重症监护病房鲍曼不动杆菌医院感染暴发调查与对策分析

目的：对发生于重症监护病房（ICU）的鲍曼不动杆菌（ABA）医院感染暴发进行调查,为控制医院感染提供依据和对策。方法按《医院消毒技术规范》要求进行采样和细菌培养,对患者、环境来源菌株进行细菌鉴定和药敏试验。结果环境中ABA检出率从高到低依次为吸痰小瓶（88．9％）、护工手（60．0％）、呼吸机回路（37．5％）、医务人员手（28．0％）、床头桌面（25．0％）、鼻拭子（13．3％）、设备按钮（12．5％）、医务人员工作服（12．0％）、工作人员拖鞋底（6．7％）。患者痰标本和医院环境中分离到的ABA具有相同的耐药菌谱。此次感染暴发的感染源为1例ABA感染患者,暴发原因为呼吸机回路非一次性使用和医护人员手卫生依从性差。结论规范医务人员操作行为、严格无菌技术、加强病房环境管理、提高医护人员手卫生依从性,能有效预防和控制医院感染。     

医护人员手卫生行为教育依从性的调查研究

目的 改善临床医护人员手卫生状况和提高手卫生行为教育的依从性。方法 根据手卫生的要求设计了调查表,对全市22所医院的2360名医护人员进行了问卷调查,收回有效问卷2219份。结果 手卫生的依从性较差：医护人员中有潜在血液接触中洗手只占22．49％;接受过相关知识教育的医护人员中有潜在血液接触中洗手占42．09％。医护人员通过不同渠道获取手卫生相关知识的仅占89．96％,仍有225人对手卫生知识知之甚少（占10．14％）。洗手中肥皂干燥保存的仅占36．36％,快速手消毒剂的提供率占45．45％。结论 完善医院手卫生设施,提供快速手消毒剂,加强手卫生知识教育,提高医护人员对手卫生重要性的认识,强化对手卫生知识的管理力度,才能有效提高医护人员手卫生的依从性。     

ICU耐甲氧西林金黄色葡萄球菌快速监测及防控

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)在ICU的定植、分布及其防控效果。方法新进入ICU病房患者即刻采鼻前庭拭子和72h后符合呼吸道感染指针患者的吸痰导管标本。采用荧光PCR快速检测mecA、nuc基因。并定期对医护人员鼻腔、手等相关环境标本跟踪监测防控。结果 MRSA阳性率检出率:患者鼻前庭拭子为9.9%,吸痰导管为2.7%;医护人员鼻前庭拭子为7.1%、手为4.0%、袖口为4.4%;MRSA阳性医护人员与患者鼻腔采用莫匹罗星擦拭,手加强消毒后MRSA检出率均为0.0%,但每季度医护人员鼻腔MRSA仍有检出。结论 PCR方法阳性率明显高于常规培养方法。鼻腔前庭是MRSA的主要定植部位,是主要感染源,手是重要传播途径,监测重症监护室患者鼻腔前庭及医护人员的鼻腔前庭、手是控制MRSA院内感染的重要防控目标。     

医护人员手卫生状况的研究进展

综述了医护人员手卫生的研究现状,主要包括手卫生的重要性、医护人员手部带菌情况以及医护人员手卫生存在的问题,认为医护人员正确的洗手方法可有效提高手卫生的质量,对控制和预防医院感染具有积极的意义,是降低医院感染最基本、最简单、最直接、最有效的措施。加强医护人员手部卫生管理、提高医护人员洗手的依从性及保证患者安全,能够有效改善手卫生现状,降低医院交叉感染的发生率。     

儿童医院ICU动态环境下细菌分布及控制对策

目的：调查儿童医院重症监护室（ICU）内在动态（工作状态）环境下细菌种类及分布情况,为医院感染控制提供依据。方法：在动态环境下,按照消毒技术规范、医院感染控制相关要求对病区电脑键盘、听诊器、病历夹、监护仪按键、吸痰管接口、拍背器、电话、医护人员双手等10个项目进行采样。结果：共送检标本330份,细菌阳性检出率为28.18%,以电话（54.55%）、拍背器（42.42%）、手消毒剂按钮（39.39%）、键盘（36.36%）细菌分布较高;细菌主要为表皮葡萄球菌,占63.44%,其余为肺炎克雷伯菌、链球菌属、铜绿假单胞菌、鲍氏不动杆菌、枯草杆菌等,但所占比率均较低。结论：ICU的细菌阳性检出率较高,医护人员应加强手卫生的依从性,保洁员要按要求做好卫生清洁工作,从而减少医院感染的发生。     

临床医护人员手卫生研究进展

综述了临床医护人员手卫生的研究进展,主要从手卫生的研究现状、影响因素、提高手卫生依从性的措施方面进行阐述。认为加强临床医护人员手卫生的培训,自觉提高洗手依从性,是切断医院内感染途径和保证护理安全的重要措施。     

医院医护人员手卫生管理措施

目的强化医护人员手卫生管理措施,控制医院感染。方法通过规范手卫生方法,加强手卫生知识培训,完善洗手设施。结果规范统一了医护人员洗手方法,制定出手卫生制度,明确了医院感染管理手卫生的责任,提高了手卫生消毒质量。结论充分认识到医护人员手卫生的重要性,强化了手卫生管理。     

