ICU多重耐药菌感染控制措施

promotion of employment, form a reasonable and orderly pattern of income distribution, build a more fair and sustainable social security systems, medical and health system reform. The plenary, innovation of social governance, must focus on the maintenance of fundamental interests of the overwhelming majority of the people, maximize factors, enhance social development, improving social governance, the interests of national security, ensure that the people live and work, social stability and order. o improve social governance, stimulating social organization, innovative and effective system of preventing and resolving social conflicts, improving the public security system, set up the National Security Council, national security systems and national security strategy to ensure national security. Plenary session, the construction of ecological civilization, you must establish systems of ecological system, using thesystem to protect the ecological environment. To improve natural resources asset property right system and use control, red line of delimitation of ecological protection, resources paid use system and ecological compensation system in ecological environment protection management system reform. Plenary session, centering on building a listening party command, can win and having a fine style of the people's army, a strong army under the new situation of the party Goals, restricting the development of national defense and army building is solved outstanding contradictions and problems, innovation and development of military theory, enhance military strategic guidance, improve the military strategy in the new period, building a modern military force system with Chinese characteristics. o deepen the adjustment of personnel system reform in the army, military policy and system reform, promote thedevelopment of military and civilian integration depth. Plenary session stressed that comprehensive reform must be to strengthen and improve the party's leadership, give full play to the core role of the party commands the overall situation and coordinating all parties, improving the party's leading water ... Margin. Challenged the leadership of the Communist Party of China, Marxism-Leninism and Mao Zedong thought by Deng Xiao-ping's flag, replaced by three representatives and the harmonic society. The former Communist Party spirit and social cohesion point of almost all political makeover. Characteristics of socialism public ownership is shifting to private ownership, planned regulation and market regulation, the proletarian regime controlled by the elite. Of universal equality, fairness and basic principles of distribution system is socialist society, however after economic monopolized by powerful, vested interests grow, employers do not have the same status, hardly seems fair social distribution. State key protection of capital interests rather than the interests of citizens, had been hits the bottom of the proletariatICU多重耐药菌感染控制措施

一、 1、

多重耐药感染的监测与报告

各临床科室应尽可能、尽早地对感染病人送检病源菌培养，要求送检病源菌培养率达到感染病人的70％以上。

2、 送检科细菌室发现耐药病历应及时通知临床科室和院感办。 3、 临床医护人员发现耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）、产超

广谱B-内酰胺酶（ESBLs）的细菌和多重耐药的鲍曼不动杆菌等应在院内网上报告医院感染病例上报卡（或电话报告医院感染管理办公室），并尽早就地隔离管理。

二、 多重耐药菌患者的隔离与预防 1、 严格实施隔离措施

（1） 首选单间隔离，也可以将同类多重耐药菌感染患者或者定植患者安置在同一房间。

（2） 气管切开、气管插管、深静脉留置导管、有开放伤口或者免疫功能抑制患者不能与多重耐

药菌感染者安置在同一房间。

（3） 医护人员诊疗、护理多重耐药菌感染患者时，应当戴手套，必要时穿隔离衣。诊疗、护理

操作完成后，应及时脱去手套和隔离衣。

（4） 多重耐药菌感染的患者周围物品、环境和医疗器械需每日清洁、消毒。

（5） 多重耐药感染的患者到其他科室与部门进行检查与治疗时，所在科室应及时通知相关部门

做好预防隔离准备工作。

（6） 接受多重耐药菌感染患者检查的其他科室与部门应积极的实施预防隔离措施，对用后的器

械设备需清洁消毒。

（7） 一般诊疗器械如听诊器、体温表、血压计等固定使用。 （8） 共用轮椅、推床在每次使用后需及时消毒。 2、 加强医务人员手卫生管理

（1） 医务人员对多重耐药菌感染患者实施诊疗、护理操作前后、应当洗手。 （2） 接触患者体液、血液等分泌物以及患者使用过的物品应洗手。 （3） 脱掉手套与隔离衣后应洗手。

（4） 诊疗、护理多重耐药菌感染患者后，无明显污染时，每诊查一个部位应使用快速手消毒剂

进行手部消毒。

三、 加强抗菌药物的应用管理

各科室应认真落实《抗菌药物临床应用指导原则》和卫生部（卫办医发（2008）48号）文件精神，正确、合理地使用抗菌药物，减少多重耐药菌的产生。 四、 加强多重耐药菌预防与控制的学习和培训 1、 各科室应做好多重耐药菌感染患者的交、接班。 2、 在诊疗、护理查房时，应准备多重耐药菌感染的预防与控制的内容，组织科内学习相关知

