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1、Surveillance ofDevice Related Infection in Intensive Care Unit ICU导管相关感染监测 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 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
2、 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 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 c
3、atheter-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 cat
4、heter-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,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、C
5、T/MAR。医生护士的会话by reviewing laboratory data.查看实验室数据 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 admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention(OT,OG
6、D,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 related infection in ICUType:VAP/CR-BSI/CR-SUTI/CR-ASBInfection date:_Device on&off date:_Dev
7、ice 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 on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical interv
8、ention(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 related infection in ICUType:VAP/CR-BSI/CR-SUTI/CR-ASBInfection date:_Device on&o
9、ff date:_Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Daily record of Devices in Neuro.ICU patient at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo.of CVCNo.of Foley12345678910111213141516171819202122232425262728293031Tot alName Antibiotics prior ICUMi
10、crobiology results 7 days prior ICUIDHNHosp.Adm.Sex/AgePre-ICU conditionDate Temp WBCVent/FiO2 CXRResp S/S RemarksIMSAntibioticsLab resultDaily record of Devices in Neuro.ICU patient at 12MN Month/year:_DateNo.of Pt.Adm.No.of Patient at 12MNNo.of VentilatorNo.of CVCNo.of Foley12345678910111213141516
11、171819202122232425262728293031Tot alDefine 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床资料Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaborator
12、y resultsDefinitions CA-BSI Had device within 48-hrs period before onset of infectionClinical manifestationsCommon skin contaminant from 2 blood culturesNo apparent source for BSI except the catheterDefinitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=10Asymptomatic bacteriuria+ve urine cul
13、ture=10No S/S of UTI55Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-daysCalculate Device utilization ratios Number of device-daysNumber of patient-daysVAP Surveillance in ICUABNo.of VAP627Patient days13734872Ventilator day
14、s 6432694Infection rates9.33(50)10.02(50)DU ratios0.47 500.55 75()NNIS device associated infection percentile NNIS device utilization percentileCA-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 i
15、nfection percentile NNIS device utilization percentileCA-UTI Surveillance 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 percentilePathogens Isolated-VAPNo.
16、of infection6No.of isolate9GM-ve microorganism66.6%Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%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 albicans
