ICU院内感染预防与控制的“Bundle”策略.ppt

《ICU院内感染预防与控制的“Bundle”策略.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、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-AcquiredInfectionHospital-AcquiredPneumoniaHAPVentilator-AssociatedPneumoniaVAPCatheter-RelatedBloodstreamInfectionHAP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

2、。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。ATS2005年指南Riskfactorsforthedevelopmentofventilator-associatedpneumoniaSeverityofillness(APACHEscore>16)Glasgowcomascale<9SevereburnsChroniclungdiseaseAcuteorchronicrespiratoryconditionsSupinebodypositionExcessivesedationM

3、echanicalventilationfor>7daysMortalityofVAPLongerlengthofstay,highermortalitywithVAPvscontrolMortalityincreasesdramaticallyifinappropriatetherapiesareusedHeylandDK,etal.AmJRespirCritCareMed.1999;159:1249-1256.PrinciplesofAntibioticpoliciesinVAPConsiderpotentialpath

4、ogensConsiderlocalepidemiologyConsiderprevioustreatmentreceivedbythepatientColonisationVsinfectionAppropriateAntibioticTherapyRightornot？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.Guidelinesforthemanagemento

5、fadultswithHAP,VAPandHCAP.AmRespirCritCareMed.2005;171:388-416.NPRS-2005绿脓杆菌的耐药变迁我们怎么做？ConventionalinfectioncontrolmeasuresHandwashinganduseofprotectivegownsandglovesChlorhexidineoralrinseStrategiesrelatedtothegastrointestinaltractStress-ulcerprophylaxisnasogastric

6、tubes(Gastricoverdistension)EnteralnutritionStrategiesrelatedtopatientplacementSemirecumbentpositionRotationalbedtherapyStrategiesrelatedtotheartificialairwayRespiratoryairwaycareDesignofendotrachealtubes:continuoussubglotticaspirationStrategiesrelatedtomechanicalv

7、entilationMaintenanceofventilatorequipment.heatandmoistureexchangersAdjustmentofsedationNon-invasivemechanicalventilationFerrerR,etal.CritCare.2002Feb;6(1):45-51.Non-antibioticstrategiesforVAPPhysicalstrategiesOralendotrachealtube√RecommendedSearchforsinusitisNorec

8、ommendationFrequencyofhumidifierchanges√RecommendedFrequencyofventilatorcircuitchanges√RecommendedClosedsuctionsystem√RecommendedDrainageofsubglo