识，强化医务人员对多重耐药菌感染的重视。

3、 加强本科室实习生、进修生管理，使之掌握预防多重耐药菌感染的控制方法，共同保障医

院及患者医疗安全。

五、 监督与管理

1、各科室应认真落实多重耐药菌的隔离预防措施，配齐相应物品，如手套、口罩、隔离衣，快速手消毒剂，院感办将定期组织检查多重耐药隔离预防措施的落实情况，并纳入院感综合质量考评。

ICU导管相关血流感染预防与控制标准操作规程

一：置管时

1：深静脉置管时应遵守最大限度的无菌屏障要求。插管部位应铺大无菌单，操作人员应带帽子、口罩，穿无菌手术衣；认真执行手消毒程序，戴外科手套，置管过程中手套意外破损应立即更换。 2：权衡利弊后选择合适的穿刺点，成人应首选锁骨下静脉，尽量避免使用股静脉。 3：宜采用2％氯已定乙醇制剂消毒穿刺点皮肤。 4：宜采用内层含有抗菌成分的导管。

5：还有疖肿、湿疹等皮肤病，患感冒等呼吸道疾病，感染或携带有MRS（耐甲氧西林金黄的葡萄球菌）工作人员，在未治愈前不应进行插管工作。

bviously, face China's Socialist system, the Communist Party is not the party. In that case, political chaos has been very tight. Is remodeling or reconstruction, is a correction or a stove. Whether to turn right or left, is back to the source or put forward new political ideas. This is to determine the road problems in China, is also the key out of the deep water of the reform of the economic system. After 18, the new Central collective leadership attaches great importance to political orientation. First, the \s\ng from the Central Government's self-restraint, which preaches and pro-image, brought fresh feeling to the community. Secondly, before reform and opening up and reform and opening two periods after non-negative, untying the tangle of the society a long time on this issue. Third, a new generation of party leaders on various occasions to Mao Ze-Dong and Mao Ze-Dong's thought of evaluation has room for manoeuvre, through to the ruling ideology of Mao Zedong thought, is the call of the soul to the Socialist Revolution and construction. Empty talks jeopardize national interests and try again, is an affirmation of Deng Xiao-ping's reform ideas. These strong political signal showing a new generation of political leaders is still keeping to the Socialist road. Four is revisiting the \o Ze-Dong's historical cycle of\profile anti-corruption and the importance of the Constitution, reorganization is bad style of officialdom, was to civilize people obey the law, while improving the color change of the regime of vigilance. Five is to reform into deeper waters and stressed that top-level design, this is a review on the reform and opening up in the past, is also looking for a way out. Six foreign and Russia closer, the flexible attitude on the issue of the Korean peninsula, Sino-Japanese fishing hardline China on the island out of the \nt\ow profile shadow began to gradually plan development. Signs show that the new leadership began to make a left turn in politics. However, as of right now, not only ideological confusion in the community, the new leadership's thinking is messy. New leaders both stressed the need to implement the Constitution, stressed the need to turn off the power in a cage. Also stresses that Mao Zedong thought cannot be lost, 30 years after the reform and opening up 30 years ago can not deny each other. Both advocate democracy and release \n does not speak of\cal constraints. Neither deny the history of the CPC Central Committee on several issues ...Comrades: today brings together members, mainly in order to provide a platform to Exchange and learn from each other in order to facilitate our work. Just now, we focus on taxation, planning and stability, safety, project construction, typical topics such as private facts presentation and interaction, and towns currently exist in the in-depth analysis of the problems to be solved, to explore new methods to solve the problem. It can be said that summing up the achievement, no grandstanding; analysispromotion of employment, form a reasonable and orderly pattern of income distribution, build a more fair and sustainable social security systems, medical and health system reform. The plenary, innovation of social governance, must focus on the maintenance of fundamental interests of the overwhelming majority of the people, maximize factors, enhance social development, improving social governance, the interests of national security, ensure that the people live and work, social stability and order. o improve social governance, stimulating social organization, innovative and effective system of preventing and resolving social conflicts, improving the public security system, set up the National Security Council, national security systems and national security strategy to ensure national security. Plenary session, the construction of ecological civilization, you must establish systems of ecological system, using thesystem to protect the ecological environment. To improve natural resources asset property right system and use control, red line of delimitation of ecological protection, resources paid use system and ecological compensation system in ecological environment protection management system reform. Plenary session, centering on building a listening party command, can win and having a fine style of the people's army, a strong army under the new situation of the party Goals, restricting the development of national defense and army building is solved outstanding contradictions and problems, innovation and development of military theory, enhance military strategic guidance, improve the military strategy in the new period, building a modern military force system with Chinese characteristics. o deepen the adjustment of personnel system reform in the army, military policy and system reform, promote thedevelopment of military and civilian integration depth. Plenary session stressed that comprehensive reform must be to strengthen and improve the party's leadership, give full play to the core role of the party commands the overall situation and coordinating all parties, improving the party's leading water ... Margin. Challenged the leadership of the Communist Party of China, Marxism-Leninism and Mao Zedong thought by Deng Xiao-ping's flag, replaced by three representatives and the harmonic society. The former Communist Party spirit and social cohesion point of almost all political makeover. Characteristics of socialism public ownership is shifting to private ownership, planned regulation and market regulation, the proletarian regime controlled by the elite. Of universal equality, fairness and basic principles of distribution system is socialist society, however after economic monopolized by powerful, vested interests grow, employers do not have the same status, hardly seems fair social distribution. State key protection of capital interests rather than the interests of citizens, had been hits the bottom of the proletariat二：插管后

