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1、英文医院感染控制英文医院感染控制2IC Practitioner (ICP) ActivitiesConsultation3Surveillance has 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.43 Key Surveillance Met
2、hods Hospital-wide Traditional SurveillanceAll infections complete- time consumingLimits time for interventions Periodic SurveillanceSelected infections or populations periodically over timeMiss some infections Targeted Surveillance5Advantages/DisadvantagesAdapted from Pottinger et al & Gaynes et al
3、.Targeted Surveillance7CDCs National Nosocomial Infections Surveillance (NNIS) System Targets:NNIS SystemAURICUHRNSurgicalPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/Pediatric)High Risk Nursery (NICU)Risk adjustedSSIs byProcedures8Your Hospital Surveillance System Targets:Your Hos
4、pitalVAPICUBSISSIVentilator-Associated PneumoniaMedical /Surgical ICUsIntensive CareUnit(Pediatric)Primary BloodStream InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures9Which infection to target? Focus on patients at high risk for HAI Patient care areas ICUs, cardio-thoracic surgery, cance
5、r ward Specific populations neonates, transplant patients, hemodialysis pts Procedures / Devices CT surgery, central vascular lines, ventilators Organisms of epidemiologic importance MRSA, VRSA10Targeted Surveillance forOutcomes Primary Bloodstream infections Ventilator-associated pneumonia, Surgica
6、l site infections MRSA, VRE infections Vascular access infections in hemodialysis patients Sharps injuries in healthcare providers.11Targeted Surveillance for Processes Hepatitis B immunity rates in personnel Personnel compliance with protocols - isolation precautions, Sterilization quality assuranc
7、e testing, Effective environmental cleaning Antimicrobial prescribing and administration12How to implement targeted surveillance13Step One ICP and MD review Microbiology reports daily Review past surveillance data periodically Develop a list of the potential infections or populations for targeted su
8、rveillance 14Step TwoInfection control team selects nosocomial infections to target based on one or more of the following criteria:15Criteria for Selecting Processes or Outcomes for Targeted SurveillanceIC program objectivesFrequency or level of risk of infectious complications for areapatient popul
9、ation procedure service Morbidity, Mortality, CostPossibility for prevention16Step 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 surveillance over ti
10、me Same definitions over time17Targeted Surveillance: A Means to an End Collect only necessary data Arrive at meaningful information18So You Can: Develop meaningful interventions DO something to reduce infections Improve patient care!19The Cycle for Success Through Targeted Surveillance1. Is there a
11、n 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: Richards C, et al. Emerg Infect Dis 200120NLM
12、Ignaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis21Targeted Surveillance for a ProcessTiming of Antibiotic Prophylaxis for Surgical Site InfectionNLM Archives221. Is There an Important Problem? Inappropriate surgical prophylaxis is a major infection risk exposes patient to
13、unnecessary toxicity increases antimicrobial resistance excess doses or inappropriate spectrum antibiotics do not reduce the incidence of surgical wound infection23“Ideal” Prophylaxis Ideal antibiotic for prophylaxis active against pathogens most likely to contaminate wound adequate concentrations d
14、uring potential contamination administered for a short time to reduce complications, resistance, and cost24Targeted Process SurveillanceTiming of Perioperative Antimicrobial Prophylaxis012345622112345678910 10# SSIs / 100 proceduresClassen DC, et al. The timing of prophylactic administration of anti
15、biotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered25Timing ofPerioperative Antimicrobial ProphylaxisTime of administration in relation to the incision # of Patients (%) Relative Risk of Infection 2-24 hours
16、 before 369 (13.0) 6.7 (2.9-14.7) 0-2 hours before 1708 (60.0) 1.0 0-3 hours after 282 (9.9) 2.4 (0.9-7.9) 3 hours after 488 (17.1) 5.8 (2.6-12.3) All 2847 (100) Classen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281262. Perform Targeted Surveillance for This Problem1) Proportion of patients who receive prophylactic antibiotics within 1 hour before surgical incision # antibiotics 1 hour # surgeries with anti
