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1、National Nosocomial Infections Surveillance(NNIS)system全国院内感染监测系统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 i
2、n hospital 减少医院导管等装置的感染率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-as
3、sociated 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Surveillance me
4、thods 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 Name Hosp source:_ Previo
5、us ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp.Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention(OT,OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther deviceDateT
6、ypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/At/o w/MVt/o w/cvct/o w/UC2d t/o w/A 2d t/o w/MV2d t/o w/cvc2d t/o w/UCDevice related infection in ICUType:VAP/CR-BSI/CR-SUTI/CR-ASBInfection date:_Device on&off date:_Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Name Hosp sou
7、rce:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp.Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention(OT,OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther
8、 deviceDateTypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/At/o w/MVt/o w/cvct/o w/UC2d t/o w/A 2d t/o w/MV2d t/o w/cvc2d t/o w/UCDevice related infection in ICUType:VAP/CR-BSI/CR-SUTI/CR-ASBInfection date:_Device on&off date:_Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _D
9、aily record of Devices in Neuro.ICU patient at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo.of CVCNo.of Foley12345678910111213141516171819202122232425262728293031Tot alName Antibiotics prior ICUMicrobiology results 7 days prior ICUIDHNHosp.Adm.Sex/AgePre-ICU conditionDat
10、e Temp WBCVent/FiO2 CXRResp S/S RemarksIMSAntibioticsLab resultDaily record of Devices in Neuro.ICU patient at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo.of CVCNo.of Foley12345678910111213141516171819202122232425262728293031Tot alDefine device-related infection 定义导管相关感
11、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Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory resultsDefinitions CA-BSI Had device within 48-hrs period before onset of
12、 infectionClinical manifestationsCommon skin contaminant from 2 blood culturesNo apparent source for BSI except the catheterDefinitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=10Asymptomatic bacteriuria+ve urine culture=10No S/S of UTICalculate Device-associated infection ratesNumber of de
13、vice-associated infection for a specific site x 1000Number of device-daysCalculate Device utilization ratios Number of device-daysNumber of patient-daysVAP Surveillance in ICUABNo.of VAP627Patient days13734872Ventilator days 6432694Infection rates9.33(50)10.02(50)DU ratios0.47 500.55 75()NNIS device
14、 associated infection percentile NNIS device utilization percentileCA-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 percentileCA-UTI Surveillance in
15、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 percentilePathogens Isolated-VAPNo.of infection6No.of isolate9GM-ve microorganism66.6%Proteus,Pseudnmonas,Acinet
16、obacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%Pathogens 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 albicansThank you
ICU导管相关感染监测PPT课件PPT文档
