提高新生儿科院内感染控制质量的实践及体会

控制医院感染是提高医疗质量、保证医疗安全的核心内容之一。通过提高新生儿科院内感染的控制质量的实践说明，将各项控感制度、措施切实落到实处并持续改进，是有效控制院内感染的保障。     

新生儿院内感染的防治探讨

新生儿科是医院感染监测的重点科室,降低新生儿院内感染是提高新生儿治愈率及降低死亡率的重要措施之一。医院感染不仅延长了患者住院时间,增加了患者的痛苦和费用,甚至可导致患儿死亡,也是造成医疗纠纷的主要原因。文章从管理学角度提出了新生儿科院内感染预防和控制的有效措施。     

新生儿科的院内感染管理

新生儿科院内感染发生影响因素较多。文章主要从新生儿感染发生的特点及原因进行分析,总结新生儿感染管理存在的问题,并提出相应措施。     

新生儿目标性检测在病区一级质控中的应用探讨

目的新生儿科医院感染目标性检测与新生儿科病区一级质控结合,便于院感控制工作在工作中落实,探讨新生儿科/NICU院内感染有效的预防与控制措施。方法按《医院感染监测规范》中新生儿病房医院感染监测的内容,对NICU2011年1月1日—2012年12月31日所有住院新生儿进行目标性监测,对监测结果进行统计分析,2012年1月1日新生儿科医院感染目标性检测纳入新生儿科病区一级质控,按照病区一级质控项目持续改进,追踪。结果 2011年监测新生儿872例,医院感染66例,科室医院感染发病率7.2%;2012年监测新生儿1119例,医院感染35例,科室医院感染发病率3.1%,效果明显。结论新生儿科医院感染目标性检测与病区一级质控结合,便于院感控制工作在工作中落实,能起到新生儿科/NICU院内感染有效的预防与控制。     

PDCA循环在我院重点科室院内感染预防与控制中的应用

目的探讨运用PDCA循环管理法在我院重点科室院内感染控制中的应用效果。我院重点科室包括手术室、产房、新生儿科、消毒供应室。方法将本2014年用PDCA循环法管理的情况同2013年未采用PDCA循环法管理的情况进行对比分析,对实施前后手术切口感染率、新生儿科院内感染发生率、会阴侧切感染率、空气采样合格率、物表采样合格率、医护人员手卫生依存性进行对比。结果 2013年与2014相比手术切口感染率由0.84%下降至0.24%,新生儿科院内感染发生率由0.76%下降至0.29%,会阴切口感染率由0.97%下降至0.56%,空气采样合格率由99.1%提升至99.7%,物表采样合格率由99.3%提升至100%,手卫生依存性由50.9%提升至80.1%结论 PDCA循环管理方法应用到重点科室院感质控工作中后能够推进医院感染预防与控制工作科学、规范、可持续发展,从而能够主动地、积极地制定有效的措施降低了医院感染的各种危险因素,有效降低了我院院内感染的发生率,保障了我院医疗护理质量,维护了患者的生命安全。     

新生儿医院感染防治对策探讨

探讨新生儿院内感染常见部位及病原体类型,加强其预防控制与管理,有效控制新生儿院内感染的发生。方法：对新生儿科2007年1月~2013年1月住院的新生儿发生院内感染的部位、病原体类型及原因进行回顾性分析。结果：新生儿院内感染常见部位为呼吸道、胃肠道、血液,病原体主要为革兰阴性菌和轮状病毒,早期发现、及时治疗是抢救新生儿重症院内感染的关键。结论：应对新生儿院内感染应从预防、控制两方面采取相应措施。     

新生儿院内感染的原因分析与应对策略研究

目的了解新生儿院内感染发生的现状,分析其原因,并提出政策建议。方法采用文献分析法,掌握新生儿发生院内感染的特殊原因,分别从新生儿自身的特殊性、新生儿科室的特殊性、新生儿治疗的特殊性3方面探讨,归纳得出新生儿科易发生院内感染的原因。结果新生儿免疫力低,新生儿病房布局合理性差、护理人员数量不足、防感意识差,新生儿治疗时侵入性操作多、医护人员与患儿接触频繁、滥用抗生素等。结论应对新生儿院内感染应从预防、发生、结束3个方面来采取相应措施。     

