多重耐药菌感染的预防与控制胡必杰ppt课件.ppt

2024/2/29 周四Dr.HU Bijie12024/2/29 周四Dr.HU Bijie1多重耐药菌多重耐药菌感染的预防与控制感染的预防与控制复旦大学附属中山医院复旦大学附属中山医院Zhongshan Hospital of Fudan UniversityZhongshan Hospital of Fudan University胡必杰胡必杰 Bijie HUBijie HU对于超级细菌对于超级细菌/多重耐药菌，多重耐药菌，要防被忽悠，更要防止麻木！要防被忽悠，更要防止麻木！耐药菌的难题，远不止耐药菌的难题，远不止NDM-1NDM-1！MRSAPDR-不动杆菌铜绿假单胞菌艰难梭菌VREESBL，KPC，NDM-1多重耐药结核分枝杆菌什么是多重耐药菌？什么是多重耐药菌？多重耐药菌（多重耐药菌（Multidrug-Resistant OrganismMultidrug-Resistant Organism，MDROMDRO），主要是指对临床使用的三类或三类以上抗菌），主要是指对临床使用的三类或三类以上抗菌药物同时呈现耐药的细菌。药物同时呈现耐药的细菌。常见多重耐药菌包括耐甲氧西林金黄色葡萄球菌常见多重耐药菌包括耐甲氧西林金黄色葡萄球菌（MRSAMRSA）、耐万古霉素肠球菌（）、耐万古霉素肠球菌（VREVRE）、产超广谱）、产超广谱-内酰胺酶（内酰胺酶（ESBLsESBLs）细菌、耐碳青霉烯类抗菌药物肠杆）细菌、耐碳青霉烯类抗菌药物肠杆菌科细菌（菌科细菌（CRECRE）（如产）（如产型新德里金属型新德里金属-内酰胺酶内酰胺酶NDM-1NDM-1或产碳青霉烯酶或产碳青霉烯酶KPCKPC的肠杆菌科细菌）、耐的肠杆菌科细菌）、耐碳青霉烯类抗菌药物鲍曼不动杆菌（碳青霉烯类抗菌药物鲍曼不动杆菌（CR-ABCR-AB）、多重耐）、多重耐药药/泛耐药铜绿假单胞菌（泛耐药铜绿假单胞菌（MDR/PDR-PA)MDR/PDR-PA)和多重耐药结和多重耐药结核分枝杆菌等。核分枝杆菌等。2024/2/29 周四Dr.HU Bijie6临床情景临床情景某男，某男，6565岁岁脑胶质瘤术后脑胶质瘤术后2020天天高热，黄痰，呼吸困难高热，黄痰，呼吸困难留置中心静脉导管、导尿管和人留置中心静脉导管、导尿管和人工气道机械通气工气道机械通气胸片肺炎胸片肺炎痰培养：痰培养：PDR-ABPDR-AB血培养：阴沟肠杆菌血培养：阴沟肠杆菌尿培养：两种念珠菌尿培养：两种念珠菌结局结局术后术后1 1月死亡月死亡花费：花费：1010万元？万元？20082008年年7 7月某医院会诊病例月某医院会诊病例医院感染越来越医院感染越来越险恶！险恶！案例案例某男，某男，9090岁，岁，COPDCOPD多年，反复感染，近日鲍曼不动多年，反复感染，近日鲍曼不动杆菌肺部感染杆菌肺部感染某男，某男，5656岁，肺癌术后一周，高热、呼吸衰竭，重岁，肺癌术后一周，高热、呼吸衰竭，重症肺炎，鲍曼不动杆菌症肺炎，鲍曼不动杆菌某男，某男，2222岁，颅脑手术后岁，颅脑手术后2 2周，高热，周，高热，CSFCSF引流液鲍引流液鲍曼不动杆菌曼不动杆菌2005-20092005-2009年上海年上海XXXX医院医院鲍曼不动杆菌对亚胺培南耐药率变化鲍曼不动杆菌对亚胺培南耐药率变化18.6%41.9%32.2%44%59.3%2006年年 2007年年 2008年年 2009年年 2005年年正确认识接触预防正确认识接触预防有效控制多重耐药菌有效控制多重耐药菌MDROMDRO耐药菌增加的原因耐药菌增加的原因耐药菌产生增加（抗生素选择性压力）：耐药菌产生增加（抗生素选择性压力）：由于医由于医生过多地使用抗生素，造成对基因突变及耐药基生过多地使用抗生素，造成对基因突变及耐药基因转移的耐药菌进行了筛选因转移的耐药菌进行了筛选耐药菌传播增加：耐药菌传播增加：通过医护人员尤其手的接触，通过医护人员尤其手的接触，细菌在病人间交叉寄生造成耐药菌株在医院内的细菌在病人间交叉寄生造成耐药菌株在医院内的传播，以及随后通过宿主病人的转移，耐药菌在传播，以及随后通过宿主病人的转移，耐药菌在医院间甚至社区进行传播医院间甚至社区进行传播Antimicrobial ResistanceAntimicrobial Resistance恶性循恶性循环环耐耐药性增加性增加 更广更广谱抗菌抗菌药物物Susceptible pathogenAntimicrobial-Resistant PathogenAntimicrobial ResistanceAntimicrobial UseInfection2024/2/29 周四Dr.HU Bijie12 预防传播预防传播合理应用抗菌药物合理应用抗菌药物有效的诊断和治疗有效的诊断和治疗预防感染预防感染Campaign to Prevent Antimicrobial Resistance in Healthcare Settings12 12 遏制医务工作者传播遏制医务工作者传播11 11 隔离患者隔离患者9 9 严格掌握万古霉素应用指证严格掌握万古霉素应用指证1 1 接种疫苗接种疫苗2 2 拔除导管拔除导管6 6 专家会诊专家会诊7 7 治疗感染，而非污染治疗感染，而非污染3 3 针对性病原治疗针对性病原治疗8 8 治疗感染，而非寄殖治疗感染，而非寄殖4 4 控制抗菌药物应用控制抗菌药物应用5 5 应用当地资料应用当地资料10 10 及时停用抗菌药物及时停用抗菌药物预防抗菌药物耐药的预防抗菌药物耐药的12项措施项措施对感染控制措施的描述，太简单！对感染控制措施的描述，太简单！