英文醫(yī)院感染控制

英文醫(yī)院感染控制1英文醫(yī)院感染控制5/9/20242IC

Practitioner(ICP)Activities

SurveillanceProgramManagementEducationMiscellaneousOutbreakInvestigationConsultation2英文醫(yī)院感染控制5/9/20243

SurveillancehasanEpidemiologicfoundationStudythedistributionofproblemsandeventswithinadefined(targeted)populationatriskfordevelopingspecificinfectionsinorder

toplan&implementinterventions.3英文醫(yī)院感染控制5/9/202443KeySurveillanceMethods

Hospital-wideTraditionalSurveillance Allinfections–complete-timeconsuming LimitstimeforinterventionsPeriodicSurveillance

Selectedinfectionsorpopulationsperiodicallyovertime Misssomeinfections

TargetedSurveillance4英文醫(yī)院感染控制5/9/20245Advantages/DisadvantagesAdaptedfromPottingeretal&Gaynesetal.5英文醫(yī)院感染控制5/9/2024TargetedSurveillance6英文醫(yī)院感染控制5/9/20247CDC’sNationalNosocomialInfectionsSurveillance(NNIS)SystemTargets:NNISSystemAURICUHRNSurgicalPatientAntimicrobialUseandResistanceIntensiveCareUnit(Adult/Pediatric)HighRiskNursery(NICU)RiskadjustedSSIsbyProcedures7英文醫(yī)院感染控制5/9/20248YourHospitalSurveillanceSystemTargets:YourHospitalVAPICUBSISSIVentilator-AssociatedPneumoniaMedical/SurgicalICUsIntensiveCareUnit(Pediatric)PrimaryBloodStreamInfectionsPrimaryOrthopedicNeurosurgicalorCABGProcedures8英文醫(yī)院感染控制5/9/20249Whichinfectiontotarget?

FocusonpatientsathighriskforHAIPatientcareareasICU’s,cardio-thoracicsurgery,cancerwardSpecificpopulationsneonates,transplantpatients,hemodialysisptsProcedures/DevicesCTsurgery,centralvascularlines,ventilatorsOrganismsofepidemiologicimportance

–MRSA,VRSA9英文醫(yī)院感染控制5/9/202410TargetedSurveillancefor

OutcomesPrimaryBloodstreaminfectionsVentilator-associatedpneumonia,SurgicalsiteinfectionsMRSA,VREinfectionsVascularaccessinfectionsinhemodialysispatientsSharpsinjuriesinhealthcareproviders.10英文醫(yī)院感染控制5/9/202411TargetedSurveillanceforProcessesHepatitisBimmunityratesinpersonnelPersonnelcompliancewithprotocols-isolationprecautions,Sterilizationqualityassurancetesting,EffectiveenvironmentalcleaningAntimicrobialprescribingandadministration11英文醫(yī)院感染控制5/9/202412Howtoimplementtargetedsurveillance

12英文醫(yī)院感染控制5/9/202413StepOne

ICPandMDreviewMicrobiologyreportsdailyReviewpastsurveillancedataperiodicallyDevelopalistofthepotentialinfectionsorpopulationsfortargetedsurveillance

13英文醫(yī)院感染控制5/9/202414StepTwoInfectioncontrolteamselectsnosocomialinfectionstotargetbasedononeormoreofthefollowingcriteria:

14英文醫(yī)院感染控制5/9/202415CriteriaforSelectingProcessesorOutcomesforTargetedSurveillance

ICprogramobjectivesFrequencyorlevelofriskofinfectiouscomplicationsfor area patientpopulation procedure serviceMorbidity,Mortality,CostPossibilityforprevention15英文醫(yī)院感染控制5/9/202416StepThree

ICPperformschartreviewsontheinfection-relatedprocessesoroutcomesidentifiedinStepTwousingstandardized,consistent,approveddefinitions.ConsistentintensityandthoroughnessofsurveillanceovertimeSamedefinitionsovertime

16英文醫(yī)院感染控制5/9/202417TargetedSurveillance:

AMeanstoanEndCollectonlynecessarydataArriveatmeaningfulinformation17英文醫(yī)院感染控制5/9/202418SoYouCan:DevelopmeaningfulinterventionsDOsomethingtoreduceinfectionsImprovepatientcare!18英文醫(yī)院感染控制5/9/202419TheCycleforSuccessThroughTargetedSurveillanceIsthereanimportantproblem?

What,why?

Multidisciplinary Teams

2.Describeandunderstandtheproblem?TargetedSurveillance

3.Howtoaffectchange?

Multidisciplinary Teams

Education Feedback Newprotocols Newproducts4.Dothechangeswork?

