1、Surveillance ofDevice Related Infection in Intensive Care Unit ICU导管相关感染监测 (A version for training purpose only, the data involved is not reflecting the real situation )National Nosocomial Infections Surveillance (NNIS) system全国院内感染监测系统Purpose目的Monitor the infection rates 监控感染率Benchmark with NNIS Sy
2、stem 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Reduce devices related infection in hospital 减少医院导管等装置的感染率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
3、for 48 hours after discharge from ICU. 病人转出 ICU 需继续跟踪 48小时Device-associated infections 导管相关感染Urinary catheter-associated Urinary tract infection (CA-UTI) 导尿管相关的尿路感染Central line- associated Bloodstream infection (CA-BSI) 中心静脉导管相关的血流感染Ventilator- associated Pneumonia (VAP) 呼吸机相关的肺炎Denominator data 分母资
4、料Count at 12 midnight in everyday 每天在午夜 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 中心静脉插管日Ventilator-days 呼吸机日Surveillance methods 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, Ph
5、ysiotherapists notes, XR report, 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 Define device-related infection 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床资料
6、Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory resultsDefinitions CA-BSI Had device within 48-hrs period before onset of infectionClinical manifestationsCommon skin contaminant from 2 blood culturesNo apparent source f
7、or BSI except the catheterDefinitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture =10Asymptomatic bacteriuria+ve urine culture =10No S/S of UTI55Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-daysCalculate Device util
8、ization ratios Number of device-daysNumber of patient-daysVAP Surveillance in ICUA BNo. of VAP 6 27Patient days 1373 4872Ventilator days 643 2694Infection rates 9.33 (50) 10.02 (50)DU ratios 0.47 50 0.55 75() NNIS device associated infection percentile NNIS device utilization percentileCA-BSI Survei
9、llance in ICU A BNo. of CA-BSI 0 8Patient days 1373 4872CVC days 402 3216 Infection rates 0 (10) 2.49(25)DU ratios 0.26 10 0.6650() NNIS device associated infection percentile NNIS device utilization percentileCA-UTI Surveillance in ICUA BNo. of UTI 23 12Patient days 1373 4872Urinary Cath days 1148
10、4711Infection rates 20.03 (90)2.55(25)DU ratios 0.84 50 0.97.90() NNIS device associated infection percentile NNIS device utilization percentilePathogens Isolated - VAPNo. of infection 6No. of isolate 9GM -ve microorganism 66.6%Proteus, Pseudnmonas, Acinetobacter, Klebsiella, EnterobacterGM +ve micr
11、oorganism 33.3%-haem. Strep., MSSA, Strep. pneumoniaeFungus 0%Pathogens Isolated CA-UTINo. of infection 23No. of isolate 28GM -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. Fungus 3.6%Candida albicansThank you