1：应用无菌透明专用贴膜或无菌纱布覆盖穿刺点，但多汗、渗血明显的患者宜选无菌纱布。

2：应定期更换穿刺点覆盖的敷料。更换间隔时间：无菌纱布为2天，专用贴膜可至7天，但敷料出现潮湿、松动、玷污时应立即更换。

3：接触导管接口或更换敷料时，应进行严格的手卫生，并戴检查手套，不能以手套代替手卫生。 4：保持三通锁闭清洁，如有血迹等污染应立即更换。

5：患者洗澡或擦身时应注意对导管的保护，不要把导管浸入水中。

6：输液管更换不宜过频，但在输入血或血制品、脂肪乳剂或停止输液时应及时更换。 7：对无菌操作不严的紧急置管，应在48h内更换导管，选择另一穿刺点。

8：怀疑导管相关感染时，应考虑拔出导管，但不要为预防感染而定期更换导管。 9：应每天评价留置导管的必要性，尽早拔出导管。 三：培训与管理

1：置管人员和导管维护人员应持续接受导管相关操作和感染预防相关知识的培训，并熟练掌握相关操作技能，严格遵循无菌造作原则。

2：定期公布导管相关血流感染（CR-BSI）的发生率。 四：询证医学不推荐的预防措施

1：常规对拔出的导管尖端进行细菌培养。 2：在穿刺部位局部涂含抗菌药物的药膏。 3：常规使用抗菌药物封管来预防CR-BSI。 4：全身用抗菌药物预防CR-BSI。

5：为了预防感染而定期更换中心静脉导管和动脉导管。 6：为了预防感染而常规通过导丝更换非隧道式导管。 7：常规在中心静脉导管内放置过滤器来预防CR-BSI。

导管相关尿路感染预防与控制标准操作规程

一：插管前

1：严格掌握留置导尿管的适应症，应避免不必要的留置导尿。 2：仔细检查无菌导尿包，如过期、外包装破损、潮湿，不应使用。

3：根据年龄、性别、尿道情况选择合适的导尿管口径、类型。成年男性宜选16F，女性宜选14F。 4：对留置导尿患者，应采用密闭式引流系统。 二：插管时

1：使用0.05％～0.1％的聚维酮碘（碘伏）棉球消毒尿道口及其周围皮肤粘膜，每一个棉球不能重复使用，程序如下：

（1） 男性：自尿道口、龟头向外旋转擦拭消毒，注意擦净包皮及冠状沟。

（2） 女性：先清洗外阴，其原则由上至下，由内向外，然后清洗尿道口、前庭、两侧大小阴唇，

最后肛门。

三：插管后

1：悬垂集尿管，不宜刚与膀胱水平，并及时清空尿袋中尿液。

2：保持尿液引流系统通畅和完整，不应轻易打开导尿管与集尿袋的接口。

3：如要留取尿标本，可从集尿袋采集，但此标本不应用于普通细菌和真菌学检查。 4：不应常规使用含消毒剂或抗菌药物的生理盐水进行膀胱冲洗或灌注来预防尿路感染。 5：疑似导尿管阻塞应更换导管，不得冲洗。

