外科重症监护室多重耐药菌医院感染控制效果研究

目的了解通过采取综合控制措施,外科重症监护室(SICU)多重耐药菌(MDROs)医院感染控制效果。方法对2007年1月1日—2010年12月31日检验科报告的所有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β-内酰胺酶大肠埃希菌及肺炎克雷伯菌、多重耐药鲍曼不动杆菌(MDR-Ab)阳性的SICU住院患者进行调查。2008年7月1日—2010年12月31日,采用前瞻性方法调查,并对感染及定植患者采取"Bundle"控制措施(如手卫生、单间隔离、戴手套、穿隔离衣等)。2007年1月1日—2008年6月30日,对住SICU且上述5种病原体阳性患者(未采取"Bundle"控制措施)的病历进行回顾性调查,调查内容相同,分析采取"Bundle"控制措施的效果。结果 2007年1月1日—2010年12月31日SICU共收治3 526例患者,11 207患者住院日,共发生104例次MDROs感染,其中ICU相关的感染65例次(62.50%),非ICU相关的感染39例次(37.50%)。随着"Bundle"控制措施的有效落实,ICU相关感染明显下降(18.75%),以MRSA和MDR-Ab医院感染控制效果最为显著(均P<0.05)。结论 SICU内MDROs医院感染严重,通过采取"Bundle"控制措施,ICU相关感染能得到有效控制。     

综合医院多药耐药菌医院感染控制效果的研究

目的了解某综合医院多药耐药菌(MDROs)医院感染的控制效果。方法对2005年1月-2010年12月某院所临床培养出MDROs的住院患者进行调查;2008年7月-2010年12月采取前瞻性调查方法,并对感染及定植患者采取组合式(Bundle)控制措施,包括手卫生、隔离、戴手套、穿隔离衣等;2005年1月-2008年7月采取回顾性调查方法,但其调查内容与调查表、诊断标准等与前瞻性调查方法相同,分析综合控制措施的效果。结果 2005年1月-2010年12月共收治243 744例患者,3 084 182患者住院日,发生2279例次MDROs感染,包括医院发病的感染(HOI)1025例次,占44.98%,社区发病的感染(COI)1254例次,占55.02%;多元线性回归分析显示,在排除MDROs-HOI的影响后,采取控制措施可有效降低MDROs-HOI感染率,以外科控制效果最为显著。结论采取预防控制措施可有效防止MDROs在医院内的传播。     

3年MRSA医院感染预防控制行动效果

目的调查某院耐甲氧西林金黄色葡萄球菌(MRSA)医院感染获得情况,了解医院感染控制措施的成效。方法采取一系列感染控制综合措施,同时分析2008-2010年每千住院日MRSA医院感染发病率和每住院日手卫生用品用量,比较两者关系。结果该院MRSA千住院日医院感染获得率,2008年为0.41‰,2009年为0.30‰,2010年为0.27‰,3年逐年下降,差异有统计学意义（χ2=18.918,P=0.000）;每住院日手卫生用品用量呈逐年上升趋势（11.36～27.41 mL/住院日）,但差异无统计学意义（F=0.108,P=0.750）;每千住院日MRSA医院感染获得率和每住院日手卫生用品用量之间无相关关系（F=0.022,P=0.886）。重症监护室（ICU）MRSA千住院日医院感染获得率,2008年为2.13‰,2009年为1.99‰,2010年为2.20‰,3年差异无统计学意义（χ2=0.178,P=0.915）。结论该院MRSA千住院日医院感染获得率逐年下降并非是手卫生用品用量增加单一因素的结果,而是综合感染控制措施的成效;ICU感染控制措施有一定成效,但并不乐观,ICU MRSA以及其他耐药菌的预防与控制仍是工作重点。     

