ICU导管相关感染调查

ICU导管相关感染调查第1页/共23页NationalNosocomialInfectionsSurveillance(NNIS)system

全国院内感染监测系统第2页/共23页Purpose目的Monitortheinfectionrates

监控感染率BenchmarkwithNNISSystem

与NNIS标竿Determinetrends

确定趋势Identifyoutbreak

定义暴发Facilitatecomparisons

易于比较Linkmonitoredratesandpreventionefforts

感染率与预防效果的联系Reducedevicesrelatedinfectioninhospital

减少医院导管等装置的感染率第3页/共23页Populationatrisk

危险人群AllpatientshasbeenadmittedinICUfor>48hours.

入ICU48小时的病人Followpatientsfor48hoursafterdischargefromICU.

病人转出ICU需继续跟踪48小时第4页/共23页Device-associatedinfections

导管相关感染Urinarycatheter-associatedUrinarytractinfection(CA-UTI)

导尿管相关的尿路感染Centralline-associatedBloodstreaminfection(CA-BSI)

中心静脉导管相关的血流感染Ventilator-associatedPneumonia(VAP)

呼吸机相关的肺炎第5页/共23页Denominatordata

分母资料Countat12midnightineveryday

每天在午夜12点计算Totalnumberofpatients’admission

所有病人Patient-days

病人日Urinarycatheter-days

导尿管日Centralline-days

中心静脉插管日Ventilator-days

呼吸机日第6页/共23页Surveillancemethods

调查方法ongoingrevieweachpatientinICU.

持续观察ICU的每个病人byreviewingDoctorsprogressnotes,Nursingnotes,

Physiotherapistsnotes,XRreport,charts,MARforms,conversationswithnursesandphysicians

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byreviewinglaboratorydata.

查看实验室数据

第7页/共23页第8页/共23页第9页/共23页第10页/共23页Definedevice-relatedinfection

定义导管相关感染ByusingstandardCDCdefinitionsthatincludelaboratory&clinicaldata使用CDC的标准包括实验室和临床资料第11页/共23页Definitions–VAPHaddevicewithin48-hrsperiodbeforeonsetofinfection

SystemicS/SRespiratoryS/SChestX-RevidenceLaboratoryresults第12页/共23页Definitions–CA-BSIHaddevicewithin48-hrsperiodbeforeonsetofinfectionClinicalmanifestationsCommonskincontaminantfrom2bloodculturesNoapparentsourceforBSIexceptthecatheter第13页/共23页Definitions–CA-UTISymptomaticUTIS/SofUTI+veurineculture>=10Asymptomaticbacteriuria+veurineculture>=10NoS/SofUTI55第14页/共23页CalculateDevice-associatedinfectionratesNumberofdevice-associatedinfectionforaspecificsitex1000Numberofdevice-days第15页/共23页CalculateDeviceutilizationratios

Numberofdevice-daysNumberofpatient-days第16页/共23页VAPSurveillanceinICU

A BNo.ofVAP 6 27Patientdays 1373 4872Ventilatordays 643 2694Infectionrates 9.33(>50) 10.02(>50)DUratios 0.47[50] 0.55[75]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentile第17页/共23页CA-BSISurveillanceinICU

A BNo.ofCA-BSI 0 8Patientdays 1373 4872CVCdays 402 3216 Infectionrates 0(10) 2.49(25)DUratios 0.26[>10] 0.66[50]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentile第18页/共23页CA-UTISurveillanceinICU A BNo.ofUTI 23 12Patientdays 1373 4872UrinaryCathdays 1148 4711Infectionrates 20.03(>90)2.55(25)DUratios 0.84[50] 0.97[.90]()NNISdeviceassociatedinfectionpercentile[]NNISdeviceutilizationpercentile第19页/共23页PathogensIsolated-VAP

No.ofinfection 6No.ofisolate 9GM-vemicroorganism 66.6% Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+vemicroorganism 33.3%

α-haem.Strep.,MSSA,Strep.pneumoniaeFungus 0%第20页/共23页PathogensIsolated–CA-UTI

No.ofinfection 23No.ofisolate 28GM-vemicroorganism 92.9% E.Coli(50%),Klebsiella(14.3%),Proteus(14.