ICU院内感染预防与控制的“Bundle”策略演示幻灯片.pptVIP

100,000 LIVES CAMPAIGN A campaign to make health care safer and more effective—to ensure that hospitals achieve the best possible outcomes for all patients A remarkably few proven interventions, if implemented on a wide enough scale, can avoid 100,000 deaths every year thereafter. 100,000 LIVES CAMPAIGN The Institute for Healthcare Improvement (IHI) Unit 2002 CR-BSI rate per 1,000 device days 2004 CR-BSI rate per 1,000 device days 2005 CR-BSI rate per 1,000 device days Medical ICU 8.2 3.4 0 Surgical ICU 10.7 4.5 N/A Burn Center 9.5 1.85 0 In 1997 VAP rates in the Surgical ICU were 29/1,000 ventilator days; in 2004, that rate had dropped to just under 18/1,000 ventilator days. Similar declines have been seen in the Medical ICU and Burn Center. The use of VAPCVP bundles is associated with reductions in infections 100,000 LIVES CAMPAIGN The Institute for Healthcare Improvement (IHI) Level of reliability (compliance with elements): all Reduction in VAP rate Unchanged 22% 95% compliance 40% 95% compliance 61% Ventilator Bundle compliance 100,000 LIVES CAMPAIGN The Institute for Healthcare Improvement (IHI) ICU院内感染预防与控制的“Bundle”策略 四川大学华西医院ICU 薛欣盛 ICU院内感染的常见类型 Hospital-Acquired Infection Hospital-Acquired Pneumonia HAP Ventilator-Associated Pneumonia VAP Catheter-Related Bloodstream Infection HAP 和VAP定义 HAP是指住院48小时后发生的感染，但入院时并不处在感染的潜伏期，可在普通病房接受治疗，仅当病情加重时转ICU治疗。 VAP是指气管内插管48－72小时以上发生的肺炎。病情转严重需接受气管内插管的HAP病人虽然不属于VAP的范畴，但治疗方案与VAP 相同。 ATS 2005年指南 Risk factors for the development of ventilator-associated pneumonia Severity of illness (APACHE score 16) Glasgow coma scale 9 Severe burns Chronic lung disease Acute or chronic respiratory conditions Supine body position Excessive sedation Mechanical ventilation for 7 days Mortality of VAP Longer length of stay, higher mortality with VAP vs control Mortality increases dramatically if inappropriate therapies are used Heyland DK, et al. Am J Respir Crit Care Med.1999;159:1249