层流ICU病区病人呼吸系统常见细菌及对策

目的监测层流净化重症监护病房(ICU)病人呼吸系统常见感染细菌,完善护理对策,控制感染。方法执行2011年制定的层流净化病区管理流程,每日监测住院病人呼吸系统医院感染发生病例,统计2011年1～12月监测情况,与医院监测结果相比较,检验相关对策的有效性。结果层流净化ICU病区细菌生长以酵母菌为主,铜绿假单胞菌、肺炎克雷伯菌发生率得到有效控制。结论层流净化ICU区域在严格管理下,借助空气净化系统能控制医院内感染常见致病菌铜绿假单胞菌、肺炎克雷伯菌的发生率,目前针对层流净化ICU病区制定的预防措施科学有效。     

重症监护病房医院感染与患者死亡关系

<正>重症监护病房(ICU)是病情危重患者集中的区域,是医院感染的高危科室。为控制ICU医院感染发生率、降低危重患者的死亡率,本研究对2004-2009年齐鲁医院ICU住院死亡患者进行调查分析,探讨死亡患者与医院感染的关系及相关危险因素,以完善相关预防和控制措施。     

重症监护病房医院感染与控制感染措施

目的为了有效地降低重症监护病房(ICU)的感染发生率,制定控制感染措施。方法对ICU患者的呼吸道、尿路感染、血管内治疗和消化道感染与护理相关的因素进行分析,并提出相应的护理控制措施。结果重视ICU的布局与环境、严格地执行各项护理规章制度、重视静脉治疗的环节,正确地使用护理程序,并加强对ICU的护理管理,使ICU的感染率保持在理想水平。结论各项的护理措施对ICU的医院感染控制是行之有效的。     

《重症监护病房医院感染预防与控制规范》解读

重症监护病房(ICU)的发展对挽救危重症患者的生命起到了不可替代的作用,但由于ICU的专业特点,客观上决定了它是一个众多医院感染危险因素高度集中的场所,使之成为医院感染预防与控制的重点部门;然而,据调查我国的ICU在建筑布局、人员管理等方面仍然存在一些不合理设置的现象;2016年,国家卫生计生委颁布了《重症监护病房医院感染预防与控制规范》,明确规定了医院重症监护病房医院感染预防与控制的各项要求,规范了各级综合医院开展重症监护病房诊疗活动中预防感染的工作准则,填补了国内重症监护病房医院感染防控工作无标准可依的空白。     

ICU医院感染预防控制的持续改进

重症监护病房(ICU)既是医院急危重症患者抢救的重要场所,也是医院感染的多发科室,一旦出现问题,将出现医院感染暴发.根据《医院感染管理办法》医院重症监护病房采取了以下的感染管理措施并加以持续改进,确保了ICU的医疗安全. 1 ICU现状分析 ICU是各种急危重症监护与救治的集中区域,无明确的病种分区,病区布局不合理,病区流程有待改善;ICU作为医院控制感染的重点科室,因其环境特殊,治疗对象往往病种繁多、病情危重、抗菌药物的长期使用、免疫力低下以及多药耐药菌的产生,均可导致医院感染;同时经常接受有创性检查等多种因素,所以ICU是医院感染暴发的高危区域.     

ICU护士对呼吸机相关性肺炎非药物预防措施执行的依从性

目的了解重症监护病房(ICU)护士对呼吸机相关性肺炎非药物预防措施的执行情况。方法参照文献制定调查问卷,调查广东省6所二级以上医院的101名ICU护士,内容包括对预防措施的认知程度,非药物预防措施的执行情况,以及不执行的原因。结果 31.7%自觉VAP预防知识足够,95.0%认为预防措施有效;对VAP预防措施总的依从率是77.0%;工龄≥5年与<5年的护士依从率差异无统计学意义。结论应加强ICU护士VAP预防知识的培训和开展循证实践,补充ICU的人力配备,提升感染预防和控制理念,有效执行VAP预防措施。     

