icu院内感染预防与控制的bundle策略.pptxVIP

ICU院内感染的常见类型Hospital-Acquired InfectionHospital-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 daysMortality of VAPLonger length of stay, higher mortality with VAP vs controlMortality increases dramatically if inappropriate therapies are usedHeyland DK, et al. Am J Respir Crit Care Med.1999;159:1249-1256.Principles of Antibiotic policiesin VAPConsider potential pathogensConsider local epidemiologyConsider previous treatment received by the patientColonisation Vs infectionAppropriate Antibiotic Therapy Right or not？HAP和VAP的多重耐药现状多重耐药菌（MDR）感染发生率显著增加，尤其是更常见于迟发性的HAP和VAP患者死亡率增高与MDR感染有关。以铜绿假单胞菌为代表的MDR近年来耐药日趋严重。ATS/IDSA. Guidelines for the management of adults with HAP, VAP and HCAP. Am Respir Crit Care Med. 2005;171:388-416.绿脓杆菌的耐药变迁我们怎么做？NPRS-2005Non-antibiotic strategies for VAPConventional infection control measuresHand washing and use of protective gowns and glovesChlorhexidine oral rinseStrategies related to the gastrointestinal tractStress-ulcer prophylaxisnasogastric tubes (Gastric overdistension)Enteral nutritionStrategies related to patient placementSemirecumbent positionRotational bed therapyStrategies related to the artificial airwayRespiratory airway careDesign of endotracheal tubes: continuous subglottic aspirationStrategies related to mechanical ventilationMaintenance of ventilator equipment. heat and moisture exchangersAdjustment of sedationNon-invasive mechanical ventilationFerrer R, et al. Crit Care. 2002 Feb;6(1):45-51. Evidence-based clinical practice guideline for the prevention of