英文版医院感染控制课件

1、英文版医院感染控制课件英文版医院感染控制课件英文版医院感染控制课件IC Practitioner (ICP) ActivitiesSurveillanceProgramManagementEducationMiscellaneousOutbreakInvestigationConsultation2021/4/272IC Practitioner (ICP) ActivitiesSurveillanceProgramManagementEducationMiscellaneousOutbreakInvestigationConsultation2021/4/272Surveillance ha

2、s an Epidemiologic foundationStudy the distribution of problems and events within a defined (targeted) population at risk for developing specific infections in order to plan & implement interventions.2021/4/2733 Key Surveillance Methods Hospital-wide Traditional SurveillanceAll infections complete-

3、time consumingLimits time for interventions Periodic SurveillanceSelected infections or populations periodically over timeMiss some infections Targeted Surveillance2021/4/274Advantages/DisadvantagesAdapted from Pottinger et al & Gaynes et al.2021/4/275Targeted Surveillance2021/4/276CDCs National Nos

4、ocomial Infections Surveillance (NNIS) System Targets:NNIS SystemAURICUHRNSurgicalPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/Pediatric)High Risk Nursery (NICU)Risk adjustedSSIs byProcedures2021/4/277Your Hospital Surveillance System Targets:Your HospitalVAPICUBSISSIVentilator-Ass

5、ociated PneumoniaMedical /Surgical ICUsIntensive CareUnit(Pediatric)Primary BloodStream InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures2021/4/278Which infection to target?Focus on patients at high risk for HAIPatient care areasICUs, cardio-thoracic surgery, cancer wardSpecific population

6、sneonates, transplant patients, hemodialysis ptsProcedures / DevicesCT surgery, central vascular lines, ventilatorsOrganisms of epidemiologic importance MRSA, VRSA2021/4/279Targeted Surveillance forOutcomesPrimary Bloodstream infectionsVentilator-associated pneumonia, Surgical site infectionsMRSA, V

7、RE infectionsVascular access infections in hemodialysis patientsSharps injuries in healthcare providers.2021/4/2710Targeted Surveillance for ProcessesHepatitis B immunity rates in personnelPersonnel compliance with protocols - isolation precautions,Sterilization quality assurance testing, Effective

8、environmental cleaningAntimicrobial prescribing and administration2021/4/2711How to implement targeted surveillance2021/4/2712Step OneICP and MD review Microbiology reports dailyReview past surveillance data periodicallyDevelop a list of the potential infections or populations for targeted surveilla

9、nce 2021/4/2713Step TwoInfection control team selects nosocomial infections to target based on one or more of the following criteria:2021/4/2714Criteria for Selecting Processes or Outcomes for Targeted SurveillanceIC program objectivesFrequency or level of risk of infectious complications for areapa

10、tient population procedure service Morbidity, Mortality, CostPossibility for prevention2021/4/2715Step ThreeICP performs chart reviews on the infection-related processes or outcomes identified in Step Two using standardized, consistent, approved definitions. Consistent intensity and thoroughness of

11、surveillance over timeSame definitions over time2021/4/2716Targeted Surveillance: A Means to an EndCollect only necessary data Arrive at meaningful information2021/4/2717So You Can:Develop meaningful interventionsDO something to reduce infectionsImprove patient care!2021/4/2718The Cycle for Success

12、Through Targeted SurveillanceIs there an important problem? What, why? Multidisciplinary Teams 2. Describe and understand the problem? Targeted Surveillance 3. How to affect change?Multidisciplinary TeamsEducationFeedbackNew protocolsNew products4. Do the changes work? Remeasure Adapted from: Richar

13、ds C, et al. Emerg Infect Dis 20012021/4/2719NLMIgnaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis2021/4/2720Targeted Surveillance for a ProcessTiming of Antibiotic Prophylaxis for Surgical Site InfectionNLM Archives2021/4/27211. Is There an Important Problem?Inappropriate s

14、urgical prophylaxis is a major infection risk exposes patient to unnecessary toxicityincreases antimicrobial resistanceexcess doses or inappropriate spectrum antibiotics do not reduce the incidence of surgical wound infection2021/4/2722“Ideal” ProphylaxisIdeal antibiotic for prophylaxisactive agains

15、t pathogens most likely to contaminate woundadequate concentrations during potential contaminationadministered for a short time to reduce complications, resistance, and cost2021/4/2723Targeted Process SurveillanceTiming of Perioperative Antimicrobial ProphylaxisClassen DC, et al. The timing of proph

16、ylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered2021/4/2724Timing ofPerioperative Antimicrobial ProphylaxisClassen DC, et al. The timing of prophylactic administration of ant

17、ibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:2812021/4/27252. Perform Targeted Surveillance for This Problem1) Proportion of patients who receive prophylactic antibiotics within 1 hour before surgical incision # antibiotics 1 hour # surgeries with antibiotics2021/4/2726Pe

18、rform Targeted Surveillance for This Problem2) Proportion of patients whose antibiotics were discontinued within 24 hours of the surgery end time# discontinue w/I 24 hours # surgeries receiving antibiotics2021/4/2727Possible Surgical Procedures to Determine Timing of Antibiotic ProphylaxisCABGColon

19、surgeryHip and knee arthroplastyAbdominal and vaginal hysterectomyVascular surgery (e.g., peripheral vascular surgery)2021/4/27283. To Affect ChangeMultidisciplinary Team to look at antibiotic delivery system: current and desiredRedesign system for timely AB deliveryMake antibiotic accessibleEducate

20、 nursing and operating room staff and anesthesiologists and surgeonsRecord time on patient chart2021/4/27294. Do the changes work?Re-measure 2 variables in 3 months after initiation of new improved procedureMeasure surgical site infection rates.2021/4/2730Targeted Surveillance for an InfectionOutcom

21、e2021/4/2731Targeted Surveillance for OutcomesNI Rate:VAPCR-BSIUTIFoley relatedNon-Foley relatedDrives Intervention For:Pneumonia preventionCR-BSI preventionFoley-care, d/c programPeri-care / hydration 2021/4/27321. Is There an Important Problem?Ventilator - associated pneumonia is a major infection

22、 risk for patientsincreased mortalityexcess length of stayexcess cost2021/4/2733Example: Challenge for Targeted SurveillanceReduce ventilator associated pneumonias (targeted adverse event) by 50% # VAP infections # 1000 ventilator days2021/4/2734Reduction of VAP with Targeted Surveillance and Interv

23、entionsKwan KL, Baker SP, Fontecabio SA. Impact of a program ofintensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia, and its cost effectivenessICHE 2003;24;11:859-63.2021/4/2735Reduction of VAP with Targeted Surveillance and Inter

24、ventionsInverventions:Raise head of bedSterile water for tube feedingsIn-line suction catheters from 24 - 48 -72- as neededCost savings $350,000 in one year.2021/4/27361. Is There an Important Problem?Catheter-related bloodstream infections are a serious infection riskdevice-relatedmorbidity and mortalityextra length of stayadditional medical costs2021/4/27370510152025JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98 - MarchSICU BSI Jan 98 - March 00Rate per 1,000 line daysRate per 1,000 line daysExample