4. การติดเชื้อในโรงพยาบาล : 13 ตาแหน่งสาคัญ
• Urinary tract
• Surgical site
• Pneumonia
• Bloodstream
• Bone and joint
• CNS
• CVS
• ENT
• GI
• Lower respiratory tract,
other than pneumonia
• Reproductive tract
• Skin & soft tissue
• Systemic
5. Definitions of healthcare-associated infection
1. Surveillance definitions
2. Site specific types of healthcare-associated
infection
-BSI
-UTI
-RTI
6. Surveillance definitions
• Infection criterion were not present the admission time
period But all present on or after the 3rd calendar day of
admission to facility
• “ Day 1, day of facility admission”
• Symptom must be documented in the chart by a
healthcare professional during POA (present on
admission)
• Physician diagnosis can be accepted as evidence of an
infection that is POA only
7. Healthcare-associated infection
• All elements of a CDC site specific infection criterion
were not present during the POA (present on
admission)
• But all present on or after the 3rd calendar day of
admission to the facility
• The day of hospital admission is calendar day 1
• All elements of infection criterion are present on the
day of discharge or the next day, the infection is
attributed to the discharging location
8.
9. Other important considerations:
• Clinical evidence may be derived from direct observation
of the infection site or clinical records or Pts’ chart
• A physician or surgeon Dx.of infection from direct
observation during an invasive procedure, endoscopic or
other diagnostic studies may be accept for an HAI
• HAI, clinical information must be utilized to determine
that original infection had resolved before reporting a
second infection at the same site.
• if the original infection had not resolved before
subsequent positive cultures are collected from the same
site, add the pathogens recovered from the subsequent
cultures to those reported for the first infection, if it was
HAI.
10. Healthcare-associated infection
• The infection has resolved includes
– signs and symptom
– results from diagnostic testing
– completion of antimicrobial therapy
18. Ventilator-associated pneumonia:
• a pneumonia where the Pt is on mechanical
ventilator for 2 days on the date of event,
• with day of ventilator placement being Day 1
Definition of pneumonia
• Chest x-ray
• Signs and symptoms
• Laboratory
19. Chest x-ray for pneumonia
1. New or progressive and persistent infiltration
2. Consolidation
3. Cavitation
4. Pneumatoceles, in ≥1 yr
– Patients with underlying disease
• 2 or more abnormal CXR
– Patients without underlying disease
• 1 or more abnormal CXR
20. Signs, symptoms, and laboratory
FOR ANY PATIENT, at least one of the following:
1. Fever (38°C) with no other recognized cause
2. Leukopenia(4,000 WBC/mm3)
or leukocytosis(12,000 WBC/mm3)
3. For adults 70 years old, altered mental status with no
other recognized cause
And at least two of the following:
21. Signs, symptoms, and laboratory
1. New onset of purulent sputum, or change in character of
sputum, or increased respiratory secretions, or increased
suctioning requirements
2. New onset or worsening cough, or dyspnea, or tachypnea
3. Rales or bronchial breath sounds
4. Worsening gas exchange, increased oxygen requirements,
or increased ventilation demand
22. Hospital-acquired pneumonia
• Reporting multiple episodes of HAP in a
single patient:
• evidence of resolution of the initial
infection.
• new signs and symptoms and radiographic
evidence
• The addition of or change in pathogen alone
is not indicative of a new episode of
pneumonia
26. Central line
• Central line : an intravascular catheter that
terminates at or closes to the heart or in one of
the great vessels which is used for infusion,
withdrawal of blood, or hemodynamic
monitoring;
– Aota, pulmonary artery, SVC, IVC, ITJ, SCV, FV
etc
– In neonates, the UVC, UAC
27. • A central line was place for > 2 calendar days on
the date of event,
• with day of device placement being day 1.
• If CVC was in place for > 2 calendar days and
the removed, the LBCI criteria must be fully met
on the day of remove or the next day.
CLABSI
28. LCBI 1
• Pt has a recognized
pathogen cultured
from one or more
blood cultures
• And organism
cultured is not related
to an infection at
another site.
Laboratory-confirmed BSI criteria (LCBI)
LCBI 2
• Pt has at least one of the
following signs and
symptoms:
•fever > 38oC,
•chill or hypotension
• and
• Positive blood culture are
not related to an infection
at another site
• and
• The same common
commensal is cultured
from ≥ 2 cultures drawn
on separate occasions
LCBI 3
• Pt ≤ 1 yr has at least one
of the followings signs
and symptoms:
•fever (> 38oC core),
•hypothermia (< 36oC
core),
•apnea, or bradycardia
and
• Positive blood culture
are not related to an
infection at another site
and
• The same common
commensal is cultured
from ≥2 cultures drawn
on separate occasions
30. Comments
• Specimens collection considerations:
–although blood cultures drawn through central lines can have a
higher rate of contamination than blood cultures collected
through peripheral veinupucture all positive blood culture ,
• Catheter tip cultures are not used to determine whether a
pts has a primary BSI
• When there is a positive blood culture and clinical signs
or symptoms of localized infection at a vascular access
site, but no other infection can be found, the infection is
considered a primary BSI