ICU院內(nèi)感染預(yù)防與控制的Bundle策略

1、1會(huì)計(jì)學(xué)ICU院內(nèi)感染預(yù)防與控制的院內(nèi)感染預(yù)防與控制的Bundle策略策略ATS 2005年指南年指南Mortality increases dramatically if inappropriate therapies are usedHeyland DK, et al. Am J Respir Crit Care Med.1999;159:1249-1256.Appropriate Right or not？ATS/IDSA. Guidelines for the management of adults with HAP, VAP and HCAP. Am Respir Crit Car

2、e Med. 2005;171:388-416.NPRS-2005我們?cè)趺醋?？我們?cè)趺醋?？Conventional 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

3、 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

4、exchangersAdjustment of sedationNon-invasive mechanical ventilationFerrer R, et al. Crit Care. 2002 Feb;6(1):45-51. Non-antibiotic strategies for VAPPhysical strategies Oral endotracheal tube Recommended Search for sinusitis No recommendation Frequency of humidifier changes Recommended Frequency of

5、ventilator circuit changes Recommended Closed suction system Recommended Drainage of subglottic secretion Consider Chest physiotherapy No recommendation Early tracheostomy No recommendationPosition strategies Kinetic beds Consider Semi-recumbent positioning Recommended Prone positioning No recommend

6、ationPharmacologic strategies Sucralfate Not recommended Intratracheal antibiotics Not recommendedEvidence-based clinical practice guideline for the prevention of VAPCanadian Critical Care Society Ann Intern Med, 2004, 141: 305捆綁式運(yùn)載火箭神州“六號(hào)”BundleCrunden E,Nurs Crit Care 2005 Sep-Oct; Vol. 10 (5), pp

7、. 242-6. 應(yīng)用應(yīng)用Ventilator Care Bundle可降低可降低VAP發(fā)病率發(fā)病率Drakulovic MB , et al:. Lancet. Nov 27 1999;354(9193):1851-1858 Drakulovic MB, et al: Lancet. Nov 27 1999;354(9193):1851-1858.30Kress JP, et al: N Engl J Med 2000; 342: 14711477 Kress JP, et al: N Engl J Med 2000; 342: 14711477Cook DJ, et al. N Engl

8、J Med 1998, 338:791-797. Dellinger RP, et al. Crit Care Med. Mar 2004;32(3):858-873.Geerts WH, et al. Chest. Sep 2004;126(3 Suppl):338S-400S OGrady NP et al. MMWR Recomm Rep. Aug 9 2002;51(RR-10):1-29. Mermel LA, et al. Am J Med. Sep 16 1991;91(3B):197S-205SRaad, II , et al. Infect Control Hosp Epid

9、emiol. Apr 1994;15(4 Pt 1):231-238 Mermel LA, et al. Am J Med. Sep 16 1991;91(3B):197S-205S McCarthy MC, et al. J Parenter Enteral Nutr. 1987 May-Jun;11(3):259-62. 100,000 LIVES CAMPAIGN The Institute for Healthcare Improvement (IHI) Unit2002 CR-BSI rate per 1,000 device days2004 CR-BSI rate per 1,0

10、00 device days2005 CR-BSI rate per 1,000 device days Medical ICU8.23.40Surgical ICU10.74.5N/ABurn Center9.51.850l In 1997 VAP rates in the Surgical ICU were 29/1,000 ventilator days; l in 2004, that rate had dropped to just under 18/1,000 ventilator days. l Similar declines have been seen in the Med

11、ical ICU and Burn Center. The use of VAP&CVP 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 rateUnchanged22%95% compliance61%Ventilator Bundle compliance100,000 LIVES CAMPAIGN The Institute for Healthcare Improvement (IHI) H.Bryant Nguyen, MD, MS. et al. Department of Emergency Medicine Loma Linda University for the STOP Sepsis Working Group“上醫(yī)治上醫(yī)治未病未病，中醫(yī)治，中醫(yī)治欲病欲病，下醫(yī)治，下醫(yī)治已病已病” 預(yù)防感染預(yù)防感染 Surviving Sepsis MO