WS/ T59—216 ZH ò ng ZH ò ng Ji ā n h ò b ò ng ò y and Yu ò ng ò n r ò n y ò ng y ? k ò ng ZH ò gu ò ò n 2 English reference
regulation for prevention and control of health care. Basic information of associated infection in intensive care unit 3
ICS 11.2
C 5
People's Republic of China * * * and national health industry standard WS/ T 59—216 Regulation for Prevention and Control of Hospital Infection in Intensive Care Unit was issued by the National Health and Family Planning Commission of the People's Republic of China on December 27th, 216, and has been implemented since June 1st, 217.
4 Foreword
This standard is formulated according to the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Measures for the Administration of Hospital Infection.
this standard is drafted according to the rules given in GB/T 1.1—29.
This standard was drafted by xuanwu hospital of Capital Medical University, Xiangya Hospital of Central South University, People's Hospital of Peking University, Shandong Provincial Hospital, Peking University First Hospital and Peking Union Medical College Hospital.
drafters of this standard: Wang Lihong, Wu Anhua, An Youzhong, Li Weiguang, Zhao Xia, Zhang Jingli, Li Liuyi and Du Bin. 5 standard text
specification for prevention and control of nosocomial infection in intensive care unit 5.1 1 scope
this standard specifies intensive care unit (intensive care unit) of medical institutions. ICU) Basic requirements of hospital infection prevention and control, building layout, necessary facilities and management requirements, personnel management, hospital infection monitoring, prevention and control measures of instrument-related infection, prevention and control measures of surgical site infection, hand hygiene requirements, environmental cleaning and disinfection methods and requirements, bed unit cleaning and disinfection requirements, toilet cleaning and disinfection requirements, air disinfection methods and requirements, etc.
this standard is applicable to ICU set up in general hospitals at all levels according to relevant regulations.
the prevention and control of nosocomial infection in ICU of infectious disease hospital and ICU of pediatrics and newborn can be combined with professional characteristics and implemented with reference to this standard. 5.2 2 normative reference documents
The following documents are essential for the application of this document. For dated reference documents, only dated version is applicable to this document. For undated reference documents, the latest version (including all amendments) is applicable to this document.
GB 15982 Hospital Disinfection Hygiene Standard
WS/T 311 Hospital Isolation Technical Specification
WS/T 312 Hospital Infection Monitoring Specification
WS/T 313 Medical Staff Hand Hygiene Specification
WS/ T 367 Technical Specification for Disinfection of Medical Institutions
Regulations on the Management of Medical Wastes the State Council 23 Edition
Administrative Measures for Medical Wastes in Medical and Health Institutions The former Ministry of Health 23 Edition
Administrative Measures for Disinfection of the former Ministry of Health and the State Environmental Protection Administration 23 Edition
The former Ministry of Health 22 Edition 5.3 3 Terms and definitions
The following terms and definitions are applicable to this document.
3.1
intensive care unit? intensive care unit； ICU
A specialized ward in a hospital for intensive care and treatment of critically ill patients, which provides systematic and high-quality medical care and treatment technology in time for patients with life-threatening or potentially high-risk factors caused by one or more organ and system dysfunction for various reasons.
3.2
air cleaning technology? Air cleaning technology
means to remove suspended particles and microorganisms in the air and create a clean environment through multi-stage air filtration system.
3.3
central catheter? The central line
is located at or near the heart or one of the following great vessels, and is used for transfusion, blood transfusion, blood collection and hemodynamic monitoring. These great vessels include: aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic vein, internal jugular vein, subclavian vein, external iliac vein and femoral vein.
3.4
targeted monitoring? Target surveillance
Hospital infection monitoring aimed at high-risk groups, high-risk sites and high-risk factors, such as hospital infection monitoring in intensive care unit, blood purification-related infection monitoring, surgical site infection monitoring, clinical application of antibacterial drugs and bacterial resistance monitoring.
3.5
Device-related infection? Deviceassociated infection
The infection related to a certain instrument occurred during the period of using the instrument or within 48 hours after stopping using the instrument (such as ventilator, urinary catheter, vascular catheter, etc.). If the related infection occurs after stopping using the related equipment for more than 48 h, there should be evidence that the infection is related to the use of the equipment, but there is no requirement for the shortest use time of the equipment.
3.6
central catheter-related bloodstream infection? central line associatedbloodstream infection； CLABSI
patients suffer from primary bloodstream infection during central catheter indwelling or within 48 hours after central catheter removal, which has nothing to do with infection in other parts.
3.7
ventilator-associated pneumonia? ventilatorassociated pneumonia； VAP
Pneumonia occurred when artificial airway (tracheal intubation or tracheotomy) was established and mechanical ventilation was performed, including those who used artificial airway for mechanical ventilation within 48 hours after pneumonia.
3.8
Catheter-associated urinary tract infection? catheterassociated urinary tract infection; CAUTI
Urinary tract infection occurred during indwelling catheter or within 48 hours after catheter removal.
3.9
Hospital infection outbreak? Health care associated infection outbreak
There are more than three cases of homologous infection in a short period of time among patients in medical institutions or their departments. 5.4 4 Basic requirements of hospital infection prevention and control
4.1 ICU should establish a hospital infection management team composed of department directors, head nurses and * * * infection control personnel, which will be fully responsible for the hospital infection management of undergraduate course room.
4.2 relevant rules and regulations on nosocomial infection management in ICU should be formulated and constantly improved, and implemented in the practice of diagnosis, treatment and nursing.