耐甲氧西林金黄色葡萄球菌医院感染及社区感染的流行特点

目的了解住院患者中耐甲氧西林金黄色葡萄球菌(MRSA)医院感染及社区感染的流行特点,为积极预防和控制MRSA的感染与传播提供科学依据。方法 2008年7月1日-2010年12月31日,由专职人员每天根据细菌培养结果按照统一的方法到病房对患者进行前瞻性调查,2005年1月1日-2008年6月30日对金黄色葡萄球菌培养阳性住院患者进行回顾性调查。结果 MRSA医院感染率为0.10‰,入院患者中MRSA社区发病的感染率为1.40‰;医院感染中MRSA感染率为70.40%,显著高于社区感染感染率为46.04%(P<0.001);MRSA感染主要发生在重症监护病房(ICU)、内科及干部病房,呼吸系统的感染;MRSA感染率最高的是ICU和干部病房,>80.0%,呼吸系统和泌尿系统的感染。结论金黄色葡萄球菌耐药状况在医院内形势依然严峻,预防与控制MRSA感染重点在ICU、内科及干部病房,主要发生在呼吸系统的感染。     

耐碳青霉烯类鲍氏不动杆菌感染医院内流行现状与预防控制

目的 了解耐碳青霉烯类鲍氏不动杆菌(CR-ABA)感染医院内流行现状,探讨CR-ABA医院感染预防控制措施.方法 前瞻性调查2011年1月-2012年12月住院患者感染鲍氏不动杆菌(ABA)情况,判断其感染类型及分析CR-ABA感染特征,采取感染预防控制措施,并观察其效果.结果 共调查ABA感染患者258例次,其中CR-ABA院内感染192例,占74.42％,发生在ICU 116例,占全院的60.42％,下呼吸道CR-ABA感染147例,占感染的76.56％;2011-2012年社区感染率从0.67/千出院例数升高至1.20/千出院例数,而医院感染率从0.77/万住院日数降至0.71/万住院日数,社区感染显著升高而医院感染有所下降.结论 CR-ABA预防控制形势严峻,ICU为预防控制重点部门,下呼吸道感染为主要的预防控制感染部位,感染综合预防控制措施有效.     

综合预防性护理对神经内科医院感染发生的影响

神经内科是医院感染的高危科室之一,患者大多数发病急、病情重、病程长,易受病原菌侵袭造成医院感染.为了有效控制神经内科医院感染发生率,我科于2010年1月采取综合预防性护理措施,收到良好的效果.现报道如下. 1 资料与方法 1.1 临床资料2009年1-12月和2010年1-12月我院神经内科所有住院患者. 1.2 方法与标准 专职医师及护士动态监测住院患者,根据《医院感染诊断标准》确定为医院感染患者,填写医院感染报告表.对2009年1-12月实施传统一般性护理阶段住院患者1012例(对照组)和2010年1-12月实施综合预防性护理阶段住院患者1026例(观察组),分别进行医院感染病例调查统计,并做比较分析.     

MRSA医院感染及耐药性研究

目的 了解耐甲氧西林金黄色葡萄球菌(MRSA)医院感染及耐药性的情况.方法 采用回顾性调查方法,对医院在2008年1月-2010年12月住院期间确诊为MRSA医院感染的患者进行分析.结果 MRSA医院感染133例,149例次,其中下呼吸道感染105例,占70.5％,菌血症8例,占5.4％,表浅切口7例,占4.7％;多集中在神经外科、综合ICU和干部病房;未发现对万古霉素、替考拉宁、利奈唑胺耐药株.结论 MRSA是医院感染的重要致病菌,了解其临床分布,加强耐药监测,规范临床用药,可有效预防耐药菌的产生.     

新生儿医院感染原因分析与预防

为了解新生儿医院感染的发生率和危险因素,为医院感染部门制定预防控制措施提供依据.笔者对2010年1-12月住院新生儿发生医院感染的原因进行回顾性调查.1资料与方法1.1 临床资料选取2010年1月1日-12月31日住院新生儿1066例,其中男668例,女398例,日龄为出生1 h～28 d.1.2研究方法采用流行病学回顾性调查方法,对调查期间病案室的每份新生儿出院病历进行筛查.对发生医院感染的病例,统一登记整理,统计与分析.     

