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1、英文版医院感染控制课件Surveillance 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.23 Key Surveillance Methods Hospital-wide Traditional SurveillanceAll infecti
2、ons complete-time consumingLimits time for interventions Periodic SurveillanceSelected infections or populations periodically over timeMiss some infections Targeted Surveillance3Advantages/DisadvantagesAdapted from Pottinger et al&Gaynes et al.4Targeted SurveillanceCDCs National Nosocomial Infection
3、s Surveillance(NNIS)System Targets:NNIS SystemAURICUHRNSurgicalPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/Pediatric)High Risk Nursery(NICU)Risk adjustedSSIs byProcedures6Your Hospital Surveillance System Targets:Your HospitalVAPICUBSISSIVentilator-Associated PneumoniaMedical/Surg
4、ical ICUsIntensive CareUnit(Pediatric)Primary BloodStream InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures7Which infection to target?Focus on patients at high risk for HAIPatient care areasICUs,cardio-thoracic surgery,cancer wardSpecific populationsneonates,transplant patients,hemodialysi
5、s ptsProcedures/DevicesCT surgery,central vascular lines,ventilatorsOrganisms of epidemiologic importance MRSA,VRSA8Targeted Surveillance forOutcomesPrimary Bloodstream infectionsVentilator-associated pneumonia,Surgical site infectionsMRSA,VRE infectionsVascular access infections in hemodialysis pat
6、ientsSharps injuries in healthcare providers.9Targeted Surveillance for ProcessesHepatitis B immunity rates in personnelPersonnel compliance with protocols-isolation precautions,Sterilization quality assurance testing,Effective environmental cleaningAntimicrobial prescribing and administration10How
7、to implement targeted surveillance11Step OneICP and MD review Microbiology reports dailyReview past surveillance data periodicallyDevelop a list of the potential infections or populations for targeted surveillance 12Step TwoInfection control team selects nosocomial infections to target based on one
8、or more of the following criteria:13Criteria for Selecting Processes or Outcomes for Targeted SurveillanceIC program objectivesFrequency or level of risk of infectious complications for areapatient population procedure service Morbidity,Mortality,CostPossibility for prevention14Step ThreeICP perform
9、s 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 timeSame definitions over time 15Targeted Surveillance:A Means to an EndCollect only necessary data Arri
10、ve at meaningful information16So You Can:Develop meaningful interventionsDO something to reduce infectionsImprove patient care!17The Cycle for Success Through Targeted Surveillance1.Is there an important problem?2.3.What,why?4.Multidisciplinary Teams 2.Describe and understand the problem?Targeted Su
11、rveillance 3.How to affect change?Multidisciplinary TeamsEducationFeedbackNew protocolsNew products4.Do the changes work?Remeasure Adapted from:Richards C,et al.Emerg Infect Dis 200118NLMIgnaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis19Targeted Surveillance for a ProcessT
12、iming of Antibiotic Prophylaxis for Surgical Site InfectionNLM Archives201.Is There an Important Problem?Inappropriate surgical prophylaxis is a major infection risk exposes patient to unnecessary toxicityincreases antimicrobial resistanceexcess doses or inappropriate spectrum antibiotics do not red
13、uce the incidence of surgical wound infection21“Ideal”ProphylaxisIdeal antibiotic for prophylaxisactive against pathogens most likely to contaminate woundadequate concentrations during potential contaminationadministered for a short time to reduce complications,resistance,and cost22Targeted Process
14、SurveillanceTiming of Perioperative Antimicrobial ProphylaxisClassen DC,et al.The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.N Engl J Med 1992;326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered23Timing ofPerioperative Antim
15、icrobial ProphylaxisClassen DC,et al.The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.N Engl J Med 1992;326:281242.Perform Targeted Surveillance for This Problem1)Proportion of patients who receive prophylactic antibiotics within 1 hour before surgica
16、l incision#antibiotics 1 hour#surgeries with antibiotics25Perform Targeted Surveillance for This Problem2)Proportion of patients whose antibiotics were discontinued within 24 hours of the surgery end time#discontinue w/I 24 hours#surgeries receiving antibiotics26Possible Surgical Procedures to Deter
17、mine Timing of Antibiotic ProphylaxisCABGColon surgeryHip and knee arthroplastyAbdominal and vaginal hysterectomyVascular surgery(e.g.,peripheral vascular surgery)273.To Affect ChangeMultidisciplinary Team to look at antibiotic delivery system:current and desiredRedesign system for timely AB deliver
18、yMake antibiotic accessibleEducate nursing and operating room staff and anesthesiologists and surgeonsRecord time on patient chart284.Do the changes work?Re-measure 2 variables in 3 months after initiation of new improved procedureMeasure surgical site infection rates.29Targeted Surveillance for an
19、InfectionOutcome30Targeted Surveillance for OutcomesNI Rate:VAPCR-BSIUTIFoley relatedNon-Foley related Drives Intervention For:Pneumonia preventionCR-BSI preventionFoley-care,d/c programPeri-care/hydration 311.Is There an Important Problem?Ventilator-associated pneumonia is a major infection risk fo
20、r patientsincreased mortalityexcess length of stayexcess cost32Example:Challenge for Targeted SurveillanceReduce ventilator associated pneumonias(targeted adverse event)by 50%#VAP infections#1000 ventilator days33Reduction of VAP with Targeted Surveillance and InterventionsKwan KL,Baker SP,Fontecabi
21、o SA.Impact of a program ofintensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia,and its cost effectivenessICHE 2003;24;11:859-63.34Reduction of VAP with Targeted Surveillance and InterventionsInverventions:Raise head of bedSterile
22、 water for tube feedingsIn-line suction catheters from 24-48-72-as neededCost savings$350,000 in one year.351.Is There an Important Problem?Catheter-related bloodstream infections are a serious infection riskdevice-relatedmorbidity and mortalityextra length of stayadditional medical costs36051015202
23、5JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98-MarchSICU BSI Jan 98-March 00Rate per 1,000 line daysRate per 1,000 line daysExample:Challenge for Targeted Surveillance372.Perform Targeted Surveillance for This Problem Monitor blood streaminfections in Surgical ICUpatients.383.Affect ChangeS
24、uccessful interventions from targeted surveillance for BSI 1.Successful education program to reduce catheter associated blood stream infections2.Drapes and full PPE during insertion3.Monitoring and care for site 394.Do the changes work?Re-measure in 3 months after initiation of new improved procedur
25、eMeasure bloodstream infection rates.400510152025JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98-MarchSICU BSI Jan 98-March 00BSIBSIInterventionInterventionsRate per 1,000 line daysRate per 1,000 line daysExample:Challenge for Targeted Surveillance41With targeted surveillance42此此课课件下件下载载可自行可自行编辑编辑修改，修改，仅仅供参考！供参考！感感谢谢您的支持，我您的支持，我们们努力做得更好！努力做得更好！谢谢谢谢