医院感染目标性监测译

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Targeted Surveillance for Nosocomial Infections,Barbara M.Soule,RN,MPA,CIC,Chinese Society for Nosocomial Infections,July 4-5,2004,Suzhou,China,1,ICP,的工作内容,IC,Practitioner(ICP)Activities,监测,Surveillance,项目管理,Program,Management,教育,Education,工作的多样性,Miscellaneous,暴发调查,Outbreak,Investigation,咨询,Consultation,2,监测应具有流行病学基础,Surveillance has an Epidemiologic foundation,为了计划和实施干预措施，研究处于某特定感染危险的人群（目标人群）中的问题和事件的分布,Study the distribution of problems and events within a defined,(targeted),population at risk for developing specific infections in order,to plan&implement interventions.,3,3,种主要的监测方法,3 Key Surveillance Methods,医院范围的传统监测,Hospital-wide Traditional Surveillance,所有的感染-全面-花费时间,All infections complete-time consuming,有限的时间用于干预,Limits time for interventions,定期监测,Periodic Surveillance,对选择的感染或人群进行定期监测,Selected infections or populations,periodically over time,遗漏有些感染,Miss some infections,目标监测,Targeted Surveillance,4,名称,Name,优点,Advantages,缺点,Disadvantages,目标性监测,Targeted/Focused Surveillance by Objective,将有限的资源集中在高感染危险病区,Concentrates limited resources to high risk areas;,重点放在有已知控制措施的感染上,Focuses on HAI with known control measures;,能够确定确切的分母,Can determine valid denominator;,灵活性，能够和其他控制策略结合起来,Flexible,can be mixed with other strategies;,增加监测的有效性,Increases efficiency of surveillance;,使,ICP,能够开展其他工作,Enables ICP to perform other activities,仅能收集监测目标病人或危险的数据,Collects data only for targeted patients or risks;,漏掉未监测病区或病人的感染集聚或暴发,May miss clusters or outbreaks in non-surveyed areas or groups,Adapted from Pottinger et al&Gaynes et al.,优/缺点,Advantages/Disadvantages,5,目标性监测,Targeted Surveillance,6,美国,CDC,国家医院感染监测系统的,目标性监测,CDCs National Nosocomial Infections Surveillance(NNIS)System,Targets:,NNIS System,AUR,ICU,HRN,Surgical,Patient,Antimicrobial,Use and,Resistance,Intensive Care,Unit,(Adult/Pediatric),High Risk,Nursery,(NICU),Risk adjusted,SSIs by,Procedures,7,你所在医院监测系统的目标性监测,Your Hospital Surveillance System Targets:,Your Hospital,VAP,ICU,BSI,SSI,Ventilator-,Associated,Pneumonia,Medical/Surgical,ICUs,Intensive Care,Unit,(Pediatric),Primary Blood,Stream,Infections,Primary Orthopedic,Neurosurgical or,CABG,Procedures,8,哪些感染作为目标性监测,Which infection to target?,重点为具有高感染危险的病人,Focus on patients at high risk for HAI,病人的护理病区,Patient care areas,重症监护病房,ICUs,心胸外科,cardio-thoracic surgery,癌症病房,cancer ward,特殊人群,Specific populations,新生儿,neonates,移植病人,transplant patients,血液透析病人,hemodialysis pts,操作/设备,Procedures/Devices,CT,外科,CT,surgery,中央静脉插管,central vascular lines,呼吸机,ventilators,具有流行病学意义的病原体,Organisms of epidemiologic importance,MRSA,VRSA,9,针对后果,的目标性监测,Targeted Surveillance for,Outcomes,原发性血液系统感染,Primary Bloodstream infections,呼吸机相关性肺炎,Ventilator-associated pneumonia,手术部位感染,Surgical site infections,MRSA,VRE infections,血液透析病人经血管的感染,Vascular access infections in hemodialysis patients,医疗机构中的锐器刺伤,Sharps injuries in healthcare providers,10,针对过程,的目标性监测,Targeted Surveillance for,Processes,医务人员的乙肝免疫率,Hepatitis B immunity rates in personnel,医务人员对操作规则的依从性-隔离预防,Personnel compliance with protocols-isolation precautions,灭菌质量监测,Sterilization quality assurance testing,有效地环境清洁,Effective environmental cleaning,抗微生物药物的使用与管理,Antimicrobial prescribing and administration,11,怎样实施目标性监测,How to implement targeted surveillance,12,第一步,Step One,感染控制护士和医生每天查看微生物学报告,ICP and MD review Microbiology reports daily,定期查阅过去的监测数据,Review past surveillance data periodically,列出作为目标性监测的潜在感染或人群,Develop a list of the potential infections or populations for targeted surveillance,13,第二步,Step Two,感染控制人员基于以下一个或多个标准选择目标性监测的医院感染,Infection control team selects nosocomial infections to,target,based on one or more of the following criteria:,14,选择过程或后果进行目标监测的的标准,Criteria for Selecting Processes or Outcomes for Targeted Surveillance,感染控制计划的目的,IC program objectives,感染并发症的危险频度或水平,Frequency or level of risk of infectious complications for,病区,area,患者人群,patient population,操作,procedure,服务,service,发病率,Morbidity,死亡率,Mortality,费用,Cost,预防的可能性,Possibility for prevention,15,第三步,Step Three,ICP,应用一致的和认可的标准，对第二步决定的与感染有关的过程或结局进行数据收集,ICP performs chart reviews on the infection-related processes or outcomes identified in Step Two using standardized,consistent,approved definitions,一定时期内持续认真的监测,Consistent intensity and thoroughness of surveillance over time,一定时期内同样的定义,Same definitions over time,16,目标性监测：方法,Targeted Surveillance:A Means to an End,仅收集必要的数据,Collect only necessary data,得到有意义的信息,Arrive at meaningful information,17,这样您可以做到,So You Can:,制定有意义的干预措施,Develop meaningful,interventions,做减少感染的工作,DO something to,reduce infections,改善患者的医疗护理,Improve patient care!,18,目标性监测的成功周期,The Cycle for Success Through Targeted Surveillance,是否有重要的问题,Is there an important problem?,是什么，为什么？多专业的控制人员,What,why?,Multidisciplinary Teams,2.描述并理解问题,Describe and understand the problem?,目标性监测,Targeted,Surveillance,3.怎样去改进,How to affect,change?,多专业的控制人员,Multidisciplinary Teams,教育,Education,反馈,Feedback,新方案,New protocols,新产品,New products