帕金森病患者医院感染临床分析

目的 分析帕金森病患者的医院感染情况,探讨其相关因素,以采取有效的控制措施.方法 对2008年1月1日-2010年12月31日神经内科出院的165例帕金森病患者的医院感染情况进行回顾性调查分析.结果 医院感染17例25例次,感染率为10.30％,例次感染率为15.15％;多发生在住院2周内;呼吸道感染最多,占55.43％,其次为泌尿道,占24.00％;共分离出33株病原菌,居首位的为肺炎克雷伯菌,占42.42％;年龄、病程、侵入性操作、抗菌药物预防性应用、住院天数、血浆白蛋白与医院感染的发生相关.结论 帕金森病患者的医院感染发生率高,应重视医院感染的相关因素,采取预防治疗措施,减少医院感染发生率,促进患者康复.     

重症监护室实施导管相关感染预防干预措施效果

目的了解某院重症监护室(ICU)实施导管相关感染预防措施后的效果。方法对2006 年1月-2007年12月与2008年1月-2009年12月入住ICU的患者,采用目标性监测方法监测医院感染发病情况,并于2008-2009年采取导管相关感染干预措施,以患者平均病情严重程度调整法(ASIS)调整医院感染发病率。结果采取干预措施后,经ASIS调整后的日感染例次发病率由2006-2007年的5.77‰下降至2008-2009年的3.63‰;导管相关感染率均有不同程度下降,其中普通外科ICU呼吸机相关肺炎发生率下降幅度最大,由2006-2007年的10.53‰下降至2008-2009年的4.79‰。结论在ICU采取医院感染预防干预措施能明显降低感染率。     

重症监护病房耐甲氧西林金黄色葡萄球菌感染的预防与控制

目的 调查分析医院重症监护病房(ICU)患者耐甲氧西林金黄色葡萄球菌(MRSA)交叉感染的原因,并探讨预防控制对策.方法 对2008年6月25日-8月1日ICU感染MRSA的两例患者进行病原学检查及环境卫生学监测.结果 从ICU医务人员手、床头桌、负压吸引器开关旋钮、墙壁供氧装置开关旋钮、吸痰用生理盐水等均检出MRSA,分离率分别为37.5%、20.0%、54.5%、37.5%、87.5%.结论 ICU患者易感染MRSA,该细菌耐药性强,治疗困难,可通过合理用药,严格无菌操作、加强消毒隔离措施可预防及控制交叉感染.     

Pre-emptive contact precautions for intubated patients reduced healthcare-associated meticillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit

Healthcare-associated infection by meticillin-resistant Staphylococcus aureus (MRSA) is still a great concern in an intensive care unit (ICU). Our surveillance data in the ICU revealed that intubated patients were at eight times higher risk of acquiring MRSA than non-intubated patients, so we hypothesised that pre-emptive contact precautions for all intubated patients would prevent healthcare-associated infection by MRSA in the ICU. Patients staying in our ICU for >2 days were included in this study. The study period was divided into two periods. During 2004 (1st period), contact precautions were performed only for patients with MRSA. During 2005-2007 (2nd period), contact precautions were applied to all intubated patients regardless of MRSA infection status. Patients were defined as MRSA-positive on admission when MRSA was detected by surveillance or clinical culture on enrolment. Other MRSA-positive results?were defined as healthcare-associated MRSA (HA-MRSA) transmission. HA-MRSA infection was diagnosed according to the National Nosocomial Infections Surveillance Manual. The 1st period comprised 415 patients, and the 2nd period comprised 1280 patients. In intubated patients, HA-MRSA infection rate decreased significantly in the 2nd period (1st period 12.2%, 2nd period 5.6%; P=0.015). HA-MRSA infection of all patients decreased from 3.6 to 2.3?incidents per 1000 patient-days (P<0.05), despite a significant increase in the rate of patients MRSA positive on admission in the 2nd period (1st period 2.9%; 2nd period 6.1%). Pre-emptive contact precautions for intubated patients would be helpful in reducing HA-MRSA infection in ICU.     