综合干预在ICU医务人员洗手依从性中的应用

目的:探讨综合干预管理措施对ICU医务人员洗手依从性的影响.方法:以我市3所三级综合医院ICU138名临床医务人员作为研究对象,2008年1～6月的68名医护人员为对照组,不采用综合干预;2008年7～12的70名医护人员为观察组,实施综合干预.比较干预前后医务人员的手卫生认知、手卫生执行率、洗手方法正确率、干预前后手细菌培养.结果:干预前后医务人员的手卫生认知、手卫生执行率和洗手方法正确率、手细菌培养、ICU院内感染率比较差异有统计学意义(P<0.01,P<0.05).结论:个体、机构、环境三个方面的综合干预管理措施能有效提高医务人员手卫生认知,提高医务人员的洗手依从性,降低ICU院内感染的发生.     

综合干预措施提升ICU医护人员手卫生依从性

目的观察综合干预措施对提升ICU医护人员手卫生依从性的效果。方法成立质量改进小组,通过增加速干手消剂的设置点、开展手卫生运动、评选洗手之星、设置洗手提示标识、定期宣教等综合措施提升ICU医护人员手卫生依从性。结果实施综合干预措施后,医生、护士手卫生依从性较干预前期均有提高。结论综合干预措施能有效提高医护人员手卫生依从性。     

ICU中心静脉导管置管护理人员手卫生依从性与相关影响因素分析

目的探讨ICU中心静脉导管(CVC)置管护理人员手卫生依从性与相关影响因素分析。方法 2018年1—9月采用方便抽样法选取本地区8所3甲医院ICU中心静脉导管置管护理人员68名进行手卫生依从性调查,了解ICU中心静脉导管置管护理人员手卫生情况,为预防CVC感染提供指导。结果 68例CVC置管护理人员手卫生依从性总评分为(44. 32±3. 84)分,不同CVC置管护理人员操作年限、职称、培训次数在手卫生依从性评分方面存在差异(P 0. 05)。影响ICU护理人员CVC手卫生依从性的相关因素中前5项依次为:忘记洗手指征、对洗手及手消毒认识不足、认为戴手套可替代洗手、认为手卫生与CVC感染关系不大、管理层对洗手不够重视。结论医院应加强其操作时手部卫生知识培训,强化CVC护理人员手卫生观念,提高手卫生依从性,从而降低CVC感染的发生。     

集束照护策略对提高NICU医护人员手卫生依从性的作用

目的 探讨集束照护策略对提高新生儿重症监护病房(NICU)医护人员手卫生依从性的作用.方法 通过开展品质罔活动,实施医护人员手卫生的集束照护策略(care bundle),即:(1)加强培训和管理,增强手卫牛意识,强化手卫牛观念;(2)进行环境改造和流程再造,创建手卫生的氛围和方便的洗手设施;(3)加强监督,医护人员共同参与,保证洗手的正确性.对实施集束照护策略前后NICU医护人员入室及接触患儿前手卫生的落实情况进行比较分析. 结果NICU医护人员入室、接触患儿前手卫生实施率分别由集束照护策略实施前的32.1%、92.0%上升至实施后的97.4%、99.3%;新生儿院内感染的发生率由实施前的2.22%下降到实施后的1.38%.结论 集束照护策略能有效提高医护人员手卫生的依从性,预防医院内感染发生.     

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison

Background

Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction.

Objectives

We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections.

Design

Observational study with two pretests and two posttest measurements and interrupted time series analysis.

Setting

A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands.

Participants

Healthcare professionals who had physical contact with very low birth weight (VLBW) infants.

Methods

The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis.

Results

During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p < 0.001). Median (interquartile range) drying time increased from 4 s (4-10) to 10 s (7-14) (p < 0.001).The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p = 0.03) and from 17.3% to 13.5% (22.0%, p = 0.03), respectively.At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI −1.41 to +1.60) per month and decreased with −1.25% (95% CI −4.67 to +2.44) after the intervention (p = 0.51). The level of instant change was −14.8% (p = 0.48).

Conclusions

The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.     

Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit

Nosocomial infections are a significant problem in neonatal intensive care units (NICUs) and hand hygiene (HH) has been stated as an effective mean to prevent spread of infections. The aim of study was to assess the baseline compliance HH practices and to evaluate the impact of hand washing educational programme on infection rate in a NICU. Continuous surveillance of nosocomial infections was done. A total of 15 797 and 12 929 opportunities for HH were observed in pre‐intervention and postintervention phases, respectively. Compliance of health‐care workers for all HH opportunities combined was 46% before intervention and improved significantly to 69% in postintervention (RR 1.49, CI 1.46–1.52, P < 0.0001). Compliance for nurses and doctors was similar. Nosocomial sepsis rate showed a significant decline from 96 per 1000 patient‐days in pre‐intervention to 47 per 1000 patient‐days in postintervention phase (RR 0.44, CI 0.33–0.58, P < 0.0001). We conclude that effective HH practices can serve as an economical and effective nosocomial infection control approach especially important in developing nations.     