6：保持尿道口清洁，日常用肥皂和水保持清洁即可，但大便失禁的患者清洁以后应消毒。

7：患者洗澡或擦身时应注意对导管的保护，不应把导管浸入水中。 8：导尿管不慎脱落或导尿管密闭系统被破坏时，应更换导尿管。

10：长期留置导尿管患者，没有充分证据表明定期更换导尿管可以预防导尿管相关感染，不提倡频繁更换导尿管。建议更换频率为两周一次，普通集尿袋2次/周，精密集尿袋1次/周。 11：应每天评价留置导尿管的必要性，尽早拔除导尿管。 四：其他预防措施

bviously, face China's Socialist system, the Communist Party is not the party. In that case, political chaos has been very tight. Is remodeling or reconstruction, is a correction or a stove. Whether to turn right or left, is back to the source or put forward new political ideas. This is to determine the road problems in China, is also the key out of the deep water of the reform of the economic system. After 18, the new Central collective leadership attaches great importance to political orientation. First, the \s\ng from the Central Government's self-restraint, which preaches and pro-image, brought fresh feeling to the community. Secondly, before reform and opening up and reform and opening two periods after non-negative, untying the tangle of the society a long time on this issue. Third, a new generation of party leaders on various occasions to Mao Ze-Dong and Mao Ze-Dong's thought of evaluation has room for manoeuvre, through to the ruling ideology of Mao Zedong thought, is the call of the soul to the Socialist Revolution and construction. Empty talks jeopardize national interests and try again, is an affirmation of Deng Xiao-ping's reform ideas. These strong political signal showing a new generation of political leaders is still keeping to the Socialist road. Four is revisiting the \o Ze-Dong's historical cycle of\profile anti-corruption and the importance of the Constitution, reorganization is bad style of officialdom, was to civilize people obey the law, while improving the color change of the regime of vigilance. Five is to reform into deeper waters and stressed that top-level design, this is a review on the reform and opening up in the past, is also looking for a way out. Six foreign and Russia closer, the flexible attitude on the issue of the Korean peninsula, Sino-Japanese fishing hardline China on the island out of the \nt\ow profile shadow began to gradually plan development. Signs show that the new leadership began to make a left turn in politics. However, as of right now, not only ideological confusion in the community, the new leadership's thinking is messy. New leaders both stressed the need to implement the Constitution, stressed the need to turn off the power in a cage. Also stresses that Mao Zedong thought cannot be lost, 30 years after the reform and opening up 30 years ago can not deny each other. Both advocate democracy and release \n does not speak of\cal constraints. Neither deny the history of the CPC Central Committee on several issues ...Comrades: today brings together members, mainly in order to provide a platform to Exchange and learn from each other in order to facilitate our work. Just now, we focus on taxation, planning and stability, safety, project construction, typical topics such as private facts presentation and interaction, and towns currently exist in the in-depth analysis of the problems to be solved, to explore new methods to solve the problem. It can be said that summing up the achievement, no grandstanding; analysispromotion of employment, form a reasonable and orderly pattern of income distribution, build a more fair and sustainable social security systems, medical and health system reform. The plenary, innovation of social governance, must focus on the maintenance of fundamental interests of the overwhelming majority of the people, maximize factors, enhance social development, improving social governance, the interests of national security, ensure that the people live and work, social stability and order. o improve social governance, stimulating social organization, innovative and effective system of preventing and resolving social conflicts, improving the public security system, set up the National Security Council, national security systems and national security strategy to ensure national security. Plenary session, the construction of ecological civilization, you must establish systems of ecological system, using thesystem to protect the ecological environment. To improve natural resources asset property right system and use control, red line of delimitation of ecological protection, resources paid use system and ecological compensation system in ecological environment protection management system reform. Plenary session, centering on building a listening party command, can win and having a fine style of the people's army, a strong army under the new situation of the party Goals, restricting the development of national defense and army building is solved outstanding contradictions and problems, innovation and development of military theory, enhance military strategic guidance, improve the military strategy in the new period, building a modern military force system with Chinese characteristics. o deepen the adjustment of personnel system reform in the army, military policy and system reform, promote thedevelopment of military and civilian integration depth. Plenary session stressed that comprehensive reform must be to strengthen and improve the party's leadership, give full play to the core role of the party commands the overall situation and coordinating all parties, improving the party's leading water ... Margin. Challenged the leadership of the Communist Party of China, Marxism-Leninism and Mao Zedong thought by Deng Xiao-ping's flag, replaced by three representatives and the harmonic society. The former Communist Party spirit and social cohesion point of almost all political makeover. Characteristics of socialism public ownership is shifting to private ownership, planned regulation and market regulation, the proletarian regime controlled by the elite. Of universal equality, fairness and basic principles of distribution system is socialist society, however after economic monopolized by powerful, vested interests grow, employers do not have the same status, hardly seems fair social distribution. State key protection of capital interests rather than the interests of citizens, had been hits the bottom of the proletariat1：定期对医务人员进行宣教。

