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ICU导导管相关感染管相关感染监测监测ICU导管相关感染监测1National Nosocomial Infections Surveillance(NNIS)system全国院内感染监测系统2ICU导管相关感染监测National Nosocomial Infections2Purpose目的Monitor the infection rates 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3ICU导管相关感染监测Purpose目的Monitor the infection3Population at risk 危险人群 All patients has been admitted in ICU 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4ICU导管相关感染监测Population at risk 危险人群 All p4ICU导管相关感染监测培训ppt课件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6ICU导管相关感染监测Denominator data 分母资料Count at 6Surveillance methods 调查方法调查方法on going review each 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 7ICU导管相关感染监测Surveillance methods 调查方法on g78ICU导管相关感染监测8ICU导管相关感染监测89ICU导管相关感染监测9ICU导管相关感染监测910ICU导管相关感染监测10ICU导管相关感染监测10Define device-related infection 定义导管相关感染定义导管相关感染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11ICU导管相关感染监测Define device-related infectio11Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory results12ICU导管相关感染监测Definitions VAPHad device wi12Definitions 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 catheter13ICU导管相关感染监测Definitions CA-BSI Had devic13Definitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=10Asymptomatic bacteriuria+ve urine culture=10No S/S of UTI5514ICU导管相关感染监测Definitions CA-UTI Symptomat14Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-days15ICU导管相关感染监测Calculate Device-associated in15Calculate Device utilization ratios Number of device-daysNumber of patient-days16ICU导管相关感染监测Calculate Device utilization r16VAP 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 percentile17ICU导管相关感染监测VAP Surveillance in ICUA17CA-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 percentile18ICU导管相关感染监测CA-BSI Surveillance in ICU 18CA-UTI Surveillance in ICUABNo.of UTI2312Patient days13734872Urinary Cath days11484711Infection rates20.03(90)2.55(25)DU ratios0.84 500.97.90()NNIS device associated infection percentile NNIS device utilization percentile19ICU导管相关感染监测CA-UTI Surveillance in ICU19Pathogens Isolated-VAPNo.of infection6No.of isolate9GM-ve microorganism66.6%Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%20ICU导管相关感染监测Pathogens Isolated-VAPNo.o20Pathogens Isolated CA-UTINo.of infection23No.of isolate28GM-ve microorganism 92.9%E.Coli(50%),Klebsiella(14.3%),Proteus(14.3%),Enterobacter(10.7%),M.morganii(3.6%)GM+ve microorganism 3.6%Enterococcus spp.Fungus3.6%Candida albicans21ICU导管相关感染监测Pathogens Isolated CA-UTINo21Thank you22ICU导管相关感染监测Thank you22ICU导管相关感染监测22
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