ICU导管相关感染监测

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Surveillance ofDevice Related Infection in Intensive Care Unit,ICU,导管相关感染监测,(A version for training purpose only, the data involved is not reflecting the real situation ),1,National Nosocomial Infections Surveillance (NNIS) system,全国院内感染监测系统,2,Purpose,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,3,Population 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,4,Device-associated infections,导管相关感染,Urinary catheter-associated Urinary tract infection (CA-UTI),导尿管相关的尿路感染,Central line- associated Bloodstream infection (CA-BSI),中心静脉导管相关的血流感染,Ventilator- associated Pneumonia (VAP),呼吸机相关的肺炎,5,Denominator 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,6,Surveillance methods,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,7,Define device-related infection,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,8,Definitions VAP,Had device within 48-hrs period before onset of infection,Systemic S/S,Respiratory S/S,Chest X-R evidence,Laboratory results,9,Definitions CA-BSI,Had device within 48-hrs period before onset of infection,Clinical manifestations,Common skin contaminant from 2 blood cultures,No apparent source for BSI except the catheter,10,Definitions CA-UTI,Symptomatic UTI,S/S of UTI,+ve urine culture =10,Asymptomatic bacteriuria,+ve urine culture =10,No S/S of UTI,5,5,11,Calculate Device-associated infection rates,Number of device-associated,infection for a specific site,x 1000,Number of device-days,12,Calculate Device utilization ratios,Number of device-days,Number of patient-days,13,VAP Surveillance in ICU,AB,No. of VAP627,Patient days13734872,Ventilator days 6432694,Infection rates9.33 (50)10.02 (50),DU ratios0.47 500.55 75,() NNIS device associated infection percentile, NNIS device utilization percentile,14,CA-BSI Surveillance in ICU,AB,No. of CA-BSI 08,Patient days13734872,CVC days4023216,Infection rates0 (10)2.49(25),DU ratios0.26 100.6650,() NNIS device associated infection percentile, NNIS device utilization percentile,15,CA-UTI Surveillance in ICU,AB,No. of UTI2312,Patient days13734872,Urinary Cath days11484711,Infection rates20.03 (90)2.55(25),DU ratios0.84 500.97.90,() NNIS device associated infection percentile, NNIS device utilization percentile,16,Pathogens,Isolated - VAP,No. of infection6,No. of isolate9,GM -ve microorganism66.6%,Proteus, Pseudnmonas, Acinetobacter, Klebsiella, Enterobacter,GM +ve microorganism33.3%,-haem. Strep., MSSA, Strep. pneumoniae,Fungus0%,17,Pathogens,Isolated CA-UTI,No. of infection23,No. of isolate28,GM -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 albicans,18,Thank you,19,