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แนวทางการป้องกัน VAP ในทารกแรกเกิด
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2554
Ventilator-associated Pneumonia
..
Rev: 20 November 2011
Ventilator-associated Pneumonia(VAP)
ICU
6.8-32% NICU
VAP/1,000
ICU ICU
3-4
VAP
VAP
48 .
: gold standard & : gold standard &
hypothermia ypsecretions
Microbiological factors pleural fluid / tracheal aspirate/BAL
CXR infiltrates
colonization
antibiotics ICU ICU
Gastroesophageal refluxGastroesophageal reflux
contact
: Antibiotic-resistantPseudomonas aeruginosaAcinetobacter spp.Acinetobacter spp.Klebsiella spp.E t b tEnterobacter spp.Methicillin resistant staphylococcus aureusp y
Organisms causing VAP in NICU Srinagarind HospitalSrinagarind Hospital
January-August 2010
28.13
2530
P.aeruginosaMRSA
21.87
15.62
25
20
25 Enterobacter sp.Xanthomonas15.62
9.3715 K.pneumoniae
A.baumanii6.25
3.13
6.25 6.25
5
10 E.coliCandida albicans
0 VAP
Serratia sp.
Ch i Vi f VAPChanging Views of VAP
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)Healthcare Organizations (JCAHO)
Medical error
VAP
VAP VAP NICU .
2546
2552 close suction
2548 KM 2549
2552 admit
TSC 2549 retrospective (2546-2548)
2550 VAP
TSC 2553 KM
100% 2550 VAP 100%
(2546-2553)
1.
Hand hygieneyg
contact precautions
Hand HygieneHand Hygiene
alcohol-based waterless antiseptic agentantiseptic agent
secretion secretion : MRSA, MDR
2
2.
: Nosocomial sinusitisNosocomial sinusitis
2
: Oral Care
ti ETT suction ETT
- ETT ETT No. 8
O l h i Oral hygiene
2.
Neonatal Resuscitation Team
SiPAPNon-invasive Ventilation
SiPAP
CPAP
2.
Wean
Individual assessment
for extubation
2.
:
30 30
:
80 100 10 15 -80 -100 . 10-15
2-4 /
15-30O15 30
:
:
:
circuit ETT
circuit ETT 15-30 ETT, OG
ETT ETT /
7
Ambu Ambu
bag
Prevention of Contamination
ventilator circuits 7
Prevention of Contamination suction
Open suction Open suction Closed-system suctionOpen suction Open suction Closed system suction
circuit
70% alcohol
Prevention of ContaminationPrevention of Contamination
70% alcohol 70% alcohol
Prevention of ContaminationPrevention of Contamination
Ambu-
b ambu-
OG tube
7
VAPVAP score
audit
audit
Hand Hygiene
1. 1. NB conference (PCT)
2.
3 3.
sensor Automatic alcohol hand rub
alcohol hand rub
1 2553 25 25531 2553 25 2553
scan
Lotion
6
scan 6 scan
6 6
VDO
35
86 19 86.19 13.81 40.00
22.85 2 86 2.86 100%
tracheal aspirate tracheal aspirate
VAP/1000
12 /1000 12 /1000
Prevention of Contamination Prevention of Contamination
1. 2 closed-system1.
2.closed-system suction
closed suction open suction closed - system suction open- system suction
1. 1 2 2. off circuit suction off circuitsuction
3. suction
4.
5 5. 6.
closed suction open suction closed - system suction open- system suction
7 Ambu bag suction 8
h
Ambub pneumothorax bag
9
10
11
12
13
2551-2554
70
5060
2551
3040 2552
25532030 2553
2554
010
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.
.
.
.
.
.
.
.
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.
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.
.
.
.
.
.
newborn conference (PCT) feed back feed back
newborn conference
2554
N=2901. 23(100%) 39(100%) 30(93.34%) 116
(100%)78(100%) 2(100%) 288(99.32%)
2. - - 2*(6.66%)
- - - 2*(0.68%)*
3. - 2**(100%) 10** 10** 8**(10.25%) 2**(100%) 32(11.11%)( %)(33.33%) (31.25%)
( %) ( %) ( %)
4. - - - 20(100%) 20(100%) - 40(100%)4. 15(100%) 18(100%) 4(100%) 10(100%) - - 47(100%)
5. - 15(100%) 18(90%)2*(10%)
2(100%) - - 35(94.60%)2*(5.40%)
6.IVF - - - 25(100%) 25(100%) - 50(100%)
7. central-line 3(100%) - - 1(100%) - - 4(100%)7. 1(100%) - - - - 2(100%) 3(100%) 8 3(100%) 2(100%) 4 (100%) - - - 9(100%) 8. 3(100%) 2(100%) 4 (100%) 9(100%) 9. LP 1(100%) 7(100%) 2(100%) 5(100%) 8(100%) - 23(100%) 10.+,
- - - 28(100%) - - 28(100%)
1. 100%2. 290 3. * 4. **
11., - - - 25(100%) 25(100%) - 50(100%)
1. : :
2. 3 3.4.:5 5. 6.
7.
Thank Youhank You