手卫生干预措施提高新生儿重症监护室手消毒依从性的观察与效果

目的研究提高新生儿重症监护室的手消毒依从性。方法建立手卫生干预措施,并用视频监测手段观察干预前后共13个月的各类接触。结果实施手卫生干预措施后手消毒依从性从25．15％上升为88．20％;培训后护理员的手消毒依从性较医生和护士低,夜间护士和护理员的手消毒依从性低于白班（P〈0．01）。结论手卫生干预措施能有效提高手消毒的依从性。     

MRSA定植及感染实时监测的暴发案例分析研究

目的分析对某大医院神经内科病房中耐甲氧西林金黄色葡萄球菌（MRSA）患者定植及感染的实时监测中暴发案例,推断MRSA传播途径并及时调整干预。方法采用前瞻性监测设计,对住院患者进行MRSA定植及感染的定期筛查,同期收集医护人员鼻前庭及手部标本并观察医护人员手卫生执行情况。IRS-PCR基因分型法对分离的MRSA菌株进行同源性分析。结果在07年10月至11月间,MRSA的定植或感染率为5％,其中入院后MRSA的定植或感染为4％;呈现暴发。同期医护人员手卫生总执行率为15．9％。对该期间住院患者临床标本、鼻前庭标本及医护人员手标本分离的共10株MRSA菌株进行IRS—PCR同源性分析,结果为同一亚型。并且,及时提出严格监督手卫生、护理MRSA阳性病人的医护分组、调整隔离病房等干预措施,制止了此次MRSA的进一步扩散。结论我们推断医护人员的手部是MRSA的暴发流行传播过程中的关键因素。并且开展MRSA的现场实时监测,对及时提出针对性的干预措施具有极大的借荐作用。     

Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program

Purpose

Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers.

Materials and Methods

A before and after study design was used to evaluate the impact on the incidence of CRBSI and VAP of a multi-modal program incorporating education, performance feedback, and a body worn hand hygiene device. Compliance was communicated quarterly. Primary outcomes were CRBSIs and VAPs per 1,000 line days or per 1,000 ventilator days and compliance rates. Secondary outcomes were hospital length of stay and mortality.

Results

A total of 1, 262 and 1,331 patients were evaluated during consecutive 12 month periods. VAP per 1000 vent days were significantly reduced after introduction of the program [3.7 vs. 6.9] P < .01. The reduction in CRBSI per 1000 line days was not significant [1.5 vs. 2.6], P = .09. Observed hand hygiene increased during the study period. There was no significant difference in mortality.

Conclusions

A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.     

The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit

This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.     

对护理专业实习学生进行手卫生教育干预的效果观察

目的探讨教育干预对感染科护理专业实习学生手卫生知识及手卫生执行状况的影响。方法选取100名感染科护理专业实习学生为研究对象,施行教育干预措施,对干预前、后情况进行调查及评价。结果干预后实习学生手卫生知识知晓率由27．50％上升到87．75％（P〈0．01）;六步洗手法操作考核合格率由24．67％上升到88．67％（P〈0．01）;在实际工作中,学生洗手率由干预前的33．79％上升到干预后的68．26％（P〈0．01）。结论对感染科护理专业实习学生开展手卫生知识及手卫生执行行为教育．可有效提高学生手卫生知识及手卫生行为依从性。     

Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units

Aims. The authors developed a video‐centred teaching program based on social learning principles to demonstrate hand‐washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand‐washing skills. Background. Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital‐acquired infections. A number of studies have shown that increased compliance with hand‐washing guidelines for health‐care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first. Study design. Quasi‐experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention. Methods. A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups – one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand‐washing skills using simple illustrations. A 20‐item hand‐washing checklist was used to examine hand‐washing compliance and accuracy. Results. No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels. Conclusion. The video‐based teaching program was effective in increasing compliance and accuracy with a hand‐washing policy among families with children in intensive care units. Relevance to clinical practice. The education program is a simple, low‐cost, low technology intervention for substantially reducing the incidence of nosocomial infection.     

Effects of hand hygiene education and individual feedback on hand hygiene behaviour,MRSA acquisition rate and MRSA colonization pressure among intensive care unit nurses

This study was conducted to increase the frequency and level of thoroughness of hand hygiene practice by nurses, and to assess the influence of the methicillin‐resistant Staphylococcus aureus (MRSA) acquired incidence rate and the MRSA colonization pressure in a medical intensive care unit (MICU). A total of 24 MICU nurses received hand hygiene education and individual feedback of hand hygiene frequency and method after a session of education, and two posteducation evaluations were followed. The frequency of hand hygiene (P = 0.001) and the methodology score of hand hygiene increased significantly (P = 0.001). The MRSA acquisition rate decreased significantly, from 11.1% before the education to 0% after (P = 0.014). The MRSA colonization pressure decreased significantly from 39.5% to 8.6% after the education sessions (P = 0.001). This indicates that providing individual feedback after hand hygiene education was very effective in increasing nurses' hand hygiene frequency and improving hand hygiene method; furthermore, it was expected to decrease health care‐associated infections.