新生儿科住院患儿医院感染病原学特点、危险因素及预防对策分析

目的探究新生儿科住院患儿医院感染的病原学特点及危险因素,进一步形成有效预防对策。方法选择2015年10月-2016年10月医院新生儿科收治的3370例新生儿作为研究对象,回顾分析胎龄、出生体质量、侵入性操作、感染前使用抗菌药物或激素、喂养方式、分娩方式、住院时间等资料,探究病原学特点,并对新生儿院内感染的危险因素进行单因素及多因素分析,形成有效预防对策。结果 3370例新生儿共发生医院感染60例,感染率为1.78%;共培养病原菌60株,其中革兰阴性菌38株占63.33%,以肺炎克雷伯菌为主,革兰阳性菌19株占31.67%,以葡萄球菌为主,真菌3株占5.00%;多因素logistic研究结果显示,胎龄<37周、非自然分娩、出生体质量<2500g、肠外营养、侵入性操作、住院时间长以及感染前使用抗菌药物或激素等,是新生儿院内感染的独立危险因素。结论通过对新生儿院内感染临床资料分析,探究病原学特点和危险因素,总结有效预防措施,以减少新生儿院内感染。     

小儿院内肺部感染状况监测分析

为了解小儿院内肺部感染状况,探讨感染发生的危险因素及预防措施,以有效控制和预防小儿院内肺部感染的发生,湖北省妇幼保健院对2005年1月～2006年12月分别在新生儿科、儿内科、小儿神经康复科住院患儿进行了监测,现将结果报告如下.     

手术空气中青霉菌污染的来源和清除措施

曾有报道丝状真菌可引起免疫功能低下,病人院内感染的爆发流行,常由丝状真菌严重地污染医院空气所致,多数与曲霉菌有关,但也有青霉菌引起的感染。本文作者发现其所在的医院由曲霉菌引起的院内感染爆发时,病区空气中均发现大量真菌孢子,并在医院供暖设备、通风设备及手术室空调系统发现大量青霉菌。医院的中心空调系统是外面的空气进入该系统     

新生儿肠道病毒医院感染28例分析

目的分析2006年夏季肠道病毒医院感染的临床特点及暴发流行严重程度。方法聚合酶链反应法(PCR)进行病原学检测,对28例肠道病毒医院感染新生儿病例进行回顾性分析,总结临床症状、病情轻重及转归。结果此次肠道病毒医院感染暴发流行持续>1个月,医院感染发生率达6.4%;22例(78.6%)的患儿首发症状为发热;14例(50.0%)静脉血/脑脊液检测到肠道病毒,根据接触史、临床症状等,28例临床诊断为肠道病毒感染,其中10例(35.7%)为病毒性脑膜炎,9例(32.1%)新生儿肺炎,1例(3.6%)肝脏损害,2例(7.1%)心肌损害,全部患儿均好转或治愈出院。结论此次发生于夏季的肠道病毒医院感染病情相对轻,临床经过良好,经治疗避免了医院感染暴发流行。     

Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality.

We describe a case-control study of a small outbreak of nosocomial sepsis and pneumonia with high mortality due to clonal dissemination of a multiresistant Klebsiella pneumoniae in the neonatal intensive care unit of a Mexican institution. Our study helped to change nosocomial infection control policy in this hospital.     

Nosocomial ringworm in a neonatal intensive care unit: a nurse and her cat.

An outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.     

医院感染暴发某致病菌的原因调查及预防

目的 探讨预防和控制铜绿假单胞菌医院感染暴发的途径。方法 通过对近10年来发生的铜绿假单胞菌医院感染暴发事件的原因进行分析。结果 正确认识是前提,领导重视是关键,全员参与是基础,监测到位是途径,正确处理是保证。结论 铜绿假单胞菌医院感染暴发可防可控。     

A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme

An abrupt and persistent 30% increase in the rate of nosocomial infections was detected at a university teaching hospital after a prolonged period with a relatively constant nosocomial infection rate. Demographic data, risk factors for nosocomial infection, features of reported cases of nosocomial infection, and policy and procedure changes were evaluated for the periods of 1 January 1997 to 30 April 1998 (endemic period) and 1 May to 31 December 1998 (epidemic period). An extensive outbreak investigation revealed no evidence of a true outbreak of nosocomial infection. The apparent outbreak involved all four major body sites, began during the same month that an antibiotic management programme was started, involved the same adult medical and surgical units where antibiotics were being controlled, and occurred months before any significant change in antibiotic usage. A greater proportion of nosocomial infection during the epidemic period was reported by the nosocomial infection surveillance nurses, based on a treating physician's diagnosis rather than on specific clinical criteria. In an attempt to justify existing antibiotic prescribing practices after the implementation of an antibiotic management programme, clinicians altered the threshold at which they documented the presence of nosocomial infection. This change in documentation produced a large pseudo-outbreak of nosocomial infection.     

