2012 IDWeek 介绍 宗志勇 四川大学华西医院医院感染管理科 感染性疾病中心.

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1 2012 IDWeek 介绍 宗志勇 四川大学华西医院医院感染管理科 感染性疾病中心

2 ID Week 4个感染学会的联合年会 美国感染病学会 IDSA 美国医疗流行病学会 SHEA 美国HIV医疗协会 HIVMA 美国儿科感染病学会 PIDS 摘要和壁报下载

3 VAP监测的改变 http://www.cdc.gov/nhsn/psc_da-vae.html
2013年1月起NHSN改变监测VAP为VAC（VAE） Ventilator-associated condition Ventilator-associated complication呼吸机相关并发症 Ventilator-associated event呼吸机相关事件

4 VAC监测 适用人群： ≥18岁成人，接受机械通气≥3天 不包括：挽救性机械通气（HFV、ECMO、俯卧位通气）

5 患者≥2天通气情况（FiO2和PEEP）稳定或改善
开始监测 患者氧疗恶化，较稳定期基线：1. 每日最低FiO2≥0.2超过2天；和/或2. PEEP≥3 cmH2O超过2天 VAC 患者带机≥48h且在氧疗恶化的前后2天内，如果同时具备以下两条：1. T>38或<36或者WBC>12000或<4000； 2. 使用了一种新抗菌药物，并且连用至少4天 感染相关VAC，IVAC

6 可能的VAP，possible VAP 以下两条中具备一条：
脓性呼吸道分泌物：肺、气管、支气管分泌物在每低倍视野中查见≥25个白细胞和≤10个鳞状上皮细胞； 痰、气管内抽吸物、支气管内灌洗液、肺组织或保护性毛刷培养阳性。

7 很可能的VAP，probable VAP 以下两条中具备至少一条：
1. 脓性呼吸道分泌物：肺、气管、支气管分泌物在每低倍视野中查见≥25个白细胞和≤10个鳞状上皮细胞，且具备以下一条： 气管内抽吸物培养阳性， ≥105 CFU/ml 支气管灌洗液培养阳性， ≥104 CFU/ml 肺组织培养阳性，≥104 CFU/ml 保护性毛刷培养阳性，≥103 CFU/ml 2. 以下任何一条（不需要脓性呼吸道分泌物） 胸水培养阳性（留置引流管取标本培养阳性除外） 肺组织病理阳性 军团菌诊断试验阳性 流感病毒、呼吸合胞病毒、腺病毒和副流感病毒诊断试验阳性

8 血透监测 美国血透 CLABSI 37000，6例 100病人月 关于血透相关事件监测和防控资源
A Four Year Experience with a Central Line Access-Related Bloodstream Infection (CL-ARB) Prevention Program in Six Outpatient Hemodialysis (HD) Centers 关于血透相关事件监测和防控资源 CDC. CDC's Dialysis BSI Prevention Collaborative. 2012; Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep. 2001;50(RR-5):1-43. Patel PR, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients. American journal of kidney diseases 2010;56(3):

9 血透相关BSI的预防措施

10 Interventions included staff engagement and education to improve adherence to recommended practices, monthly feedback of CL-ARB rates, and participation in the CDC Dialysis BSI Prevention Collaborative. The Collaborative interventions included standard catheter care and vascular access practices including use of an observation audit tool to educate and assess compliance, participation in a catheter reduction initiative, use of an alcohol-based chlorhexidine solution for skin antisepsis, implementation of an enhanced catheter hub cleansing method, surveillance of hand hygiene and glove use, use of antimicrobial ointment at catheter exit sites, and patient education.

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12 Surgical Site Infections after Craniotomy and Craniectomy: Risk Factors and Outcomes
1:3配对研究 104 SSI 312 control

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14 The Relationship of Operating Room Size, Length of Surgery and Surgical Site Infection Rates in Neurosurgical Procedures <64平方米的手术室，感染风险增高

15 The Effect of Removal of Alcohol-Based Skin Prep on Operating Room Fires and Surgical Site Infection Rates After removal of alcohol prep, povidone-iodine and 4% chlohexadine gluconate were substituted as the standard skin prep agents.