2010201020102010年上海某医院年上海某医院年上海某医院年上海某医院ICUICUICUICU中中中中22222222例病人痰培养检出例病人痰培养检出例病人痰培养检出例病人痰培养检出多重耐药菌鲍曼不动杆菌，多重耐药菌鲍曼不动杆菌，多重耐药菌鲍曼不动杆菌，多重耐药菌鲍曼不动杆菌，PFGEPFGEPFGEPFGE结果结果结果结果M MM MT1T1T2T2T3T3T8T8 T7T7 T6T6T5T5T12T12 T11T11 T10T10 T9T9National Patient Safety Goals,Hospital National Patient Safety Goals,Hospital&Critical Access Hospital,2009&Critical Access Hospital,20097c.Prevent multiple drug-resistant organisms(MDRO)infections,especially methicillin-resistant Staphylococcus aureus(MRSA)and Clostridium difficile-associated disease(CDAD).7d.Prevent catheter-associated BSI(CABSI)7e.Prevent surgical site infections(SSI)13a.Patient involvement in their care:respiratory&hand hygiene on day of admission pt.&family美国美国National Patient Safety GoalNational Patient Safety GoalNPSG.07.03.01-Implement NPSG.07.03.01-Implement evidence-based evidence-based practicespractices to prevent health care-associated to prevent health care-associated infections due to multi-drug resistant organisms infections due to multi-drug resistant organisms(MDRO).These organisms are not transmitted by(MDRO).These organisms are not transmitted by air.They are air.They are spread by contact via hands or spread by contact via hands or contaminated environmentcontaminated environment.MRSAMRSAC.difficileC.difficileVRE VRE MDR gram negative bacteriaMDR gram negative bacteriaSpread of MDROs Can Be Spread of MDROs Can Be Controlled By:Controlled By:1.1.Good Good infection control practicesinfection control practices2.2.Meticulous Meticulous hand hygienehand hygiene for contact with for contact with patient and patients environment of patient and patients environment of Standard PrecautionsStandard Precautions3.3.Good Good environmental and equipment environmental and equipment cleaningcleaning practices practices4.4.HCW knowledgeHCW knowledge regarding these regarding these organisms and how they are spreadorganisms and how they are spread5.5.Judicious use of Judicious use of antibioticsantibiotics6.6.Teaching Teaching patient and familypatient and familyFIGHTSFIGHTSF Follow isolation practicesI In-service training for staff G Gauging disinfectant efficacyH Hand hygieneT Testing environmental surfacesS Standardized cleaning procedures卫生部办公厅关于印发卫生部办公厅关于印发卫生部办公厅关于印发卫生部办公厅关于印发多重耐药菌医院感染预多重耐药菌医院感染预多重耐药菌医院感染预多重耐药菌医院感染预防与控制技术指南（试行）防与控制技术指南（试行）防与控制技术指南（试行）防与控制技术指南（试行）的通知的通知的通知的通知（2011.1.172011.1.172011.1.172011.1.17）一、加强多重耐药菌医院感染管理一、加强多重耐药菌医院感染管理（一）重视多重耐药菌医院感染管理（一）重视多重耐药菌医院感染管理（二）加强重点环节管理（二）加强重点环节管理（三）加大人员培训力度（三）加大人员培训力度二、强化预防与控制措施二、强化预防与控制措施（一）加强医务人员手卫生（一）加强医务人员手卫生（二）严格实施隔离措施（二）严格实施隔离措施（三）遵守无菌技术操作规程（三）遵守无菌技术操作规程（四）加强清洁和消毒工作（四）加强清洁和消毒工作三、合理使用抗菌药物三、合理使用抗菌药物四、建立和完善对多重耐药菌的监测四、建立和完善对多重耐药菌的监测（一）加强多重耐药菌监测工作（一）加强多重耐药菌监测工作（二）提高临床微生物实验室的检测能力（二）提高临床微生物实验室的检测能力WHOWHO抵御细菌耐药的抵御细菌耐药的6 