综合性医院ICU医院感染目标监测研究分析

目的 为加强ICU医院感染管理,探索目标性监测在ICU实施效果.方法 确定ICU前瞻性研究计划、制定ICU患者日志,对2006年1月-2007年12月进入医院ICU的患者进行前瞻性调查,并对监测结果 进行研究分析.结果 2年共调查患者3917例,感染217例,千日床位感染率为11.7‰,2006、2007年患者千日床位感染率分别为13.4‰、10.0‰,2007年较2006年下降3.4‰;2年动静脉插管相关血液感染率分别为1.2‰、0.9‰,呼吸机相关肺部感染率分别为14.2‰、6.0‰,尿路插管相关泌尿道感染率分别为4.1‰、2.8‰,分别下降0.3‰、8.2‰、1.3‰;医院感染以呼吸机相关性肺部感染为主,ICU中肝移植重症监护病房感染率最高.结论 ICU前瞻性目标监测是一种科学的监测方法 ,便于及时掌握ICU医院感染动态变化,制定有效感染控制措施,值得借鉴与推广.     

神经外科重症监护病房患者医院感染的分析及对策

目的调查医院神经外科重症监护病房(ICU)患者医院感染的发生率及相关因素,制定相应干预措施。方法对2007年1月~2008年10月收住神经外科重症监护病房的236例患者,住院期间发生医院感染的资料进行回顾性分析。结果236例神经外科患者在ICU住院期间发生医院感染39例,感染率为16.53%;感染47例次,例次感染率为19.92%;发生的首要部位是下呼吸道,其次是泌尿道;医院感染与患者意识障碍、机械通气、侵入性操作、住院时间长有关。结论加强ICU环境管理、严格执行消毒隔离措施、严格管理侵入性操作及合理使用抗菌药物等综合干预措施是预防和控制医院感染的有效途径。     

综合ICU目标性监测的比较分析

目的通过分析综合重症监护病房(ICU)医院感染控制方面存在的问题及改进的重点,进而为提出更好的干预控制措施提供参考。方法对综合ICU 2010—2011年入住患者的医院感染发生情况,呼吸机、中心静脉置管及留置尿管的使用率及相关感染率进行统计分析。结果 2011年较2010年,医院感染率下降显著,感染例次率下降不显著;中心静脉导管使用率增加不显著,而留置导尿管及呼吸机使用率下降显著;同时,对应的导管相关血流感染(CRBSI)及呼吸机相关肺炎(VAP)感染率也呈下降趋势,仅导尿管相关尿路感染(CAUTI)感染率略有增加;医院感染(HAI)患者发生感染时的插管日数比较差别不显著。结论综合ICU导管相关感染率的下降趋势与医院增加的干预及控制措施有关,但仍需进一步加强导管相关性感染的危险因素控制,保证其持续下降。     

重症监护病房医院感染的分析及护理措施

目的探讨重症监护病房(ICU)医院感染的原因和护理措施. 方法对我院ICU所发生的医院感染进行回顾分析. 结果ICU医院感染多见于呼吸道、泌尿系统感染,血管内导管相关感染,切口及烧伤创面的感染. 结论必须加强预防控制医院感染措施,严格执行无菌技术操作,是控制ICU医院感染的主要措施.     

Taking care of the sick and scared: a local response in pandemic preparedness

Virtually all health care operations, including public health, are undertaken only at a local or regional level. Large-scale infectious disease emergencies, such as SARS or pandemic influenza, will be recognized and managed at a local level. The creation of the Public Health Agency of Canada (PHAC) was an important step in strengthening public health capacity. However, we need adequate operational capacity in local public health departments to have a strong public health system. Local public health takes an integral role in the preparation for and management of infectious disease emergencies. Local public health departments and regional public health infrastructures must be positioned to both maintain core functions and to lead and support health sector response to emergencies. The local establishment of a flexible and sustainable emergency management system must address the need to: integrate health care and first responders; provide all-hazards tools for managing a crisis at the frontline; rank service priorities and provide surge resources; and provide accurate information on a timely basis. Only the leaders within the local or regional health care facilities and organizations can develop workable plans to deliver health care. PHAC must ensure and support the local public health infrastructure and local emergency preparedness. Without this support, there will be consequences for local response to major public health emergencies.     

