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1、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 rates and prevention efforts 感染率与预防效果的联系 Reduce devices related
2、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 catheter-associated Urinary tract infection (CA-UTI) 导尿管相
3、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 catheter-days 导尿管日 Central line-days 中心静
4、脉插管日 Ventilator-days 呼吸机日 Surveillance methods 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、CT/MAR。医生护士的会话 by reviewing
5、laboratory data. 查看实验室数据 Click to edit Master title style Click to edit Master subtitle style *10 Define device-related infection 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 VAP Had device within 48-hrs period before onset of inf
6、ection Systemic S/S Respiratory S/S Chest X-R evidence Laboratory results Definitions CA-BSI Had device within 48-hrs period before onset of infection Clinical manifestations Common skin contaminant from 2 blood cultures No apparent source for BSI except the catheter Definitions CA-UTI Symptomatic U
7、TI S/S of UTI +ve urine culture =10 Asymptomatic bacteriuria +ve urine culture =10 No S/S of UTI Click to edit Master title style Click to edit Master subtitle style *14 Calculate Device- associated infection rates Number of device-associated infection for a specific site x 1000 Number of device-day
8、s Click to edit Master title style Click to edit Master subtitle style *15 Calculate Device utilization ratios Number of device-days Number of patient-days VAP Surveillance in ICU AB No. of VAP627 Patient days13734872 Ventilator days 6432694 Infection rates9.33 (50) 10.02 (50) DU ratios0.47 500.55 7
9、5 () NNIS device associated infection percentile NNIS device utilization percentile CA-BSI Surveillance in ICU AB No. of CA-BSI 08 Patient days13734872 CVC days4023216 Infection rates0 (10)2.49(25) DU ratios0.26 10 0.6650 () NNIS device associated infection percentile NNIS device utilization percent
10、ile CA-UTI Surveillance in ICU AB No. of UTI2312 Patient days13734872 Urinary Cath days11484711 Infection rates20.03 (90)2.55(25) DU ratios0.84 500.97.90 () NNIS device associated infection percentile NNIS device utilization percentile Pathogens Isolated - VAP No. of infection6 No. of isolate9 GM -v
11、e microorganism66.6% Proteus, Pseudnmonas, Acinetobacter, Klebsiella, Enterobacter GM +ve microorganism33.3% -haem. Strep., MSSA, Strep. pneumoniae Fungus0% Pathogens Isolated CA-UTI No. of infection23 No. of isolate28 GM -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 Click to edit Master title style Click to edit Master subtitle style *21 Thank you