导尿管相关性尿路感染预防措施课件

导尿管伴随性尿路感染（CA-UTI）的诊断、预防和管理砀山县中医院院感科导尿管伴随性尿路感染（CA-UTI）的诊断、1Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.重点内容导尿管伴随性尿路感染（CA-UTI）的诊断导尿管伴随性尿路感染（CA-UTI）的预防导尿管伴随性尿路感染（CA-UTI）的管理重点内容导尿管伴随性尿路感染（CA-UTI）的诊断2Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.一、导尿管伴随性尿路感染（CA-UTI）的诊断一、定义（两个）1、导尿管伴随性无症状菌尿（CA-ASB）对于没有出现尿路感染的症状的留置导尿、耻骨上导尿或间歇导尿患者，单次导管尿液标本中，至少有1个菌种以上达到105cfu/ml，可确定患者出现导尿管伴随性无症状菌尿。2、导尿管伴随性尿路感染（CA-UTI）留置导尿、耻骨上导尿或间歇导尿患者若出现尿路感染的症状或体征，且单次导管尿液标本中段尿标本中，至少有1个菌种以上达到103cfu/ml，可确定患者出现导尿管伴随性尿路感染一、导尿管伴随性尿路感染（CA-UTI）的诊断一、定义（两个3Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.一、导尿管伴随性尿路感染（CA-UTI）的诊断二、导尿管伴随性尿路感染（CA-UTI）的诊断依据1、导尿管伴随性尿路感染（CA-UTI）的相关症状和体征包括：无其它明确原因引起的新出现的或加重的发热、寒颤、精神状态改变、全身乏力或嗜睡症状、腰痛、肋脊角压痛、急性血尿、盆腔不适，尿管拔除后尿痛、尿急、尿频或耻骨上疼痛或压痛。（推荐等级IB）一、导尿管伴随性尿路感染（CA-UTI）的诊断二、导尿管伴随4Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.一、导尿管伴随性尿路感染（CA-UTI）的诊断2、导尿管伴随性无症状菌尿（CA-ASB）不应常规进行筛查，除非是在干预研究中为了评价干预措施对减少CA-ASB、CA-UTI的作用（推荐等级IB），或是在某些特定临床情况下，如孕妇出现无症状菌尿时（推荐等级IB），3、导尿患者出现脓尿并不能作为CA-ASB、CA-UTI的诊断指标（推荐等级IB）。一、导尿管伴随性尿路感染（CA-UTI）的诊断2、导尿管伴随5Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.一、导尿管伴随性尿路感染（CA-UTI）的诊断4、导尿患者的尿液有异味或尿液混浊不能用于区分CA-ASB、CA-UTI，也不能作为尿液培养或抗生素治疗的指征（推荐等级IB），5、留取尿液、血液标本进行细菌培养应在使用抗菌药之前（推荐等级IB），一、导尿管伴随性尿路感染（CA-UTI）的诊断4、导尿患者的6Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防一、降低发生导尿管伴随尿路感染（CA-UTI）风险的策略1、控制不必要的导尿2、及时拔除导尿管3、预防感染4、留置导尿的替代方案5、间歇导尿技术6、保持引流系统的密闭性7、在导尿管表面涂抹抗菌剂问题8、预防性的全身应用抗生素问题9、集尿袋中抗生素应用问题10、更换导尿管时间11、拔除或更换尿管时预防性地应用抗生素问题二、导尿管伴随性尿路感染（CA-UTI）的预防一、降低发生导7Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防1、控制不必要的导尿*必须在有留置导尿指征的情况下才实施留置导尿，尿失禁患者不宜通过导尿来解决，除非其它解除尿失禁的方法都无效且患者要求时才选择留置导尿。（推荐等级IB）*医院要提出实施留置导尿和适应症，且定期评估该适应症是否与特定的指南相符合。（推荐等级IB）*需要有医生的书面医嘱，方可实施留置尿管（推荐等级IB）*对于术后患者，可考虑使用便携式膀胱超声仪确定是否需要实施导尿（推荐等级IB）二、导尿管伴随性尿路感染（CA-UTI）的预防1、控制不必要8Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防2、及时拔除导尿管*如果不需要继续留置尿管导尿时，应尽快拔除尿管以降低发生导尿管伴随性无症状菌尿或尿路感染的风险（推荐等级IB）*护士应该考虑提醒医生及时拔除尿管，以减少不适当的导尿和降低导尿管伴随性尿路感染（CA-UTI）的发生（推荐等级IB）*应考虑使用医嘱自动终止系统以减少不适当的导尿的发生（推荐等级IB）二、导尿管伴随性尿路感染（CA-UTI）的预防2、及时拔除导9Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.3、预防感染*制定导尿管留置及、拔除和更换指征以及导尿管的维护流程（推荐等级IB）*应定期反馈导尿管伴随性无症状菌尿的发生率，以降低发生导尿管伴随性无症状菌尿的风险（推荐等级IB）3、预防感染10Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防4、留置导尿的替代方案*对需要留置尿管的男性患者，膀胱残余尿量较少时，可考虑用阴茎套作力短期或长期留置导尿替代方案*可考虑选择间歇性导尿作为短期或长期留置导尿的替代方案*可考虑选择耻骨上膀胱造瘘作为短期留置导尿的替代方案以降低发生导尿管伴随性无症状菌尿的风险和降低导尿管伴随性尿路感染的风险（不推荐、未解决的问题）*如果患者不能自行排尿，患有尿失禁的女性患者可采用尿垫，男性患者可以采用男性专用尿袋或加长的塑料袋进行接尿二、导尿管伴随性尿路感染（CA-UTI）的预防4、留置导尿的11Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防5、间歇导尿技术 与留置导尿管相比间歇导尿术可降低导尿管伴随性无症状菌尿或导尿管伴随性尿路感染的风险，若长期留置导尿管的患者可以行间歇导尿术。