16 SSI监测多久合适？ How Long is Long Enough
SSI监测多久合适？ How Long is Long Enough? Determining the Optimal Surgical Site Infection Surveillance Period 97%的SSI发生在术后6个月内

17 Impact of Single Center Universal Screening followed by Universal Chlorhexidine (CHG) Bathing and Targeted Mupirocin Use in 3 ICUs on Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) Acquisition Rates 主动筛查+去定植对MRSA无效，但减少了VRE却未能阻止VRE暴发 In 3 ICUs from a single center, a quality initiative of decolonization with universal CHG bathing and targeted mupirocin substantially reduced VRE acquisition, but did not prevent a VRE outbreak. Decolonization showed no effect on MRSA.

18 Use of Fluorescent Marking Dye to Improve Compliance with Environmental Cleaning
美国约翰霍普金斯大学医院日常清洁中只有43%应该清洁的实际上清洁了，而出院后终末消毒有60%做好了清洁。通过教育、采取凝胶监测并反馈结果，日常清洁率提高到51%（8% 增长, p = 0.03）、终末清洁率提高到了70% （10% 增长, p=0.06）.

19 Hospital Ward Design and Prevention of Nosocomial Infection and Colonization Events: A Prospective Clinical Trial 单间vs 4人间 全院改成4人间并未减少HAIs

20 铜绿假单胞菌暴发 An Outbreak of Pseudomonas aeruginosa Among Cardiovascular Surgery Patients Related to Intrinsically-Contaminated Ultrasound Transmission Gel 经食道超声 凝胶污染 16例 PSA

21 戴手套前是否需要做手卫生？ Utility of Hand Hygiene Before Donning Non-Sterile Gloves: A Randomized Controlled Trial WHO Guidelines state that hand hygiene (HH) performed before donning non-sterile gloves is an unresolved issue. HH before donning non-sterile gloves does not decrease already low bacterial counts on gloves. The utility of HH before donning non-sterile gloves may be unnecessary; further study is needed to support current recommendations.

22 手卫生改善与多重耐药菌的降低 Improved Hand Hygiene Compliance and Association with Reduced Incidence of Multidrug-Resistant Organisms A sustained improvement in HH compliance was associated with an ongoing decrease in HO MDRO rates across a large healthcare system; a similar decrease in C. difficile was not observed.

23 Effectiveness of Ultraviolet (UV)-C light against C
Effectiveness of Ultraviolet (UV)-C light against C. difficile, Acinetobacter, and Vancomycin-Resistant Enterococci in the Hospital Environment

24 隔帘的细菌污染情况 Evaluation of Bacterial Contamination of Cubical Curtains in Contact Precaution ICU and non-ICU Rooms Although no evidence of visible soiling, all curtains were positive for bacterial growth, as soon as 1 day after admission. The number of colonies isolated increased over time as the curtains remained in the patient rooms. Although most recovered bacteria were normal skin flora (i.e., Staph epidermidis and micrococcus), 2 curtains were contaminated with more ESO. A non-ICU curtain at day 1 contained 5 colonies/16 cm2 of methicillin sensitive Staph aureus, (MSSA) and an ICU curtain at 2 weeks contained 1 colony/16 cm2 of an extended spectrum beta lactamase (ESBL) producing Klebsiella pneumonia (KP). CC should only be used when privacy cannot be accomplished by other means. CC must be removed after a terminal clean in all contact isolation rooms. CC in non-ICU rooms were just as likely to become contaminated as ICU rooms.

25 中国的HAI现患率调查汇总 Healthcare-associated Infection in Mainland China A Systematic Review of Point Prevalence Survey Literature