthcareSystem:133LTCFs,11,475 √HAIprevalence: √Indwellingmedicaldevice:25%ofallNCHS,MMWRMay16,2008;Healthcare-associatedInfectionsinNon-hospitalSettingsAmbulatorysurgicalcenters:5,175DataonHAIsfromoutbreaks;nonationalExample:hepatitisCoutbreakassociatedwithsyringereuseresultedinlettersto>40,000endoscopycenter NCHS, MMWRMay16,2008; Healthcare-associatedInfectionsinNon-hospitalSettingsDialysiscenters:4,950Catheter-relatedbloodstreaminfections:4.2per100patientmonths導(dǎo)管相關(guān)血流 Incidenceofmethicillin-resistantStaphylococcusaureus(MRSA)bloodstreaminfection:100xgreaterthaninnondialysispopulation耐甲氧西林金黃色葡萄球菌 NCHS,MMWRMay16,2008;MRSAInfectionsAreaPatientSafetyChallengenotLimitedtoAcuteCareHospitalSetting 25%ial”25%60identifiedbeforeorinfirst2daysofhospitalization(butwithcontactstohealthcaresettings)60%的最初兩天發(fā)現(xiàn)（存在與醫(yī)療相關(guān)的接觸）醫(yī)療相關(guān)EmergingThreatsinHealthcareEstimateofClostridiumdifficileCases,bySetting Hospital-acquired,hospital-onset165,000,$1.3billioninexcesscosts,and9,000deathsannually (upto450,000,$0.3billioninexcesscosts,and3,000deathsannually Nursinghome-onset263,000,$2.2billioninexcesscosts,and16,500deathsannually Primarydiagnosis01997199819992000200120022003200420052006

Elixhauseretal.HCUPStatisticalBrief#50.%GramNegativeBacteriaResistanttoKeyDrugsbyHealthcare-associatedInfectionTypeSource:NationalHealthcareSafetyNetwork

Cef/Ctrresistant

Hidronetal.ICHEStateofPreventionHICPAC/CDCEvidence-basedPreventionGuidelinesaredevelopedforeachtypeofinfectionandbasedonsystematicreviewsofthemedicalli ture在系統(tǒng)綜述醫(yī)學(xué)文 Categoriesof Category1A1AStrongmendation/strongormoderatequalityofCategory1B1BStrongmendation/weakqualityofevidenceor StateofPreventionHICPAC/CDCEvidence-basedPreventionCategory1C1CStrongmendationrequiredbystateorfederalCategory22Weakmendationsupportedbylimited Nomendation/unresolvedInsufficientevidencetosupportaStateofPreventionSuboptimalAdherencetoHICPAC/CDCHandhygieneadherence581(overallaverage40%5-81%按照標(biāo)準(zhǔn)（總體平均：<50adherencetomendations執(zhí)行小于FullcompliancewithmajorHAIguidelines全面執(zhí)行HAIAmong1,256UShospitals—30.7%to ArchSurg StateofPreventionSuccessfulPreventionofBloodstreamInfectionsMichigan&PennsylvaniaImplementationofCDC/HICPACInfectionPreventionGuideline執(zhí)行CDC/HICPAC中心靜脈 ForinsertionandremovalofintravascularIntensivecareunitsSWPennsylvania(66),Michigan(103)Interventionstoincreasedadherencetomendationsweresimilar Educationofstaff人員教育Creationofacentral-linecart中心靜脈介入操作推Data/feedbackonadherencetopracticesandMutoetalMMWR,Ot45rottJ6ryroundsStrategiestoimprovesafetycultureStateofpreventionPreventsBloodstreamInfections Michigan密西根108103ICUsat67 hospitals,1820

PronovostP.NewEnglJMed2006;355:2725-TrendsinMRSABloodstreamInfectionsbyICU PooledMeanAnnualCLABSIRatePooledMeanAnnualCLABSIRateper1,000CentralLine 1,800lives $50-180Min43 321 PreliminaryEstimatesofPreventableInfections,Deaths&BasedonPublished Typeofhealthcare-

Preventable可防止的 Costavoided UrinarytractSurgicalsite

Umschied,C.UniversityofPennsylvania.PresentationatHICPAC,MarchKeysfortheEliminationofHealthcare-associatedInfections DataforAddressgapsinDataforAction HHS nforHAINational5Year National5-Year50%30%30%25%50%25%25%95%NHSN=NationalHealthcareSafetyNetwork HCUP=HealthcareCostandUtilizationProject EIPs=EmergingInfectionsProgramSCIP=SurgicalCareImprovementProjectRecognizeExcellencein Healthreformbillsproposemandatorynationalpublic HAIpreventionwouldbetiedtoMedicare/Medicaid Reducedpaymentforhospital-acquiredconditions(HACs)includinghealthcare-associatedinfections EffectiveOctober Includeshospital-associatedbloodstreaminfections,urinarytractinfections,andselectedsurgicalsiteinfections TopCDCmendationstopreventhealthcareassociatedinfections StateofPreventionHICPAC/CDCEvidence-basedPreventionGuidelinesaredevelopedforeachtypeofinfectionandbasedonsystematicreviewsofthemedicalli ture在系統(tǒng)綜述醫(yī)學(xué)文 Categoriesof Category1A1AStrongmendation/strongormoderatequalityofCategory1B1BStrongmendation/weakqualityofevidenceor Topreventcatheterassociatedurinarytract Insertcathetersonlyforappropriate Leavecatheters ceonlyaslongas Ensurethatonlyproperlytrained sinsertandmaintain Insertcathetersusingaseptictechniqueandsterileequipmentacutecaresetting) Followasepticinsertion,maintainacloseddrainagesystem Maintainunobstructedurine ComplywithCDChandhygienemendationsandStandard TopreventsurgicalsiteBefore Administerantimicrobialprophylaxisinaccordancewithbasedstandardsand

Treatremoteinfections-wheneverpossiblebeforeelective Avoidhairremovalattheoperativesiteunlessitwillinterferetheoperation;donotuse

Useappropriateantisepticagentandtechniqueforskin TopreventsurgicalsiteDuring KeepORdoorsclosedduringsurgeryexceptasneededpassageof nel,andtheAfterSurgeryMaintainimmediatepostoperative

ProtectprimaryclosureincisionswithsteriledressingControlbloodglucoselevelduringtheimmediatepost-operativeperiod(cardiac)保持血糖正常水平Discontinueantibioticsaccordingtoevidence-basedstandardsandguidelines TopreventcentrallineassociatedbloodstreamRemoveunnecessarycentrallinesFollowproperinsertionpracticesFacilitateproperinsertionpracticesComplywithCDChandhygienemendationsUseappropriateagentforskinantisepsis采用合理的皮膚 ChoosepropercentrallineinsertionsitesPerformadequatehub/accessportdisinfection對(duì)插管部件進(jìn)行消ProvidestaffeducationoncentrallinemaintenanceandTopreventClostridiumdifficileinfectionsContactPrecautionsfordurationof ComplywithCDChandhygieneAdequatecleaninganddisinfectionofequipmentandLaboratory-basedalertsystemforimmediatenotificationofpositivetestresults EducateaboutCDI:healthcare nel,housekee administration,patients,familiesTo