Use of palivizumab to control an outbreak of syncytial respiratory virus in a neonatal intensive care unit

To evaluate the safety and effectiveness of a humanized respiratory syncytial virus (RSV) monoclonal antibody (palivizumab) to control an outbreak of RSV in a neonatal intensive care unit (NICU), we retrospectively analysed two RSV outbreaks. Between 11 November 1998 and 18 March 1999, two separate RSV outbreaks occurred in a large (26 beds) NICU. All procedures for preventing nosocomial spread of RSV (including the use of palivizumab in the second outbreak) were retrospectively analysed. The cumulative incidence (CI), secondary attack rate (SAR) and risk ratio of infection were determined before and after the use of palivizumab for all patients and for those with gestational age below and above 32 weeks in the NICU during the second outbreak. Standard infection control measures were effective in the first outbreak (three cases). In the second outbreak, after three index cases, five additional infants were newly RSV-infected within one month. Three infants had RSV pneumonia and required mechanical ventilation; one infant died. Standard infection control procedures were initiated from the beginning of this outbreak. Palivizumab was given to all infants in the NICU after the fifth case was identified. CI was 2.4% in the first 15 days and 10.5% in the second, and SAR was 2.9 per thousand in the first 15 days and 14.1 per thousand in the second, both dropping to zero after the administration of palivizumab. The risk ratio of infection was 4.65 times higher in infants under 32 weeks gestational age. After the use of palivizumab, there were no additional identified cases. In addition to careful infection control procedures, the use of palivizumab might have contributed to arresting the outbreak of RSV infection in the NICU, suggesting that it could be an additional resource in the control of severe nosocomial RSV outbreaks.     

基层医院新生儿感染因素分析及防控对策

目的探讨分析造成新生儿医院感染的因素,为加强新生儿医院感染管理提出规范化建议。方法根据医院感染管理相关文献,采用临床调查和管理层分析法,明确造成新生儿医院感染主要因素。结果通过增强医务人员医院感染控制意识,合理使用抗菌药物,提高医护人员洗手依从性,加强新生儿病房管理,可以降低新生儿的医院感染率。结论新生儿医院感染与多种因素有关,但只要合理而全面实施有效的医院感染管理对策,可以使之得到有效预防与控制。     

Nosocomial outbreak of Enterobacter gergoviae bacteraemia in a neonatal intensive care unit

A nosocomial outbreak of bacteraemia, caused by Enterobacter gergoviae infected 11 babies, nine of whom were premature, and was investigated in the neonatal intensive care unit (NICU) of a general hospital in Johor Bahru, Malaysia. The strain that was isolated from the babies was also isolated from the dextrose saline used for the dilution of parenteral antibiotics and from the hands of a healthcare worker on duty in the nursery. Pulsed-field gel electrophoresis (PFGE) of Xba I-digested chromosomal DNA confirmed a possible cross-contamination of parenteral dextrose saline and the healthcare worker. Prompt and effective control measures were initiated within NICU and the nosocomial infection of E. gergoviae was brought to an abrupt end. To the best of our knowledge, this is the first documented outbreak of E. gergoviae in the NICU in a hospital in the state of Johor, Malaysia.     

Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus

Some have reported that adopting Centers for Disease Control and Prevention guidelines requiring contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) had no impact on rates of nosocomial spread or infection, and may therefore waste money. The objective of the present study was to evaluate the cost-effectiveness of active surveillance cultures and barrier precautions for controlling MRSA. Estimated costs of surveillance cultures and isolation measures used during an MRSA outbreak at this hospital were compared with the estimated attributable excess costs of methicillin resistance (i.e., the difference between MRSA and methicillin-sensitive S. aureus costs) for bacteraemias occurring during an MRSA outbreak not promptly controlled at another hospital. The study was set in the neonatal intensive care units of two tertiary care hospitals. Estimated costs of controlling the 10.5-month outbreak in this neonatal intensive care unit that resulted in 18 colonized and four infected infants ranged from $48 617 to $68 637. The estimated attributable excess cost of 75 MRSA bacteraemias in a second neonatal intensive care unit outbreak that resulted in 14 deaths and lasted 51 months was $1 306 600. Weekly active surveillance cultures and isolation of patients with MRSA halted an outbreak at this hospital, and cost 19- to 27-fold less than the attributable costs of MRSA bacteraemias in another outbreak that was not promptly controlled. The costs of infections at other body sites and the human cost of deaths from infection were not estimated but would further help to justify the cost of identifying colonized patients and implementing effective preventive measures.