二、导尿管伴随性尿路感染（CA-UTI）的预防5、间歇导尿技12Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防6、保持引流系统的密闭性*尿管末端开小口以促进尿液引流以及维持尿液引流系统的密闭性有助于短期留置导尿或上导尿患者发生导尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生率*导尿管预先与集尿袋连接再插入尿道进行导尿可降低导尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生率*尿管置入后使用复合封闭引流装置或在尿管和尿袋连接处使用胶带并不能降低尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生率二、导尿管伴随性尿路感染（CA-UTI）的预防6、保持引流系13Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防7、在导尿管表面涂抹抗菌剂*可使用涂有抗菌剂（银、银合金或抗生素）的导尿管（不推荐、未解决的问题）*在导尿管表面喷涂JUC（洁悠神）长效抗菌材料，形成物理抗菌生物膜，阻止细菌生物膜的形成二、导尿管伴随性尿路感染（CA-UTI）的预防7、在导尿管表14Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防8、预防性的全身应用抗生素为防止发生抗生素耐药，不应常规全身预防性应用抗生素来减少尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生，但可嘱患者多饮水排尿或加强外阴护理9、集尿袋中抗生素应用问题 常规不应在集尿袋中应用抗生素或消毒剂二、导尿管伴随性尿路感染（CA-UTI）的预防8、预防性的全15Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防10、更换导尿管时间循证护理学证明，若患者尿液PH6.8，每2周更换导尿管，若患者尿液PH6.7，每4周更换导尿管，若尿液混浊有沉淀尿或导尿管伴随性尿路感染的发生二、导尿管伴随性尿路感染（CA-UTI）的预防10、更换导尿16Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防11、拔除或更换尿管时预防性地应用抗生素 不应在置入导尿管、更换导尿管、或拔除导尿管时，全身或通过膀胱灌注使用抗生素以减少尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生二、导尿管伴随性尿路感染（CA-UTI）的预防11、拔除或更17Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.二、导尿管伴随性尿路感染（CA-UTI）的预防二、重视导尿管的正确使用，以降低导尿管伴随性尿路感染的风险1、确保导尿管的正确使用2、明确拔管指征并拔除导尿管3、确保手卫生及导尿管的正确护理二、导尿管伴随性尿路感染（CA-UTI）的预防二、重视导尿管18Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿导尿患者减少发生导尿管伴随性尿路感染（CA-UTI）的管理策略二、导尿管伴随性尿路感染患者（CA-UTI）的管理策略三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿19Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿导尿患者减少发生导尿管伴随性尿路感染的管理策略*对于短期或长期留置导尿的患者，不应时行尿管伴随性无症状菌尿的筛查和治疗。来尿管伴随性无症状菌尿或导尿管伴随性尿路感染的发生。*短期间歇性导尿的神经性膀胱功能障碍患者，不应进行尿管伴随性无症状菌尿的筛查和治疗*除孕妇和有明显尿道黏膜出血可能的患者除外，其它患者不应时行导尿管伴随性无症状菌尿的筛查和治疗。三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿20Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿导尿患者减少发生导尿管伴随性尿路感染的管理策略*为减少导尿管伴随性尿路感染的发生，在拔除导尿管时，对尿管伴随性无症状菌尿进行筛查和治疗。对拔除可能有尿管伴随性无症状菌尿患者的尿管前不应预防性应用抗生素拔除尿管后给予抗生素治疗可能带来的益处有待进一步研究*无症状菌尿留置尿管患者，应先考虑拔除尿管而不是局部或全身使用抗菌药三、导尿管伴随性尿路感染（CA-UTI）的管理一、无症状菌尿21Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.三、导尿管伴随性尿路感染（CA-UTI）的管理二、导尿管伴随性尿路感染患者（CA-UTI）的管理策略*治疗前进行尿培养和更换导尿管由于细菌耐药性不断增强，因此对可能发生导尿管伴随性尿路感染患者的患者，在抗生素治疗前，需采集尿标本进行细菌培养。如导尿管留置超过2周，开始出现导尿管伴随性尿路感染患者的症状，则需更换导尿管。在抗生素治疗前，应从刚置入的导尿管收集尿标本进行细菌培养以指导治疗。在拔除导尿管时，应收集中段尿时行细菌培养以指导治疗。三、导尿管伴随性尿路感染（CA-UTI）的管理二、导尿管伴随22Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.三、导尿管伴随性尿路感染（CA-UTI）的管理二、导尿管伴随性尿路感染患者（CA-UTI）的管理策略*导尿管伴随性尿路感染患者的治疗配合对于症状能很快改善的导尿管伴随性尿路感染患者，需遵医嘱持续应用抗生素57天，对于症状较重的患者，不管其是否仍继续留置导尿，需遵医嘱持续应用抗生素714天。*若为有症状的念珠菌尿患者，应系统地使用抗真菌药物进行治疗。三、导尿管伴随性尿路感染（CA-UTI）的管理二、导尿管伴随23Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.谢谢聆听！谢谢聆听！24