医学专题一ICU-导管相关感染调查.ppt

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1、Surveillance ofDevice Related Infection in Intensive Care Unit ICU导管相关感染(gnrn)监测(A version for training purpose only,the data involved is not reflecting the real situation)第一页，共二十三页。National Nosocomial Infections Surveillance(NNIS)system全国(qun u)院内感染监测系统第二页，共二十三页。Purpose目的(md)Monitor the infection r

2、ates 监控感染率Benchmark with NNIS System 与NNIS标竿(bio n)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第三页，共二十三页。Population at risk 危险(wixin)人群 All patients has been adm

3、itted in ICU for 48 hours.入ICU48小时(xiosh)的病人Follow patients for 48 hours after discharge from ICU.病人转出ICU 需继续跟踪48小时第四页，共二十三页。Device-associated infections 导管(dogun)相关感染Urinary catheter-associated Urinary tract infection(CA-UTI)导尿管相关(xinggun)的尿路感染Central line-associated Bloodstream infection(CA-BSI)中心

4、静脉导管相关的血流感染Ventilator-associated Pneumonia(VAP)呼吸机相关的肺炎第五页，共二十三页。Denominator data 分母(fnm)资料Count at 12 midnight in everyday 每天在午夜(wy)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(zhngxn)静脉插管日Ventilator-days 呼吸机日第六页，共二十三页。Surveillance metho

5、ds 调查调查(dio ch)方法方法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(hl)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 第七页，共二十三页。第八页，共二

6、十三页。第九页，共二十三页。第十页，共二十三页。Define device-related infection 定义导管相关定义导管相关(xinggun)感染感染By using standard CDC definitions that include laboratory&clinical data使用CDC的标准(biozhn)包括实验室和临床资料第十一页，共二十三页。Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R e

7、videnceLaboratory results第十二页，共二十三页。Definitions 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 catheter第十三页，共二十三页。Definitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=1

8、0Asymptomatic bacteriuria+ve urine culture=10No S/S of UTI55第十四页，共二十三页。Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-days第十五页，共二十三页。Calculate Device utilization ratios Number of device-daysNumber of patient-days第十六页，共二十三页。

9、VAP 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 percentile第十七页，共二十三页。CA-BSI Surveillance in ICU ABNo.of CA-BSI 08Patient days13734872CVC days40

10、23216Infection rates0(10)2.49(25)DU ratios0.26 100.6650()NNIS device associated infection percentile NNIS device utilization percentile第十八页，共二十三页。CA-UTI Surveillance in ICUABNo.of UTI2312Patient days13734872Urinary Cath days1148 4711Infection rates20.03(90)2.55(25)DU ratios0.84 500.97.90()NNIS devic

11、e associated infection percentile NNIS device utilization percentile第十九页，共二十三页。Pathogens Isolated-VAPNo.of infection6No.of isolate9GM-ve microorganism66.6%Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%第二十页，共二十三页。Pathogens I

12、solated 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 albicans第二十一页，共二十三页。Thank you第二十二页，共二十三页。内容(nirng)总结Surveillance ofDevice Related Infection in Intensive Care Unit ICU导管相关感染(gnrn)监测。AB。Patient days13734872。CVC days4023216。Fungus0%。Fungus3.6%第二十三页，共二十三页。