1、ICUICU导管相关感染监测导管相关感染监测National Nosocomial Infections Surveillance(NNIS)system全国院内感染监测系统2ICU导管相关感染监测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
2、Reduce devices related infection in hospital 减少医院导管等装置的感染率3ICU导管相关感染监测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4ICU导管相关感染监测Denominator data 分母资料Count at 12 midnight in everyday 每天在午夜12
3、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6ICU导管相关感染监测Surveillance methods 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
4、,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 7ICU导管相关感染监测Name Hosp source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp.Adm.Sex/AgeDiagnosis on ICU admis
5、sionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention(OT,OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther 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
6、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 source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp.Adm.Sex/AgeDiagnosis
7、on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention(OT,OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther 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
8、 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:_ _8ICU导管相关感染监测Daily record of Devices in Neuro.ICU patient at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo
9、.of CVCNo.of Foley12345678910111213141516171819202122232425262728293031Tot alName Antibiotics prior ICUMicrobiology results 7 days prior ICUIDHNHosp.Adm.Sex/AgePre-ICU conditionDate Temp WBCVent/FiO2 CXRResp S/S RemarksIMSAntibioticsLab result9ICU导管相关感染监测Daily record of Devices in Neuro.ICU patient
10、at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo.of CVCNo.of Foley12345678910111213141516171819202122232425262728293031Tot al10ICU导管相关感染监测Define device-related infection 定义导管相关感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
11、床资料11ICU导管相关感染监测Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory results12ICU导管相关感染监测Definitions CA-BSI Had device within 48-hrs period before onset of infectionClinical manifestationsCommon skin contaminant from 2 blood
12、 culturesNo apparent source for BSI except the catheter13ICU导管相关感染监测Definitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=10Asymptomatic bacteriuria+ve urine culture=10No S/S of UTI5514ICU导管相关感染监测Calculate Device-associated infection ratesNumber of device-associated infection for a specific
13、site x 1000Number of device-days15ICU导管相关感染监测Calculate Device utilization ratios Number of device-daysNumber of patient-days16ICU导管相关感染监测VAP Surveillance in ICUABNo.of VAP627Patient days13734872Ventilator days 6432694Infection rates9.33(50)10.02(50)DU ratios0.47 500.55 75()NNIS device associated inf
14、ection percentile NNIS device utilization percentile17ICU导管相关感染监测CA-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 percentile18ICU导管相关感染监测CA-UTI Surve
15、illance in 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 percentile19ICU导管相关感染监测Pathogens Isolated-VAPNo.of infection6No.of isolate9GM-ve microorganism66.6%Pr
16、oteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%20ICU导管相关感染监测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 albicans21ICU导管相关感染监测Thank you22ICU导管相关感染监测
