ICU医院感染现状与对策090527-护理-sific幻灯片.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * The “12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults” intervention program is the first “12 Steps” to be launched because hospital patients are at especially high risk for serious antimicrobial-resistant infections. Each year nearly 2 million patients in the United States get an infection in a hospital. Of those patients, about 90,000 die as a result of their infection. More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them. Persons infected with antimicrobial-resistant organisms are more likely to have longer hospital stays and require treatment with second-or third-choice drugs that may be less effective, more toxic, and/or more expensive. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best. * * * * * * * * Dr.HU Bijie * 对超级细菌MRSA感染 的“零宽容” 主动筛查：快速监测 积极隔离：包括疑似病例的隔离 就地消灭：包括环境消毒 * Dr.HU Bijie * 哪些病原体感染需要隔离？ 耐药菌 MRSA，不动杆菌 艰难梭菌，VRE ESBL？铜绿假单胞菌？ 传染病 TB，SARS，诺如病毒…… HIV？HBV？ 耐药菌危害严重，我国必须制订政策，进行严格隔离！ 耐药菌隔离的警告标识 * Dr.HU Bijie * * Dr.HU Bijie * * Dr.HU Bijie * 2008年2月18日：卫生部与法国生物梅里埃公司共同签署了《医院感染项目计划》 实施步骤 确定监测指标 本底调查 制定SOP 教育培训 实施SOP 复查与评估 样板医院 协和、北医、人民、中日 中山、瑞金 湘雅、中国医大一院、南方 * Dr.HU Bijie * 中山医院ICU病人MDROs筛查 鼻拭子 MRSA 肛拭子 ESBLs 鲍曼不动杆菌 铜绿假单胞菌 * Dr.HU Bijie * ICU 多重耐药菌定植状况基线调查进度小结（2008年11月） * Dr.HU Bijie * C. difficile voluntary reporting 1991 – 2005: England, Wales and Northern Ireland * Dr.HU Bijie * Percentage of C. difficile-positive cultures  n=9 rooms 80 70 60 50 40 30 20 10 0 Percent positive Before cleaning After housekeeping cleaning After disinfection by research team* Bedrail Bedside table Phone Call button Toilet Door handle Eckstein et al, BMC Infect Dis. 2007 Jun 21;7:61.  *Similar results found after ES cleaning following interventions Dr.HE L