6项政策项政策 制定并执行一套完整的、有资金支持的国家计划制定并执行一套完整的、有资金支持的国家计划加强监测与实验室能力加强监测与实验室能力确保不间断获得质量有保证的基本药物确保不间断获得质量有保证的基本药物规范并促进药物的合理使用规范并促进药物的合理使用加大感染防控力度加大感染防控力度促进创新和新工具的研发促进创新和新工具的研发最新最新MDRO BundleMDRO BundleHand Hygiene Hand Hygiene 手卫生手卫生Contact precautions Contact precautions 接触隔离接触隔离Minimize shared equipment Minimize shared equipment 减少设备共用减少设备共用Environmental cleaning Environmental cleaning 环境清洁环境清洁HAI Preventive Bundles HAI Preventive Bundles 医院感染的组合预防医院感染的组合预防Catheter-associated BSI Catheter-associated BSI 导管相关血流感染导管相关血流感染Ventilator-associated pneumonia Ventilator-associated pneumonia 呼吸机相关肺炎呼吸机相关肺炎Catheter-associated UTI Catheter-associated UTI 导尿管相关尿路感染导尿管相关尿路感染Active surveillance cultures Active surveillance cultures 主动监测培养主动监测培养Chlorhexidine baths Chlorhexidine baths 洗必泰洗浴洗必泰洗浴Antimicrobial stewardship Antimicrobial stewardship 抗菌药物管理抗菌药物管理ANTIBIOTIC RESISTANT PATHOGENSON/INPATIENTSENVIRONMENTAL SURFACESHCWHANDSSUSCEPTABLE PATIENTSISOLATIONHAND HYGENEDISINFECTION CLEANING超级细菌出现超级细菌出现/MDRO/MDRO泛滥，泛滥，我们需要改变什么呢？我们需要改变什么呢？接触传播的隔离接触传播的隔离手卫生：洗手液、抗菌洗手液、手消毒液手卫生：洗手液、抗菌洗手液、手消毒液医院环境消毒：手接触的物表医院环境消毒：手接触的物表隔离衣、口罩与手套隔离衣、口罩与手套隔离隔离多重耐药菌主动筛查与去污染多重耐药菌主动筛查与去污染。更明智地合理使用抗菌药物更明智地合理使用抗菌药物2024/2/29 周四Dr.HU Bijie24手卫生手卫生酒精擦手的优点酒精擦手的优点 比洗手有更高的依从性比洗手有更高的依从性比洗手有更高的依从性比洗手有更高的依从性 比普通洗手和用抗菌产品洗比普通洗手和用抗菌产品洗比普通洗手和用抗菌产品洗比普通洗手和用抗菌产品洗手更有效手更有效手更有效手更有效 比洗手对手部皮肤伤害少比洗手对手部皮肤伤害少比洗手对手部皮肤伤害少比洗手对手部皮肤伤害少 比洗手和戴手套浪费少比洗手和戴手套浪费少比洗手和戴手套浪费少比洗手和戴手套浪费少 所用时间少，作用快所用时间少，作用快所用时间少，作用快所用时间少，作用快 不需要水和毛巾不需要水和毛巾不需要水和毛巾不需要水和毛巾感染控制，不仅感染控制，不仅仅是手卫生仅是手卫生!2024/2/29 周四Dr.HU Bijie26接触隔离接触隔离接触隔离的要求接触隔离的要求隔离：尽量将患者安置于单间隔离：尽量将患者安置于单间个人防护用品：手套、围裙或隔离衣、面罩个人防护用品：手套、围裙或隔离衣、面罩手卫生：洗手液、抗菌洗手液、手消毒液手卫生：洗手液、抗菌洗手液、手消毒液物品专用：如血压计、听诊器。不能专用者，则物品专用：如血压计、听诊器。不能专用者，则清洁、消毒后才能用于其他病人清洁、消毒后才能用于其他病人医院环境消毒：手接触的物表医院环境消毒：手接触的物表多重耐药菌主动筛查与去污染多重耐药菌主动筛查与去污染2024/2/29 周四Dr.HU Bijie28哪些病原体感染需要隔离？哪些病原体感染需要隔离？耐药菌耐药菌MRSAMRSA，不动杆菌，不动杆菌艰难梭菌，艰难梭菌，VREVREESBLESBL？铜绿假单胞菌？铜绿假单胞菌？传染病传染病TBTB，SARSSARS，诺如病毒，诺如病毒HIVHIV？HBVHBV？耐药菌危害严耐药菌危害严重，我国必须重，我国必须制订政策，进制订政策，进行严格隔离！行严格隔离！耐药菌隔离的警告标识耐药菌隔离的警告标识多重耐药菌进行专门标记（德国某医院）多重耐药菌进行专门标记（德国某医院）何时开始隔离？何时解除隔离？何时开始隔离？何时解除隔离？发现多重耐药菌感染患发现多重耐药菌感染患者和者和定植定植患者后，患者后，要尽要尽快反馈相关临床科室快反馈相关临床科室，指导采取有效治疗和感指导采取有效治疗和感染控制措施。染控制措施。患者隔离期间需要定期患者隔离期间需要定期监测多重耐药菌感染情监测多重耐药菌感染情况，直至况，直至连续连续3 3次（每次次（每次间隔应大于间隔应大于24h24h）多重）多重耐药菌培养阴性或感染耐药菌培养阴性或感染已经痊愈方可解除隔离已经痊愈方可解除隔离。