European countries' responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wave

The COVID-19 pandemic has placed unprecedented pressure on health systems’ capacities. These capacities include physical infrastructure, such as bed capacities and medical equipment, and healthcare professionals. Based on information extracted from the COVID-19 Health System Reform Monitor, this paper analyses the strategies that 45 countries in Europe have taken to secure sufficient health care infrastructure and workforce capacities to tackle the crisis, focusing on the hospital sector. While pre-crisis capacities differed across countries, some strategies to boost surge capacity were very similar. All countries designated COVID-19 units and expanded hospital and ICU capacities. Additional staff were mobilised and the existing health workforce was redeployed to respond to the surge in demand for care. While procurement of personal protective equipment at the international and national levels proved difficult at the beginning due to global shortages, countries found innovative solutions to increase internal production and enacted temporary measures to mitigate shortages. The pandemic has shown that coordination mechanisms informed by real-time monitoring of available health care resources are a prerequisite for adaptive surge capacity in public health crises, and that closer cooperation between countries is essential to build resilient responses to COVID-19.     

A country-level analysis comparing hospital capacity and utilisation during the first COVID-19 wave across Europe

BackgroundThe exponential increase in SARS-CoV-2 infections during the first wave of the pandemic created an extraordinary overload and demand on hospitals, especially intensive care units (ICUs), across Europe. European countries have implemented different measures to address the surge ICU capacity, but little is known about the extent. The aim of this paper is to compare the rates of hospitalised COVID-19 patients in acute and ICU care and the levels of national surge capacity for intensive care beds across 16 European countries and Lombardy region during the first wave of the pandemic (28 February to 31 July).MethodsFor this country level analysis, we used data on SARS-CoV-2 cases, current and/or cumulative hospitalised COVID-19 patients and current and/or cumulative COVID-19 patients in ICU care. To analyse whether capacities were exceeded, we also retrieved information on the numbers of hospital beds, and on (surge) capacity of ICU beds during the first wave of the COVID-19 pandemic from the COVID-19 Health System Response Monitor (HSRM). Treatment days and mean length of hospital stay were calculated to assess hospital utilisation.ResultsHospital and ICU capacity varied widely across countries. Our results show that utilisation of acute care bed capacity by patients with COVID-19 did not exceed 38.3% in any studied country. However, the Netherlands, Sweden, and Lombardy would not have been able to treat all patients with COVID-19 requiring intensive care during the first wave without an ICU surge capacity. Indicators of hospital utilisation were not consistently related to the number of SARS-CoV-2 infections. The mean number of hospital days associated with one SARS-CoV-2 case ranged from 1.3 (Norway) to 11.8 (France).ConclusionIn many countries, the increase in ICU capacity was important to accommodate the high demand for intensive care during the first COVID-19 wave.     

Pandemic influenza and hospital resources

Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area. We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support. Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.     

Responding to pandemic influenza: a local perspective

OBJECTIVE: To assess, via a tabletop exercise, the ability of a rural health unit to manage an influenza pandemic. PARTICIPANTS: The exercise brought together community stakeholders including representation from public health, hospitals, long-term care, social services, first responders, morticians, local government and the media. SETTING: Leeds, Grenville and Lanark, a rural region of Ontario. INTERVENTION: In June 2002, exercise participants were presented with a scenario involving the local response to pandemic influenza. Facilitators prepared a framework for the mock emergency in advance. However, the scenario was guided by decisions made by participants and the probable consequences of those decisions. Following the exercise, a debriefing session identified recommendations to be included in future plan development. OUTCOMES: The exercise identified critical issues, including communication, emergency decision-making, vaccination priorization, local surge capacity, and disease containment. Both participants and observers deemed the exercise successful. CONCLUSION: Improvements in the local contingency plan for pandemic influenza were identified. The exercise was an opportunity to familiarize participants with the contingency plan, practice working collectively and identify areas for further planning. The principles and lessons generated from the exercise can be used to guide the response to other large-scale infectious disease outbreaks.     