Remeasure

Adaptedfrom:RichardsC,etal.EmergInfectDis200119英文醫(yī)院感染控制5/9/202420NLMIgnazSemmelweisTargetedSurveillanceAndInterventionForPuerperalSepsis20英文醫(yī)院感染控制5/9/202421TargetedSurveillanceforaProcessTimingofAntibioticProphylaxisforSurgicalSiteInfectionNLMArchives21英文醫(yī)院感染控制5/9/2024221.IsThereanImportantProblem?Inappropriatesurgicalprophylaxisisamajorinfectionriskexposespatienttounnecessarytoxicityincreasesantimicrobialresistanceexcessdosesorinappropriatespectrumantibioticsdonotreducetheincidenceofsurgicalwoundinfection22英文醫(yī)院感染控制5/9/202423“Ideal”ProphylaxisIdealantibioticforprophylaxisactiveagainstpathogensmostlikelytocontaminatewoundadequateconcentrationsduringpotentialcontaminationadministeredforashorttimetoreducecomplications,resistance,andcost23英文醫(yī)院感染控制5/9/202424TargetedProcessSurveillance

TimingofPerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281IncisionHoursbeforeincisionHoursafterincisionAntibioticAdministered24英文醫(yī)院感染控制5/9/202425Timingof

PerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:28125英文醫(yī)院感染控制5/9/2024262.PerformTargetedSurveillanceforThisProblem

1)Proportionofpatientswhoreceiveprophylacticantibioticswithin1hourbeforesurgicalincision

#antibiotics1hour#surgerieswithantibiotics26英文醫(yī)院感染控制5/9/202427PerformTargetedSurveillanceforThisProblem

2)Proportionofpatientswhoseantibioticswerediscontinuedwithin24hoursofthesurgeryendtime

#discontinuew/I24hours#surgeriesreceivingantibiotics27英文醫(yī)院感染控制5/9/202428PossibleSurgicalProcedurestoDetermineTimingofAntibioticProphylaxisCABGColonsurgeryHipandkneearthroplastyAbdominalandvaginalhysterectomyVascularsurgery(e.g.,peripheralvascularsurgery)28英文醫(yī)院感染控制5/9/2024293.ToAffectChangeMultidisciplinaryTeamtolookatantibioticdeliverysystem:currentanddesiredRedesignsystemfortimelyABdeliveryMakeantibioticaccessibleEducatenursingandoperatingroomstaffandanesthesiologistsandsurgeonsRecordtimeonpatientchart29英文醫(yī)院感染控制5/9/2024304.Dothechangeswork?Re-measure2variablesin3monthsafterinitiationofnewimprovedprocedureMeasuresurgicalsiteinfectionrates.30英文醫(yī)院感染控制5/9/202431TargetedSurveillanceforanInfection

Outcome31英文醫(yī)院感染控制5/9/202432TargetedSurveillanceforOutcomesNIRate:VAP CR-BSIUTI Foleyrelated Non-Foleyrelated

DrivesInterventionFor:PneumoniapreventionCR-BSIpreventionFoley-care,d/cprogramPeri-care/hydration32英文醫(yī)院感染控制5/9/2024331.IsThereanImportantProblem?Ventilator-associatedpneumoniaisamajorinfectionriskforpatientsincreasedmortalityexcesslengthofstayexcesscost33英文醫(yī)院感染控制5/9/202434Example:ChallengeforTargetedSurveillanceReduceventilatorassociatedpneumonias(targetedadverseevent)by50%

#VAPinfections#1000ventilatordays34英文醫(yī)院感染控制5/9/202435ReductionofVAPwithTargetedSurveillanceandInterventionsKwanKL,BakerSP,FontecabioSA.Impactofaprogramofintensivesurveillanceandinterventionstargetingventilatedpatientsinthereductionofventilator-associatedpneumonia,anditscosteffectivenessICHE2003;24;11:859-63.35英文醫(yī)院感染控制5/9/202436ReductionofVAPwithTargetedSurveillanceandInterventionsInverventions:RaiseheadofbedSterilewaterfortubefeedingsIn-linesuctioncathetersfrom24-48-72-asneededCostsavings$350,000inoneyear.36英文醫(yī)院感染控制5/9/2024371.IsThereanImportantProblem?Catheter-relatedbloodstreaminfectionsareaseriousinfectionriskdevice-relatedmorbidityandmortalityextralengthofstayadditionalmedicalcosts37英文醫(yī)院感染控制5/9/2024380510152025JanAprilJulyOctJanAprilJulyOctJan'98'99'00SICUBSIJan'98-MarchSICUBSIJan'98-March

‘00Rateper1,000linedaysRateper1,000linedaysExample:ChallengeforTargetedSurveillance38