Jarvis教授保护患者及医护人员的安全.ppt
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ImprovingPatientandHealthcareWorkerSafety改进患者与医护人员的安全性WILLIAMR.JARVIS,M.D.医学博士WILLIAMR.JARVISJASONANDJARVISASSOCIATES,LLCDr.JarvisisapaidconsultantforBecton,DickinsonandCompany.ThedevelopmentofthispresentationwascommissionedbyBecton,DickinsonandCompany.ThecontentsofthispresentationareintendedforgeneralinformationpurposesonlyandtheviewsexpressedthereinaresolelythoseofthepresenterandnotBecton,DickinsonandCompanyJarvis22Objectives目的1.Describemechanismsofcatheter-relatedinfections.描述导管相关感染的机制2.Outlineinsertionandmaintenancebundlestopreventcatheter-relatedinfections.概述预防导管相关感染的置入和维护措施集3.Discusstheimportanceofpreventingneedlestickinjuriesinhealthcareworkers.讨论预防医护人员针刺伤害的重要性4.Describeoptimalneedlelessconnectordesignfeaturesidentifiedinthird-partyclinicalevidence描述第三方临床证据中的最佳无针接头设计特征5.Review2recentpublicationsevaluatingtheperformanceofapositivepressureneedlelessconnector.回顾最近2篇评价正压无针接头性能的出版物。
33ImpactofPrimaryBloodstreamInfection(BSI)原发性血流感染的影响(BSI)Crudemortality粗死亡率10%-40%Attributablemortality归因死亡率2%-15%Prolongationofhospitalization住院延长5to20days5-20天Attributablecost可归属成本US$34,000-$56,000CR-BSI44FactorsThatInfluenceCatheter-RelatedBloodstreamInfections(CR-BSI)Rates影响导管相关血流感染(CR-BSI)率的因素Patientsdiagnosis患者诊断Insertereducation置管人员教育Patientpreparationandstandardizedinsertionmethods患者准备和标准化置管方法Type,insertionlocation,numberoflumensofcatheter导管的类型、置入位置以及管腔数量Designfeaturesofneedlelessconnectors/hubs/stopcocks无针接头/三通的设计特征Pre-entryhubdisinfectant.Whatisused&how?
预连接接头消毒剂。
使用了什么,如何使用?
Medicationinfusedthroughthecatheter通过导管输注的药物MethodofdocumentingBSI(centralline)andfrequencyofbloodcultures(aftersymptomsandbeforeantimicrobials)记录BSI(中心导管)和血培养频率(症状后和抗菌剂前)的方法Interpretationandapplicationofsurveillanceprotocols监督方案的解释和应用Infectioncontrolpracticesimplemented实施的感染控制实践5EXTRALUMINAL:
FirstWeek管腔外:
第一周ExtraluminalbiofilmisthemajorsourceofCRBSIwithinthefirstweekofcatheterizationinshort-termcatheters.管腔外生物膜是短期导管置入后第1周内的主要CRBSI来源。
Extraluminalbiofilmisthemajorsourceoftunnelinfectionsinlong-termcatheters.管腔外生物膜是长期导管隧道型感染的主要来源。
5MicrobialSourceofCatheterRelatedBloodstreamInfection(CR-BSI)导管相关性血流感染(CR-BSI)的微生物来源Skin皮肤Vein静脉Catheter导管Hub导管接口Skin皮肤INTRALUMINAL:
Afterfirstweek管腔内:
第一周后IntraluminalbiofilmisthemajorsourceofCRBSIafter1weekinbothshort-andlong-termcatheters.管腔内生物膜是短期和长期导管置入1周后的主要CRBSI来源。
66SkinSkin皮肤皮肤VeinVein静脉静脉FibrinSheath,FibrinSheath,ThrombusThrombus纤维鞘血栓纤维鞘血栓2ContaminatedCatheterHub导管接口受污染Endogenous内源性Skinflora皮肤菌群Extrinsic外源性HCWhandsHCW手部1SkinOrganisms皮肤生物体Endogenous内源性Skinflora皮肤菌群Extrinsic外源性HCWhands医护人员手部Contaminateddisinfectant消毒剂受污染ContaminatedInfusate注入液受污染Extrinsic外在污染Fluid液体Medication药物Intrinsic内在污染Manufacturer生产商7TrendsofCLA-BSIUnitedStates,2008and20092008年和2009年美国CLA-BSI趋势STUDYDESIGN:
CentersforDiseaseControlandPrevention(CDC)estimateofCLA-BSIratesfromtheirNationalHealthcareSafetyNetwork(NHSN)surveillancesystem研究设计:
疾病控制与预防中心(CDC)根据其国家健康照护安全网络(NHSN)监测系统对CLA-BSI发生率的估计CONCLUSION:
Currently,outpatienthemodialysispatientshavethehighestrateofCLA-BSIs.MoreaggressiveCLA-BSIpreventioninterventions(proveninICUpatients)needtobeappliedtothesepatients.结论:
目前,门诊透析患者的CLA-BSI率最高。
需要对这些患者使用更积极的CLA-BSI预防干预(在ICU患者中经证实)。
Population群体Year年份Estimated#ofCLA-BSIsCLA-BSI的估计量ICU200925,000Inpatientwards住院病房200923,000Outpatienthemodialysis门诊透析门诊透析200837,0007InterruptingBSITrends中断BSI趋势Recognizeneedforimprovement确定改善的需求Embracetechnologydesignedtoreducerisks包括设计用于降低风险的技术CommittoCare&Maintenanceprotocols致力于护理和维护方案Anewlypublishedclinicalstudy新发表的临床研究899ImpactofHubDisinfectionOnBloodstreamInfectionsInDialysisPatients接头消毒对透析患者血流感染的影响Interventionin17outpatienthemodialysiscenters.17个门诊透析中心的干预。
Fouryearfollow-up(evenafterthestudyended)四年随访(即使是在研究结束之后)Intervention:
asystematicprotocolfordisinfectinghubsbeforeandaftermanipulation(suchasconnectingthedialysisline).干预:
操作前后接头消毒的系统方案(如连接透析导管)OverallBloodstreaminfection(BSI)andaccessrelatedBSI(ARBSI)usedCentersforDiseaseControlandPreventiondefinitions.总血流感染(BSI)和通路相关BSI(ARBSI)采用疾病控制与预防中心定义。
1010ImpactofHubDisinfectionOnBloodstreamInfectionsInDialysisPatients接头消毒对透析患者血流感染的影响BaselineVersusInterventionPeriodPercentChangesinOverallandAccess-RelatedBloodstreamInfectionIncidenceRatesAmongFacilitiesParticipatingintheCDCDialysisBloodstreamInfectionPreventionCollaborative:
EffectofInterventions参与CDC透析血流感染预防合作:
干预影响的机构中总血流感染发生率与通路相关血流感染发生率的基线百分变化率和干预期间百分变化率UnadjustedPooledRates未调整的合并率未调整的合并率BaselineMonthlyTrend月趋势月趋势InterventionandBaselinePeriods干预和基线期干预和基线期InterventionMonthlyTrend月趋势月趋势BaselineMonthlyTrend月趋势月趋势每每100患者月事件数量患者月事件数量(95%CI)%Change变化百分比变化百分比(95%CI)%Change变化百分比变化百分比(95%CI)%Change变化百分比变化百分比(95%CI)%Change变化百分比变化百分比(95%CI)Measure