2024/2/29 周四Dr.HU Bijie31减少设备共用减少设备共用ICUICU减少共用物品减少共用物品听诊器听诊器血压计血压计体温表体温表微量输液泵微量输液泵2024/2/29 周四Dr.HU Bijie33环境清洁环境清洁2024/2/29 周四Dr.HU Bijie34 环境微生物菌落总数卫生标准环境微生物菌落总数卫生标准类别类别 范围范围 空气空气 物体表面物体表面 医医务人员手务人员手 层流室层流室 10 5 10 5 55 普通手术室等普通手术室等 200 5 5200 5 5 普通病房等普通病房等 500 10 10500 10 10 传染科及病房传染科及病房 15 1515 15环境微生物监测要求必须改变！环境微生物监测要求必须改变！Pathogen Survival in the EnvironmentPathogen Survival in the EnvironmentPathogen Survival in the EnvironmentPathogen Survival in the EnvironmentAdapted from:Kramer A,et al.How long do nosocomial pathogens persist on inanimate surfaces?A systematic review.BMC Infect Dis.2006;16(6):130.Used with permission.OrganismDuration of persistence(range)Acinetobacter spp.3 days-5 monthsClostridium difficile(spores)5 monthsEscherichia coli1.5 hours-16 monthsEnterococcus spp,including VRE5 days-4 months Influenza virus1-2 daysNorovirus8 hours-7 daysStaphylococcus aureus,including MRSA7 days-7 monthsDecontaminationRisk of infection by used items in healthcareRisk of infection by used items in healthcare1968 Earle H Spaulding 1968 Earle H Spaulding Critical items:Critical items:Items that enter sterile tissue or vascular systemItems that enter sterile tissue or vascular systemSemi-critical itemsSemi-critical itemsItems that come in contact with mucous membranes or Items that come in contact with mucous membranes or non intact skinnon intact skinNon-critical itemsNon-critical itemsItems that come in contact with intact skinItems that come in contact with intact skin手频繁接触的物体表面，手频繁接触的物体表面，是高度危险的！是高度危险的！High-touch equals high-risk:High-touch equals high-risk:surface cleaning plus hand hygiene surface cleaning plus hand hygiene key to HAI preventionkey to HAI preventionWith the ever increasing proliferation of superbugs,comes not only a need for new products and protocols but also a look back at fundamental interventions.Hand hygiene and environmental cleaning and disinfection are the two primary interventions that we can make and those are definitely back to basics,said Sue Barnes,national leader,infection prevention and control and patient safety,Kaiser Permanente Program Offices,and a member of the National APIC communications committee.Healthcare Purchasing News,June,2009 ICUICU中，容易被污染的物表中，容易被污染的物表温度计温度计输液泵和支架输液泵和支架氧气流量表氧气流量表呼吸机控制面板呼吸机控制面板/旋钮旋钮生命监测仪面板生命监测仪面板/旋钮旋钮血压计袖带血压计袖带听诊器听诊器电脑键盘、鼠标电脑键盘、鼠标电话电话呼叫按钮呼叫按钮床头桌床头桌床上托盘床上托盘电视遥控器电视遥控器床上用台灯床上用台灯床边便桶床边便桶床架和控制器床架和控制器ICUICU环境中耐药鲍曼不动杆菌污染严重环境中耐药鲍曼不动杆菌污染严重 Removes organic soil/visible soil Removes potentially