4.3 we should regularly study the problems existing in the prevention and control of nosocomial infection in ICU and the improvement scheme.
4.4 hospital infection management professionals should supervise the implementation of hospital infection prevention and control measures in ICU, make relevant records, and feed back the inspection results in time.
4.5 a system of on-the-job training and continuing education should be established according to the characteristics of nosocomial infection in ICU. All T-workers, including doctors, nurses, trainees, interns, cleaning staff, etc., should be trained in the knowledge and skills related to hospital infection prevention and control.
4.6 the application and management of antibacterial drugs should follow the relevant national laws, regulations, documents and guiding principles.
4.7 the disposal of medical wastes shall comply with the regulations on the management of medical wastes, the measures for the management of medical wastes in medical and health institutions and the classified catalogue of medical wastes.
4.8 medical staff should preach the relevant regulations on prevention and control of nosocomial infection to patients' families. 5.5 5 Building layout, necessary facilities and management requirements
5.1 ICU should be located in an area convenient for patient transport, examination and treatment.
5.2 the overall layout of ICU should be based on the principle of separation of cleaning and sewage, and the medical area, medical auxiliary room area and sewage treatment area should be relatively independent.
5.3 The use area of bed units should be not less than 15m2, and the bed spacing should be more than 1m.
5.4 ICU should be equipped with at least one single ward (room) with an area of not less than 18m2.
5.5 should have good ventilation and lighting conditions. The temperature in the medical area should be maintained at 24℃ 1.5℃ and the relative humidity should be maintained at 3% ~ 6%.
5.6 decoration should follow the principles of no dust, no dust accumulation, corrosion resistance, moisture and mildew prevention, antistatic, easy cleaning and disinfection.
5.7 dried flowers, fresh flowers or potted plants should not be placed indoors. 5.6 6 personnel management 5.6.1 6.1 management requirements for medical personnel
6.1.1 ICU should be equipped with a sufficient number of professional medical personnel who are specially trained and have the ability to work independently. ICU professional medical personnel should master the basic theory, basic knowledge and basic operation technology of critical care medicine and master the knowledge and skills of hospital infection prevention and control. The ratio between the number of nurses and the actual number of beds should be no less than 3:1.
6.1.2 when nursing patients infected or colonized by multi-drug-resistant bacteria, it is advisable to divide them into groups, and the personnel are relatively fixed.
6.1.3 medical personnel suffering from infectious diseases such as respiratory tract infection and diarrhea should avoid direct contact with patients. 5.6.2 6.2? Occupational protection of medical personnel
6.2.1 Medical personnel should take standard precautions and the protective measures should meet the requirements of WS/T 311.
6.2.2 ICU should be equipped with sufficient and convenient personal protective equipment, such as medical masks, hats, gloves, goggles, protective masks and isolation gown.
6.2.3 medical personnel should master the correct use of protective equipment.
6.2.4 Work clothes should be kept clean.
6.2.5 You don't need to change your shoes when entering ICU. If necessary, you can wear a shoe cover or replace special shoes.
6.2.6 those with negative hepatitis b surface antibody should be injected with hepatitis b vaccine before taking up their posts. 5.6.3 6.3 Placement and isolation of patients
6.3.1 Placement and isolation of patients should follow the following principles:
a) Infected, suspected infected and non-infected patients should be placed in different areas;
b) On the basis of standard prevention, corresponding isolation and prevention measures should be taken according to the transmission routes of diseases (contact transmission, droplet transmission and air transmission).
6.3.2 Patients infected with multidrug-resistant bacteria or pan-resistant bacteria or colonized should be isolated in a single room; If the isolation room is insufficient, patients infected or colonized by similar drug-resistant bacteria can be placed in a centralized way, and eye-catching signs should be set up. 5.6.4 6.4 management of visitors
6.4.1 visiting hours should be clearly stated and the number of visitors should be limited.
6.4.2 visitors should wear special visiting clothes when entering ICU. Visiting clothes are specially designed for beds, and they are cleaned and disinfected after the visiting day.
6.4.3 visitors may not change their shoes when entering ICU, and they may wear shoe covers or replace special shoes when necessary.
6.4.4 When visiting patients with respiratory tract infection, visitors should follow the requirements of WS/T 311 for protection.
6.4.5 visitors suffering from respiratory infectious diseases should be refused. 5.7 7 Monitoring of nosocomial infection
7.1 The incidence of nosocomial infection, the proportion of infection sites, pathogenic microorganisms, etc. of ICU patients should be routinely monitored, and the relevant information of nosocomial infection monitoring should be recorded. The contents and methods of monitoring shall comply with the requirements of WS/T 312.
7.2 targeted monitoring should be actively carried out, including ventilator-associated pneumonia (VAP), vascular catheter-associated bloodstream infection (CLBSL), catheter-associated urinary tract infection (CAUTI) and multi-drug resistant bacteria monitoring. For patients suspected of infection, corresponding samples should be collected for microbiological examination and drug sensitivity test. Specific methods refer to the requirements of WS/T 312.
7.3 Early identification of hospital infection outbreaks and implementation of effective intervention measures are as follows:
a) A hospital infection outbreak reporting system should be established, and relevant departments should be promptly reported when hospital infection outbreaks or suspected outbreaks occur;
b) The possible transmission routes should be analyzed and determined through case data collection, epidemiological investigation and microbiological examination, and corresponding measures should be made accordingly.