FluSurge--a tool to estimate demand for hospital services during the next pandemic influenza.

PURPOSE: To assess the impact of pandemic influenza on hospital services. METHODS: Based on census data and estimates of hospital resources (non-ICU [intensive care unit] beds, ICU beds, and mechanical ventilators) in a given area, FluSurge software estimates the number of hospital admissions and deaths due to pandemic influenza under variable duration and virulence scenarios and compares hospital resources needed during a pandemic with existing hospital resources. RESULTS: Sample results from Metropolitan Atlanta illustrate how the next influenza pandemic may overwhelm existing hospital resources, given that hospitals increasingly operate at nearly full capacity. CONCLUSIONS: Hospitals need to consider and plan for a surge in demand for hospital services during the next influenza pandemic.     

Responding to simulated pandemic influenza in San Antonio, Texas.

OBJECTIVE: To describe the results of a simulation study of the spread of pandemic influenza, the effects of public health measures on the simulated pandemic, and the resultant adequacy of the surge capacity of the hospital infrastructure and to investigate the adequacy of key elements of the national pandemic influenza plan to reduce the overall attack rate so that surge capacity would not be overwhelmed. DESIGN: We used 2 discrete-event simulation models: the first model simulates the contact and disease transmission process, as affected by public health interventions, to produce a stream of arriving patients, and the second model simulates the diagnosis and treatment process and determines patient outcomes. SETTING: Hypothetical scenarios were based on the response plans, infrastructure, and demographic data of the population of San Antonio, Texas. RESULTS: Use of a mix of strategies, including social distancing, antiviral medications, and targeted vaccination, may limit the overall attack rate so that demand for care would not exceed the capacity of the infrastructure. Additional simulations to assess social distancing as a sole mitigation strategy suggest that a reduction of infectious community contacts to half of normal levels would have to occur within approximately 7 days. CONCLUSIONS: Under ideal conditions, the mix of strategies may limit demand, which can then be met by community surge capacity. Given inadequate supplies of vaccines and antiviral medications, aggressive social distancing alone might allow for the control of a local epidemic without reliance on outside support.     

Hospital capacity and management preparedness for pandemic influenza in Victoria

Objective : This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. Methods : A prospective study was conducted by questionnaire and semi‐structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone‐based semi‐structured interview (response rate 11/22 = 50%). Results : Rural/regional hospitals demonstrated higher levels of clinical (86%) and non‐clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one‐third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. Conclusions and implications : Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in‐service training to provide staff with confidence in their ability to work safely during a future pandemic.     

A new era of emergency care: planning and design consideration

Emergency care is one of the most complex, rapidly growing areas of ambulatory care. Providers need to consider new issues related to management of low-acuity patients, capacity for surge events, and the need to integrate patient focused care into the emergency department environment. This article explores these issues and discusses basic organizational topologies for facilities.     

Nutritional support of the critically ill. Part II--Guidelines for clinical dietitians.

The second of a two part article, this section focuses on aspects of dietetic practice in a general adult Intensive Care Unit (ICU). Current recommendations for nutritional support are briefly outlined. Techniques of nutritional assessment and monitoring of nutritional support are reviewed, with a case study example taken from actual practice in the ICU at the University of Alberta Hospitals. The results of an audit of nutritional support in ICU patients at the University of Alberta Hospitals are presented. The audit provided documentation of the benefits of expanded dietitian involvement in the nutritional care of adult ICU patients.