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1、ssi危险因素与预防策略3m沈泳,1,1,2,3M Infection Prevention Division,2,3M Infection Prevention Division Institute of Medicines To Err is Human. Washington DC: The National Academy Press,1999. SSI,3,3M Infection Prevention Division,3,CDCs National Nosocomial Infections Surveillance (NNIS) system,4,3M Infection Pr
2、evention Division,4,5,3M Infection Prevention Division,5,6,3M Infection Prevention Division,6,Goal 7: Reduce the risk of health care associated infections NPSG.07.05.01: Implement best practices for preventing surgical site infections,ssi危险因素与预防策略3m沈泳,2,2,7 9,3M Infection Prevention Division 3M Infe
3、ction Prevention Division,8 10,8 10,11,3M Infection Prevention Division,11,7 9 Cushing H: Concerning the result of operations for brain tumor, JAMA 64:189-195,1915,12,3M Infection Prevention Division,12,3M Infection Prevention Division 3M Infection Prevention Division 1. Astagneau P, LHeriteau F, Da
4、niel F et al. Reducing surgical site infection incidence through a network, results from the French ISO-RAISIN surveillance system. J. Hosp. Infect. 72, 127134 (2009). 2. Mannin J, van den Hof S, Muilwijk J et al. Trends in the incidence of surgical site infection in,The Netherlands. Infect. Control
5、 Hosp. Epidemiol. 29, 11321138 (2008).,ssi危险因素与预防策略3m沈泳,3,3,13,3M Infection Prevention Division,13,Bolon Mk, et al, Clin Infect Dis 2009;48:1223-1229,14,3M Infection Prevention Division,14, Yokoe DS, et al, Emerg Infect Dis 2004;10,1924-1930,15,3M Infection Prevention Division,15,MRSA,VRE,CA-MRSA,ND
6、M-1,PDRAB VISA VRSA,16,Staphylococcus aureus,30.0%,Coagulase-negative staphylococci Enterococcus spp. Escherichia coli Pseudomonas aeruginosa Enterobacter spp Klebsiella pneumoniae,13.7% 11.2% 9.6% 5.6% 4.2% 3.0%,Candida spp. Klebsiella oxytoca Acinetobacter baumannii,2.0% 0.7% 0.6%,N=7,025 Hidron A
7、I, et.al., Infect Control Hosp Epidemiol 2008;29:996-1011 Hidron AI et.al., Infect Control Hosp Epidemiol 2009;30:107107(ERRATUM),17,3M Infection Prevention Division,17,18,3M Infection Prevention Division,18,无菌操作不会产生“耐药性”,ssi危险因素与预防策略3m沈泳,4,4,19,3M Infection Prevention Division,19,1895,39.0%,1897 18
8、99 1912,7.0% 3.2% 2.4%,1913,1.6%,(would bring the profession in disrepute ),George Emerson Brewer, M.D. JAMA April 24, 1915,20,3M Infection Prevention Division,20,SSI Studies in Aseptic Technique ,21,3M Infection Prevention Division,21,22,3M Infection Prevention Division,22,1.,Guideline For Preventi
9、on Of Surgical Site Infection, 1999,X 1 =,23,3M Infection Prevention Division,23,106 102,6hrs,3-5 days,1 day,Dr. Maxwell Finland RI Med J 1960;43:499-504,1hr,2hrs,24,3M Infection Prevention Division,24,ssi危险因素与预防策略3m沈泳,5,5,25,3M Infection Prevention Division,25,26,3M Infection Prevention Division,26
10、,SSI Rate,20%,7.10%,3.10%,24,24,“,”,U.S. Department of Health 188:225-230,32,3M Infection Prevention Division,32,33,3M Infection Prevention Division,33,3M Infection Prevention Division Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after c
11、lean surgery: a randomised controlled trial. Lancet 358, 876880 (2001),34,3M Infection Prevention Division,34,35,3M Infection Prevention Division,35,36,3M Infection Prevention Division,36,Latham R,et al. Infect Control Hosp Epidemiol.2001;22:607-612,ssi危险因素与预防策略3m沈泳,7,Ref: Christopher T. Drake, Ann.
12、 Surgery 1977.,7,37,3M Infection Prevention Division,37,38,3M Infection Prevention Division,38,39,3M Infection Prevention Division,39,40,3M Infection Prevention Division,40,=100/g,=1,000,000/g,/ MRSA/MRSE,41,3M Infection Prevention Division,41,42,3M Infection Prevention Division,42,细菌从何而来？ 10%,ssi危险
13、因素与预防策略3m沈泳,8,8,43,3M Infection Prevention Division,43,1. 2.,Rabih O. Darouiche ChlorhexidineAlcohol versus PovidoneIodine for Surgical- Site Antisepsis N Engl J Med 2010;362:18-26 Strategies to Prevent Central LineAssociated Bloodstream Infections in Acute,Care Hospitals 3. Chlorhexidine gluconate
14、preoperative skin preparation initiated a 100% reduction ofincisional Cesarean section infections while other risk factors were evaluated and corrected,University of Minnesota Medical Center, Fairview, Minneapolis, MN,2008,44,3M Infection Prevention Division,44,Jan. 2010,45,3M Infection Prevention D
15、ivision,45,46,3M Infection Prevention Division,46,47,3M Infection Prevention Division,47,1.French ML, Eitzen HE, Ritter MA. The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg 1976;184:46. 2. Johnston DH, Fairclough JA, Brown EM, et al. Rate of bacteri
16、al ecolonization of the skin after preparation: four methods compared. Br J Surg 1987;74:64. 3. Alexander JW, Aerni S, Plettner JP. Development of a safe and effective one-minute preoperative skin preparation. Arch Surg 1985;120:1357.,48,3M Infection Prevention Division,48,ssi危险因素与预防策略3m沈泳,9,CFU,9,49,49,10,1,10,100,1000,10000,100000,10000 Ioban 2 1000 100,CFU,50,50,Alexander JW, Aerni S, Plettner JP: Development of a safe and effective one-minute preoperative,skin preparation. Arch Surg 120:1357
