医院感染目标性监测译ppt课件

医院感染的目标性监测Targeted Surveillance for Nosocomial InfectionsBarbara M. Soule, RN, MPA, CICChinese Society for Nosocomial InfectionsJuly 4-5, 2004 Suzhou, China1ICP 的工作内容IC Practitioner (ICP) Activities监测监测 Surveillance项目管理项目管理 ProgramManagement教育教育 Education工作的多样性工作的多样性Miscellaneous暴发调查暴发调查 OutbreakInvestigation咨询Consultation2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 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 groupsAdapted from Pottinger et al 326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered24围手术期抗微生物药物预防应用的时机Timing of Perioperative Antimicrobial ProphylaxisClassen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281252. 针对该问题进行目标性监测Perform Targeted Surveillance for This Problem1) 手术切口前一小时接受预防性抗生素的患者比例Proportion of patients who receive prophylactic antibioticswithin 1 hour before surgical incision术前 1小时使用抗生素的人数， # antibiotics 1 hour使用抗生素的所有病人数， # surgeries with antibiotics 26针对问题进行目标监测Perform Targeted Surveillance for This Problem2) 手术结束后 24小时内停用抗生素的患者比例Proportion of patients whose antibiotics were discontinued within 24 hours of the surgery end time# discontinue w/I 24 hours# surgeries receiving antibiotics27手术操作决定预防性的抗生素给药时间选择Possible Surgical Procedures to Determine Timing of Antibiotic Prophylaxis 冠脉搭桥手术 CABG 结肠手术 Colon surgery 髋和膝关节形成术 Hip and knee arthroplasty 经腹或阴道子宫切除术 Abdominal and vaginal hysterectomy 血管手术 Vascular surgery (e.g., peripheral vascular surgery)283. 改进To Affect Change 多学科小组检查抗生素给药制度：现状和期望的制度Multidisciplinary Team to look at antibiotic delivery system: current and desired 重新设计抗生素的及时应用制度 Redesign system for timely AB delivery 抗生素的可得性， Make antibiotic accessible 培训护理和手术室人员以及麻醉师和外科大夫Educate nursing and operating room staff and anesthesiologists and surgeons 在病历上记录给药时间， Record time on patient chart294.改进工作有效吗？Do the changes work? 在新的改良操作开始后的 3个月内重新检查 2个