医院感染的目标性监测bzfshrw0.ppt

预防与控制的干预评价 依然要通过目标性监测进行干预的评价 * 欢迎交流 谢谢 贵州省人民医院 医院感染管理科 张骥 感染控制主治医师 Guizhou Provincial People’s Hospital Doctor of Infection Control * * * 1998 included Hospital Wide Component – no good risk adjustment. AUR – no infection data. * Identify specific problems and their risk factors Evaluate the success of focused interventions Collect and analyze outcomes data for specific problems over time Target most important adverse events * Examples of process indicators include: medication errors; influenza vaccination rates in personnel, residents, or patients; hepatitis B immunity rates in personnel; and personnel compliance with protocols such as standard precautions, isolation precautions, tuberculin skin testing, hand hygiene, instrument processing, sterilization quality assurance testing, environmental cleaning, communicable disease reporting, antimicrobial prescribing and administration, and installing and maintaining barriers during construction and renovation projects. * Take rates – determine problem, -- go through process – continue surveillance – compare with own data over time. NNIS created to do certain things – comparative data. Performance Measurement cycle * 41 24 * 42 25 * * 0 5 10 15 20 25 Jan April July Oct Jan April July Oct Jan 98 99 00 SICU BSI Jan 98 - March SICU BSI Jan 98 - March ‘00 Rate per 1,000 line days Rate per 1,000 line days 通过目标监测和干预减少插管相关性血流感染 2.针对问题进行目标监测 * 对ICU患者进行血液感染的监测 3. 改进血液系统感染目标性监测的成功干预 成功的教育计划以减少导管相关血液系统感染 置管时应用无菌手术巾和全套个人防护设备 对插管部位进行监测和护理 * 4. 改进是否有效 新的改良操作实施后3个月内再 监测血流感染率 * 监测是个循环过程 * 3.预防：决定和修改措施 2.反馈和分发：资料分析、解释、比较、讨论 1.监测的执行：明确目标，收集监测资料 4.通过监测（趋势）或其他研究来评价医院感染所产生的影响 手术部位感染监测 C．1 监测对象 被选定监测手术的所有择期和急诊手术患者。 C．2 监测内容 C．2．1 基本资料 监测月份、住院号、科室、床号、姓名、年龄、调查日期、疾病诊断、切口类型（清洁切口、清洁-污染切口、污染切口）。 C．2．2 手术资料 手术日期、手术名称、手术腔镜使用情况、危险因素评分标准（见表C．1），包括手术持续时间、手术切口清洁度分类、美国麻醉协会（ASA）评分（见表C．2）、围手术期抗菌药物使用情况、手术医师。 C．2．3 手术部位感染资料 感染日期与诊断、病原体。 C．3 监测方法 C．3．1 宜采用主动的监测方法；也可专职人员监测与临床医务人员报告相结合；宜住院监测与出院监测相结合。 C．3．2 每例监测对象应填写手术部位感染监测登记表。 * 表C．1危险因素评