infectious micro organisms Removes soil which protects m.o.during disinfectionCareful cleaning Mechanical energy-friction,flushing,scrubbingChemical products-detergents or enzymesRight Method-manual&machinalManual CleaningManual CleaningManual CleaningNO SAFE Products!Everybody is an“EXPERT”Difficult to monitor Responsibilities not clear Health-risk Manual CleaningManual CleaningNO SAFE Procedure!Common in Households Not Common in Healthcare settings Easy to use Standardization&Validation Better Result Saves Nursing Time Monitoring Thermal Disinfection Machinal CleaningMachinal CleaningMachinal Cleaning is Safer病区的基本配置：清洗消毒机病区的基本配置：清洗消毒机日本尿壶与便盆的消毒日本尿壶与便盆的消毒关注频繁手接触物体表面的去污染关注频繁手接触物体表面的去污染 MICRO FIBER MICRO FIBER The“cleaner”cleaning system The“cleaner”cleaning system关东病院设备科关东病院设备科-保养与维修保养与维修How Can We Evaluate How Can We Evaluate Environmental CleaningEnvironmental CleaningDirect observationCulture the environmentATP bioluminescence ToolFluorescent marking tool03/26/2010TSICP51 TESTING OF SURFACESTESTING OF SURFACESATP bioluminescenceATP bioluminescence Swab surface luciferase tagging of ATP Hand held luminometerUsed in the commercial food preparation industry to evaluate surface cleaning before reuse and as an educational tool for more than 30 years.ATP is present in blood,ATP is present in blood,ATP is present in blood,ATP is present in blood,skin cells,other bodily skin cells,other bodily skin cells,other bodily skin cells,other bodily fluids and microbes.fluids and microbes.fluids and microbes.fluids and microbes.ATPATP存在于血液，皮肤细胞，存在于血液，皮肤细胞，其它体液和微生物中。其它体液和微生物中。Dazo SolutionDazo Solution(Initially called(Initially called“GOO”)“GOO”)Baseline Environmental Evaluation of 36 Acute Care Hospitals%of Objects CleanedHospitalsMean=48.5%(20,056 Objects)PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 PROPORTION OF OBJECTS CLEANED AS PART OF TERMINAL ROOM CLEANING IN 20 ACUTE CARE HOSPITALSACUTE CARE HOSPITALSACUTE CARE HOSPITALSACUTE CARE HOSPITALS%17 HOSPITALS10 HOSPITALS8 HOSPITALSTerminal Room Cleaning Project Three Programmatic ResponsesHospitals Environmental Hygiene Study Group36 Hospital Results%of Objects Cleaned PRE INTERVENTION POST INTERVENTIONP=100 ppm available chlorinePhenolic germicidal detergent solutionIodophor germicidal detergent solutionEthyl or isopropyl alcohol(70-90%)Hydrogen peroxide solutionsClean/disinfect:On a regular basis,When spills occur,When visibly soiled Follow manufacturers instructions for proper