英文版醫(yī)院感染控制課件

1、Targeted Surveillance for Nosocomial InfectionsBarbara M. Soule, RN, MPA, CICChinese Society for Nosocomial InfectionsJuly 4-5, 2004 Suzhou, China1IC Practitioner (ICP) ActivitiesSurveillanceProgramManagementEducationMiscellaneousOutbreakInvestigationConsultation2Surveillance has an Epidemiologic fo

2、undationStudy the distribution of problems and events within a defined (targeted) population at risk for developing specific infections in order to plan & implement interventions.33 Key Surveillance Methods Hospital-wide Traditional SurveillanceAll infections complete- time consumingLimits time for

3、interventions Periodic SurveillanceSelected infections or populations periodically over timeMiss some infections Targeted Surveillance4Advantages/DisadvantagesAdapted from Pottinger et al & Gaynes et al.5CDCs National Nosocomial Infections Surveillance (NNIS) System Targets:NNIS SystemAURICUHRNSurgi

4、calPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/Pediatric)High Risk Nursery (NICU)Risk adjustedSSIs byProcedures7Your Hospital Surveillance System Targets:Your HospitalVAPICUBSISSIVentilator-Associated PneumoniaMedical /Surgical ICUsIntensive CareUnit(Pediatric)Primary BloodStream

5、InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures8Targeted Surveillance forOutcomesPrimary Bloodstream infectionsVentilator-associated pneumonia, Surgical site infectionsMRSA, VRE infectionsVascular access infections in hemodialysis patientsSharps injuries in healthcare providers.10Targete

6、d Surveillance for ProcessesHepatitis B immunity rates in personnelPersonnel compliance with protocols - isolation precautions,Sterilization quality assurance testing, Effective environmental cleaningAntimicrobial prescribing and administration11How to implement targeted surveillance12Step TwoInfect

7、ion control team selects nosocomial infections to target based on one or more of the following criteria:14Criteria for Selecting Processes or Outcomes for Targeted SurveillanceIC program objectivesFrequency or level of risk of infectious complications for areapatient population procedure service Mor

8、bidity, Mortality, CostPossibility for prevention15Targeted Surveillance: A Means to an EndCollect only necessary data Arrive at meaningful information17So You Can:Develop meaningful interventionsDO something to reduce infectionsImprove patient care!18The Cycle for Success Through Targeted Surveilla

9、nceIs there an 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

10、Dis 200119NLMIgnaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis20Targeted Surveillance for a ProcessTiming of Antibiotic Prophylaxis for Surgical Site InfectionNLM Archives211. Is There an Important Problem?Inappropriate surgical prophylaxis is a major infection risk exposes

11、 patient to unnecessary toxicityincreases antimicrobial resistanceexcess doses or inappropriate spectrum antibiotics do not reduce the incidence of surgical wound infection22Targeted Process SurveillanceTiming of Perioperative Antimicrobial ProphylaxisClassen DC, et al. The timing of prophylactic ad

12、ministration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281IncisionHours beforeincisionHours afterincisionAntibioticAdministered24Timing ofPerioperative Antimicrobial ProphylaxisClassen DC, et al. The timing of prophylactic administration of antibiotics and the ri

13、sk of surgical-wound infection. N Engl J Med 1992;326:28125Perform 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 antibiotics27Possible Surgical Procedures to

14、Determine Timing of Antibiotic ProphylaxisCABGColon surgeryHip and knee arthroplastyAbdominal and vaginal hysterectomyVascular surgery (e.g., peripheral vascular surgery)283. To Affect ChangeMultidisciplinary Team to look at antibiotic delivery system: current and desiredRedesign system for timely A

15、B deliveryMake antibiotic accessibleEducate nursing and operating room staff and anesthesiologists and surgeonsRecord time on patient chart294. Do the changes work?Re-measure 2 variables in 3 months after initiation of new improved procedureMeasure surgical site infection rates.30Targeted Surveillan

16、ce for an InfectionOutcome31Targeted Surveillance for OutcomesNI Rate:VAPCR-BSIUTIFoley relatedNon-Foley relatedDrives Intervention For:Pneumonia preventionCR-BSI preventionFoley-care, d/c programPeri-care / hydration 321. Is There an Important Problem?Ventilator - associated pneumonia is a major in

17、fection risk for patientsincreased mortalityexcess length of stayexcess cost33Example: Challenge for Targeted SurveillanceReduce ventilator associated pneumonias (targeted adverse event) by 50% # VAP infections # 1000 ventilator days34Reduction of VAP with Targeted Surveillance and InterventionsKwan

18、 KL, Baker SP, Fontecabio 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;11:859-63.35Reduction of VAP with Targeted Surveillance and InterventionsInvervention

19、s:Raise head of bedSterile water for tube feedingsIn-line suction catheters from 24 - 48 -72- as neededCost savings $350,000 in one year.361. Is There an Important Problem?Catheter-related bloodstream infections are a serious infection riskdevice-relatedmorbidity and mortalityextra length of stayadditional medical costs370510152025JanAprilJulyOctJanAprilJulyOctJan989900SICU BSI Jan 98 - MarchSICU BSI Jan 98 - March 00Rate per 1,000 line daysRate per 1,000 line daysExample: Challenge for Targeted Surveillance382. Perform Targeted Surveillance for This ProblemMon