2：定期公布导尿管相关尿路感染（CAUTI）的发生率。

医院内肺炎预防与控制标准操作流程

医院内肺炎（HAP）是我国最常见的医院感染类型，呼吸机相关肺炎（VAP）是其中的重要类型，预后较差。

1、对存在HAP高危因素的患者，建议使用含0.2％氯已定（洗必泰）漱口或空腔冲洗，每2-6小时一次。

2、如无禁忌症，应将床头抬高30度。

3、鼓励手术后患者（尤其是胸部和上腹部手术患者）早期下床活动。 4、指导患者正确咳嗽，必要时予以翻身、拍背，以利于痰液引流。 5、提倡积极使用胰岛素控制血糖在80－110mg/dl。

6、不应常规采用选择性消化道脱感染（SDD）来预防HAP(VAP)。 7、对于使用呼吸机的患者，还应考虑以下几点。

（1）严格掌握气管插管或气管切开适应症，使用呼吸机辅助呼吸的患者应优先考虑无创通气； （2）如需插管，尽量使用经口的气管插管；

（3）有建议保存气管插管气囊压力在20厘米水柱以上。

（4）吸痰时应严格遵循无菌操作原则，吸痰前、后，医务人员应做手卫生；

（5）呼吸机螺纹管和湿化器应每周更换1－2次，有明显分泌物污染时应及时更换；螺纹管冷凝水应及时倾倒，不可使冷凝水流向患者气道；湿化器添加水应使用无菌用水，每天更换；

（6）每日停用镇静剂，评估是否撤机和拔管，减少插管天数。 8、应对医务人员包括护工，定期进行有关预防措施的教育培训。

bviously, face China's Socialist system, the Communist Party is not the party. In that case, political chaos has been very tight. Is remodeling or reconstruction, is a correction or a stove. Whether to turn right or left, is back to the source or put forward new political ideas. This is to determine the road problems in China, is also the key out of the deep water of the reform of the economic system. After 18, the new Central collective leadership attaches great importance to political orientation. First, the \s\ng from the Central Government's self-restraint, which preaches and pro-image, brought fresh feeling to the community. Secondly, before reform and opening up and reform and opening two periods after non-negative, untying the tangle of the society a long time on this issue. Third, a new generation of party leaders on various occasions to Mao Ze-Dong and Mao Ze-Dong's thought of evaluation has room for manoeuvre, through to the ruling ideology of Mao Zedong thought, is the call of the soul to the Socialist Revolution and construction. Empty talks jeopardize national interests and try again, is an affirmation of Deng Xiao-ping's reform ideas. These strong political signal showing a new generation of political leaders is still keeping to the Socialist road. Four is revisiting the \o Ze-Dong's historical cycle of\profile anti-corruption and the importance of the Constitution, reorganization is bad style of officialdom, was to civilize people obey the law, while improving the color change of the regime of vigilance. Five is to reform into deeper waters and stressed that top-level design, this is a review on the reform and opening up in the past, is also looking for a way out. Six foreign and Russia closer, the flexible attitude on the issue of the Korean peninsula, Sino-Japanese fishing hardline China on the island out of the \nt\ow profile shadow began to gradually plan development. Signs show that the new leadership began to make a left turn in politics. However, as of right now, not only ideological confusion in the community, the new leadership's thinking is messy. New leaders both stressed the need to implement the Constitution, stressed the need to turn off the power in a cage. Also stresses that Mao Zedong thought cannot be lost, 30 years after the reform and opening up 30 years ago can not deny each other. Both advocate democracy and release \n does not speak of\cal constraints. Neither deny the history of the CPC Central Committee on several issues ... Comrades: today brings together members, mainly in order to provide a platform to Exchange and learn from each other in order to facilitate our work. Just now, we focus on taxation, planning and stability, safety, project construction, typical topics such as private facts presentation and interaction, and towns currently exist in the in-depth analysis of the problems to be solved, to explore new methods to solve the problem. It can be said that summing up the achievement, no grandstanding; analysis