use:use-dilution,dwell time,material compatibility,storage,shelf-life.1:10 Bleach recommended for C.difficileCleaning&Disinfecting Non-critical Items2024/2/29 周四Dr.HU Bijie67主动监测培养主动监测培养Reservoir for Spread of Antibiotic Resistant PathogensClinical InfectionsColonized (Asymptomatic)Patients2024/2/29 周四Dr.HU Bijie69对超级细菌对超级细菌MRSAMRSA感染感染的的“零宽容零宽容”主动筛查：快速监测主动筛查：快速监测积极隔离：包括疑似病例的隔离积极隔离：包括疑似病例的隔离就地消灭：包括环境消毒就地消灭：包括环境消毒Outcomes:Active Surveillance Outcomes:Active Surveillance Controls MRSA BSIsControls MRSA BSIsHuang et al.,CID 2006;43:971-8美国美国2020个州立法：个州立法：住院病人主动筛查、隔离住院病人主动筛查、隔离MRSAMRSA和和VREVRE进行主动筛查的人群进行主动筛查的人群全部新入住全部新入住ICUICU的病人？的病人？使用机械通气的病人？使用机械通气的病人？具有高危因素的具有高危因素的ICUICU病人？病人？全体住院病人？全体住院病人？医务人员？医务人员？2024/2/29 周四73ICUICU病人病人MDROsMDROs主动监测培养主动监测培养鼻拭子鼻拭子MRSAMRSA肛拭子肛拭子ESBLsESBLs鲍曼不动杆菌鲍曼不动杆菌铜绿假单胞菌铜绿假单胞菌2024/2/29 周四Dr.HU Bijie74医院感染的组合预防医院感染的组合预防ICUICU需要重点防范的医院感染需要重点防范的医院感染呼吸机相关肺炎呼吸机相关肺炎VAPVAP插管相关的血流感染插管相关的血流感染CA-BSICA-BSI插管相关的尿路感染插管相关的尿路感染CA-UTICA-UTI多重耐药菌感染多重耐药菌感染MDROsMDROs医院感染暴发医院感染暴发outbreakoutbreak2024/2/29 周四Dr.HU Bijie76美国目前推行的美国目前推行的预防预防VAPVAP bundle bundle床头抬高至少床头抬高至少30度度Head of bed-30 每天一次停用镇静剂并评价是否可以撤机每天一次停用镇静剂并评价是否可以撤机Sedation Holiday/weaning尽早停用应激性溃疡预防药物尽早停用应激性溃疡预防药物Peptic Ulcer Disease(PUD)Prophylaxis口腔护理：用洗必泰冲洗每口腔护理：用洗必泰冲洗每26小时小时Oral care 深静脉血栓预防深静脉血栓预防Deep Vein Thrombosis(DVT)Prophylaxis插管气囊上方分泌物的吸引（？）插管气囊上方分泌物的吸引（？）2024/2/29 周四Dr.HU Bijie77预防预防CR-BSI：bundle留置导管术时最大无菌屏障留置导管术时最大无菌屏障Maximal sterile barriers洗必泰皮肤消毒洗必泰皮肤消毒Chlorhexidine skin antisepsis尽量使用锁骨下静脉部位穿刺尽量使用锁骨下静脉部位穿刺Site choice严格执行手卫生规则严格执行手卫生规则HAND HYGIENE每天评估是否需要继续留置导管每天评估是否需要继续留置导管抗菌导管抗菌导管Antibiotic-coated or antiseptic-impregnated catheter插管后的护理插管后的护理Post-insertion care2024/2/29 周四Dr.HU Bijie78洗必泰洗浴洗必泰洗浴洗必泰对于洗必泰对于鲍曼不动杆菌鲍曼不动杆菌的控制的控制Impact of 4%Chlorhexidine(CHG)Whole-Body Impact of 4%Chlorhexidine(CHG)Whole-Body Impact of 4%Chlorhexidine(CHG)Whole-Body Impact of 4%Chlorhexidine(CHG)Whole-Body Washing on Multidrug-resistant Acinetobacter Washing on Multidrug-resistant Acinetobacter Washing on Multidrug-resistant Acinetobacter Washing on Multidrug-resistant Acinetobacter baumannii(ACBA)Skin Colonisation-Patients in a baumannii(ACBA)Skin Colonisation-Patients in a baumannii(ACBA)Skin Colonisation-Patients in a baumannii(ACBA)Skin Colonisation-Patients in a MICUMICUMICUMICUAll patients daily whole-body disinfection with All patients daily whole-body disinfection with CHGCHGOf 320 patients at admission,Of 320 patients at admission,55(17%)55(17%)ACBA-ACBA-positive skin swabspos