Characteristics of hospital patients colonized with livestock-associated meticillin-resistant Staphylococcus aureus (MRSA) CC398 versus other MRSA clones

Meticillin-resistant Staphylococcus aureus (MRSA) associated with the clonal complex (CC) 398 has emerged among livestock and humans exposed to these animals. MRSA CC398 has so far contributed relatively little to spread of MRSA and the burden of disease in the healthcare setting. This study aimed to assess whether demographic and clinical differences in patients colonized with MRSA CC398 and those carrying other MRSA clones contribute to the observed differences in transmission and infection rates. Age, sex, length of stay (LOS), diagnoses and medical procedures were assessed in all patients with MRSA admitted to a university hospital in 2008 and 2009. S.?aureus protein A gene (spa) typing was performed on the first MRSA isolate from each patient. Patients colonized or infected with MRSA that had spa types indicative of CC398 (MRSA CC398) were compared with patients who had other MRSA clones (MRSA non-CC398). Age (53 vs 59 years), mean LOS (8 vs 13 days) and percentage of patients admitted to an intensive care unit (12% vs 17%) differed significantly between MRSA CC398 and MRSA non-CC398 patients, respectively. The mean numbers and types of diagnoses and medical procedures performed for patients in these two groups also differed significantly. The differences in patient characteristics could explain, at least in part, the relatively low rates of transmission and infection associated with MRSA CC398 in the healthcare setting.     

Infection control and meticillin-resistant Staphylococcus aureus in nursing homes in Oslo

Healthcare workers (HCWs) might be important in reducing healthcare-associated infections but infected or colonised HCWs may still spread pathogenic microbes to others. Norwegian policies for infection control in healthcare environments emphasise infection control programmes for both patients and HCWs. In this study, HCWs from 42 of 55 nursing homes in Oslo participated in an investigation concerning the implementation of infection control programmes during 2006-2007. Three separate questionnaires were used: the first aimed at nursing staff (enrolled nurses and assisting staff); the second for ward sisters; and the third for institution managers. Nearly 70% of the nursing homes had policies for controlling infection and transmission of meticillin-resistant Staphylococcus aureus (MRSA). About 60% of the institutions had policies for tracing MRSA infections. Four of five ward sisters tested patients for MRSA when wounds were not healing, when admitted from hospitals overseas, when patients shared a room with an MRSA-infected patient, or if patients had ever been MRSA positive. Two of five sisters would test patients with chronic urinary tract infection or patients admitted from another hospital. Among nursing staff, one out of five had cared for MRSA-positive patients. Only 4% of the staff had worked in healthcare institutions abroad, and only a few of them had been tested for MRSA. Almost 20% of the responding nursing staff worked at several institutions at the same time.     

Community-associated Methicillin-Resistant Staphylococcus aureus Strains in Pediatric Intensive Care Unit

Virulent community-associated methicillin-resistant Staphylococcus-aureus (CA-MRSA) strains have spread rapidly in the United States. To characterize the degree to which CA-MRSA strains are imported into and transmitted in pediatric intensive care units (PICU), we performed a retrospective study of children admitted to The Johns Hopkins Hospital PICU, March 1, 2007–May 31, 2008. We found that 72 (6%) of 1,674 PICU patients were colonized with MRSA. MRSA-colonized patients were more likely to be younger (median age 3 years vs. 5 years; p = 0.02) and African American (p<0.001) and to have been hospitalized within 12 months (p<0.001) than were noncolonized patients. MRSA isolates from 66 (92%) colonized patients were fingerprinted; 40 (61%) were genotypically CA-MRSA strains. CA-MRSA strains were isolated from 50% of patients who became colonized with MRSA and caused the only hospital-acquired MRSA catheter-associated bloodstream infection in the cohort. Epidemic CA-MRSA strains are becoming endemic to PICUs, can be transmitted to hospitalized children, and can cause invasive hospital-acquired infections. Further appraisal of MRSA control is needed.     

Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures

Since the 1980s, methicillin-resistant Staphylococcus aureus (MRSA) has been identified as a significant infectious agent with an increasing incidence within both hospitals and the community. The aim of this study was to measure the incidence of MRSA colonization in patients admitted with a neck of femur fracture requiring implant surgery and to assess the outcome of these cases. We also sought to identify any risk factors associated with MRSA colonization, and to assess the need for any prophylactic treatment to prevent postoperative MRSA infection. Nasal, perineal and (where present) wound site swabs were taken on a sequential series of patients admitted with a neck of femur fracture who required a surgical implant. The presence of MRSA isolates from these swabs and the presence of a significant postoperative infection in both the colonized and non-colonized patients were recorded. A total of 66 patients were enrolled in the study, of whom 63 had surgical treatment for their fracture. A total of four patients were found to be colonized with MRSA. Of the study group, 27 patients had been admitted to hospital in the previous year, three of whom were found to be colonized with MRSA. Four of the patients were noted to have a postoperative infection-all of these cases were in the non-colonized group. The incidence of MRSA colonized patients in this series was 6%-a figure broadly consistent with previous studies. This does not appear to justify the routine screening of all neck of femur fracture admissions, though the results do suggest that a selective policy of screening only those who patients who had been admitted to hospital within the last year may be profitable. Our study does not appear to show any correlation between MRSA colonization and postoperative infection however. This is consistent with previous studies and does not support the adoption of an aggressive strategy for detection or eradication of MRSA prior to neck of femur fracture surgery.     

Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients,on admission to a Welsh hospital

Nosocomial infection with methicillin-resistant Staphylococcus aureus (MRSA) is on the increase and expensive to treat. Because surgical wound infection is one of the most frequent MRSA-induced infections with often disastrous consequences, it was decided to estimate the incidence and risk factors of MRSA colonization in surgical patients. All patients admitted to general surgical and orthopaedic wards were studied prospectively. At the time of admission, a detailed questionnaire was completed, nasal swabs and swabs of any pre-existing wound sites in each patient were sent for culture. Of 430 patients studied, 23 patients were positive for MRSA on admission. The prevalence of MRSA colonization in this study was 5.3% of whom 15 (65%) were nasal carriers and eight (35%) had MRSA colonization elsewhere. All nasal MRSA carriers had at least one documented hospital admission in the preceding year. Among the MRSA-positive patients, 10 (43%) either were admitted directly from, or had been previously admitted to, a nursing home. MRSA remains mainly a hospital-acquired infection although a significant proportion is acquired in the community. The risk factors identified were previous hospital admission, patients from nursing homes, male and aged over 70.     

Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit

Between June 1985 and March 1986, 14 cases of severe nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection, including septicemia, were observed in the intensive care unit (ICU) of a 400-bed cancer reference center. Simple control measures including contact isolation of colonized patients and reinforcement of handwashing practices among personnel were followed by a sharp decrease in the rate of infection and colonization. An epidemiological investigation showed that a single serophage variant MRSA strain was involved; peak incidence of infection was 17 per 100 ICU patient discharges; the index case was identified as a patient admitted from another hospital and the epidemic strain was then transmitted from patient-to-patient in the ICU; risk factors for acquiring infection were length of prior hospitalization, invasive procedures and number of antibiotic treatments; dissemination of the strain to other wards was only anecdotal. These results stress the effectiveness of simple measures to control outbreaks of MRSA nosocomial infections even in immunocompromised cancer patients.     

Prevalence of MRSA among Staphylococcus aureus isolated from hospital inpatients, 2005: report from the Australian Group for Antimicrobial Resistance

The Australian Group for Antimicrobial Resistance conducted a survey of the prevalence of antimicrobial resistance in unique clinical isolates of Staphylococcus aureus from patients admitted to hospital for more than 48 hours. Thirty-two laboratories from all states and territories collected 2,908 isolates from 1 May 2005, of which 31.9% were methicillin-resistant Staphylococcus aureus (MRSA). The regional prevalence of MRSA varied significantly (P < 0.0001) from 22.5% in Western Australia to 43.4% in New South Wales/Australian Capital Territory. Prevalence of MRSA from individual laboratories varied even more from 4% to 58%. This variation was explained in part by distribution of age with the risk of MRSA significantly (P < 0.0001) increasing with age. Other unmeasured factors including hospital activity and infection control practices in the individual institution may have also contributed. Further investigation is warranted as reductions in prevalence would reduce morbidity, mortality and healthcare costs.     

Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates.

OBJECTIVE: To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital. DESIGN: A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA. Risk factors associated with the likelihood of MRSA colonization on admission were investigated. SETTING: Tertiary-care military medical facility. PARTICIPANTS: All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion. RESULTS: Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns. CONCLUSIONS: Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.