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1、ICU院內(nèi)感染預(yù)防與控制的“Bundle”策略ICU院內(nèi)感染的常見(jiàn)類型Hospital-AcquiredInfectionHospital-AcquiredPneumoniaHAPVentilator-AssociatedPneumoniaVAPCatheter-RelatedBloodstreamInfectionHAP和VAP定義HAP是指住院48小時(shí)后發(fā)生的感染，但入院時(shí)并不處在感染的潛伏期，可在普通病房接受治療，僅當(dāng)病情加重時(shí)轉(zhuǎn)ICU治療。VAP是指氣管內(nèi)插管48－72小時(shí)以上發(fā)生的肺炎。病情轉(zhuǎn)嚴(yán)重需接受氣管內(nèi)插管的HAP病人雖然不屬于VAP的范疇，
2、但治療方案與VAP相同。ATS2005年指南HAP和VAP的多重耐藥現(xiàn)狀多重耐藥菌（MDR）感染發(fā)生率顯著增加，尤其是更常見(jiàn)于遲發(fā)性的HAP和VAP患者死亡率增高與MDR感染有關(guān)。以銅綠假單胞菌為代表的MDR近年來(lái)耐藥日趨嚴(yán)重。ATS/IDSA.GuidelinesforthemanagementofadultswithHAP,VAPandHCAP.AmRespirCritCareMed.2005;171:388-416.NPRS-2005綠膿桿菌的耐藥變遷我們?cè)趺醋觯緾onventionalinfectioncontrolmeasuresHandwashi
3、nganduseofprotectivegownsandglovesChlorhexidineoralrinseStrategiesrelatedtothegastrointestinaltractStress-ulcerprophylaxisnasogastrictubes(Gastricoverdistension)EnteralnutritionStrategiesrelatedtopatientplacementSemirecumbentpositionRotationalbedtherapyStrategiesrelatedtotheartific
4、ialairwayRespiratoryairwaycareDesignofendotrachealtubes:continuoussubglotticaspirationStrategiesrelatedtomechanicalventilationMaintenanceofventilatorequipment.heatandmoistureexchangersAdjustmentofsedationNon-invasivemechanicalventilationFerrerR,etal.CritCare.2002Feb;6(1):45-51.Non-
5、antibioticstrategiesforVAPPhysicalstrategiesOralendotrachealtube√RecommendedSearchforsinusitisNorecommendationFrequencyofhumidifierchanges√RecommendedFrequencyofventilatorcircuitchanges√RecommendedClosedsuctionsystem√RecommendedDrainageofsubglotticsecretionConsiderChestphysiotherap
6、yNorecommendationEarlytracheostomyNorecommendationPositionstrategiesKineticbedsConsiderSemi-recumbentpositioning√RecommendedPronepositioningNorecommendationPharmacologicstrategiesSucralfateNotrecommendedIntratrachealantibioticsNotrecommendedEvidence-basedclinicalpracticeguidelinefo
7、rthepreventionofVAPCanadianCriticalCareSocietyAnnInternMed,2004,141:305ICU院內(nèi)感染的類型Hospital-AcquiredInfectionVentilator-AssociatedPneumoniaVAPVentilatorCareBundleCatheter-RelatedBloodstreamInfectionCentralLineBundle捆綁式運(yùn)載火箭神州“六號(hào)”Bundle何謂“Bundle”一個(gè)組合治療計(jì)劃，當(dāng)同時(shí)實(shí)施時(shí)能比單一方案產(chǎn)生更好的臨床效果循證醫(yī)學(xué)為導(dǎo)向的治療
8、，強(qiáng)調(diào)臨床實(shí)用性Bundle的產(chǎn)生需有幾個(gè)前提:1.
