英文版医院感染控制-课件.ppt
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1、Targeted Surveillance for Nosocomial InfectionsBarbara M.Soule,RN,MPA,CICChinese Society for Nosocomial InfectionsJuly 4-5,2004 Suzhou,China2IC Practitioner(ICP)ActivitiesConsultation3Surveillance has an Epidemiologic foundationStudy the distribution of problems and events within a defined (targeted
2、)population at risk for developing specific infections in order to plan&implement interventions.43 Key Surveillance Methods Hospital-wide Traditional SurveillanceAll infections complete-time consumingLimits time for interventions Periodic SurveillanceSelected infections or populations periodically o
3、ver timeMiss some infections Targeted Surveillance5Advantages/DisadvantagesAdapted from Pottinger et al&Gaynes et al.Targeted Surveillance7CDCs National Nosocomial Infections Surveillance(NNIS)System Targets:NNIS SystemAURICUHRNSurgicalPatientAntimicrobialUse and ResistanceIntensive CareUnit(Adult/P
4、ediatric)High Risk Nursery(NICU)Risk adjustedSSIs byProcedures8Your Hospital Surveillance System Targets:Your HospitalVAPICUBSISSIVentilator-Associated PneumoniaMedical/Surgical ICUsIntensive CareUnit(Pediatric)Primary BloodStream InfectionsPrimary OrthopedicNeurosurgical or CABGProcedures9Which inf
5、ection to target?Focus on patients at high risk for HAI Patient care areas ICUs,cardio-thoracic surgery,cancer ward Specific populations neonates,transplant patients,hemodialysis pts Procedures/Devices CT surgery,central vascular lines,ventilators Organisms of epidemiologic importance MRSA,VRSA10Tar
6、geted Surveillance forOutcomes Primary Bloodstream infections Ventilator-associated pneumonia,Surgical site infections MRSA,VRE infections Vascular access infections in hemodialysis patients Sharps injuries in healthcare providers.11Targeted Surveillance for Processes Hepatitis B immunity rates in p
7、ersonnel Personnel compliance with protocols-isolation precautions,Sterilization quality assurance testing,Effective environmental cleaning Antimicrobial prescribing and administration12How to implement targeted surveillance13Step One ICP and MD review Microbiology reports daily Review past surveill
8、ance data periodically Develop a list of the potential infections or populations for targeted surveillance 14Step TwoInfection control team selects nosocomial infections to target based on one or more of the following criteria:15Criteria for Selecting Processes or Outcomes for Targeted SurveillanceI
9、C program objectivesFrequency or level of risk of infectious complications for areapatient population procedure service Morbidity,Mortality,CostPossibility for prevention16Step ThreeICP performs chart reviews on the infection-related processes or outcomes identified in Step Two using standardized,co
10、nsistent,approved definitions.Consistent intensity and thoroughness of surveillance over time Same definitions over time17Targeted Surveillance:A Means to an End Collect only necessary data Arrive at meaningful information18So You Can:Develop meaningful interventions DO something to reduce infection
11、s Improve patient care!19The Cycle for Success Through Targeted Surveillance1.Is 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 ch
12、anges work?Remeasure Adapted from:Richards C,et al.Emerg Infect Dis 200120NLMIgnaz Semmelweis Targeted Surveillance And InterventionFor Puerperal Sepsis21Targeted Surveillance for a ProcessTiming of Antibiotic Prophylaxis for Surgical Site InfectionNLM Archives221.Is There an Important Problem?Inapp
13、ropriate surgical prophylaxis is a major infection risk exposes patient to unnecessary toxicity increases antimicrobial resistance excess doses or inappropriate spectrum antibiotics do not reduce the incidence of surgical wound infection23“Ideal”Prophylaxis Ideal antibiotic for prophylaxis active ag
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