ICU目标性监测调查分析

开展重症监护病房（ICU）医院感染目标性监测，及时分析医院感染发生的原因，对有效降低医院感染的发生率和病死率起着重要作用。因此，我科于2003年起即对ICU进行目标性监测，现将2005年1-12月ICU目标性监测调查分析结果报道如下。     

目标性监测中现场培训效果观察

目的探讨目标性监测在医院感染知识培训中的作用。方法通过对目标性监测的重症监护病房及普通病房医务人员问卷调查结果进行对比,了解实施目标性监测病房与未实施目标性监测病房工作人员对医院感染知识掌握的程度。结果医院感染诊断方面的知晓率重症监护病房(85.71%)高于非重症监护病房(54.16%),差异有统计学意义(2χ=4.55,P0.05);耐药菌消毒隔离物品的知晓率重症监护病房(89.58%)高于非重症监护病房(38.46%),差异有统计学意义(2χ=34.63,P0.01);手卫生的知晓率重症监护病房(89.58%)高于非重症监护病房(45.19%),差异有统计学意义(2χ=26.80,P0.01)。结论目标性监测中进行现场培训是一种有效的医院感染知识培训的方法。     

外科重症监护病房医院感染及相关死亡危险因素分析

目的：探讨外科重症监护病房的医院感染发生情况及相关的死亡危险因素。方法选取我院2012年1-7月收治的外科重症病房患者250例,对患者的感染部位、感染病原微生物等情况进行相关记录,最后再对患者医院感染的相关死亡危险因素进行筛选分析。结果外科重症监护病房医院感染发生率为20%,病死率为48%;最常见的感染部位是下呼吸道、血液系统、泌尿系统;感染病原微生物中革兰阴性杆菌占70%,革兰阳性球菌占21.4%。结论要加强对外科重症监护病房患者下呼吸道、血液系统、泌尿系统感染的相关监测,同时,也要针对外科重症监护病房医院感染的病原菌分布情况选择性使用抗菌药物。     

综合重症监护病房医院感染干预的临床研究

目的 加强综合重症监护病房的医院感染管理,提高医疗质量.方法 医院感染管理部门建立医院感染管理制度和规范并予督查,实施目标性监测,干预医院感染的发生;综合重症监护病房成立医院感染管理小组,落实医院感染防控措施.结果 通过对医院感染的干预和预防,减少综合重症监护病房的医院感染的发生.结论 多途径加强医院感染管理,严格监控质量,是提高医疗质量、确保医疗安全的可靠保证.     

ICU医院感染控制目标性监测

对重症监护病房(ICU)进行医院感染目标性监测,分析医院感染发生的原因,对提高危重患者的抢救成功率起着重要的作用。现将2009年7月-2010年6月我院ICU目标性监测结果报道如下。     

NICU医院感染监测及护理对策

目的 了解新生儿重症监护病房医院感染的特点,为实施科学有效的干预措施提供依据.方法 2009年7月-2010年6月入住新生儿重症监护病房＞48 h的全部住院患儿1480例,进行医院感染前瞻性监测,对转出患儿随访48 h.结果 医院感染发生率为3.51％,其中主要感染为呼吸道感染占44.23％,其次为胃肠道感染占38.46％;呼吸机的利用率1.66％,呼吸机使用日的感染率为0.13‰.结论 加强新生儿医院感染的监测,严格执行感染控制措施,降低医院感染率.     

外科重症监护病房医院感染分析

外科重症监护病房(SICU)以收治手术后危重患者为主，医院感染发生率显著高于外科普通病房。本文分析了SICU医院感染状况．并对有关困素进行探讨，以降低SICU医院感染率的发生。     

某综合性医院消毒效果现状

医院环境消毒效果质量控制是院内感染管理的重要内容,消毒效果的监测是了解医院消毒与灭菌质量、评价消毒方法是否合理的主要手段。对医院环境进行微生物学监测,可发现造成医院感染的危险因素，为了进一步提高河南省某综合性医院消毒质量和消毒效果，减少医源性感染，笔者于2006年1—12月对该院重点科室（供应室、手术室、新生儿监护病房、重症监护病房、产房、内镜中心、血液净化室）环境消毒效果监测结果进行了统计分析。监测项目主要包括：空气、物体表面、工作人员手和使用中的消毒液。     

焦作市1998年-2004年直属医疗机构消毒效果监测

<正>为加强医院感染管理和监督,按照卫生部《消毒管理办法》,于1998年至2004年每年春秋季两次对市直十一家医疗单位的消毒工作进行日常监测。现将结果报告如下。1方法1.1监测对象选择市直医疗单位普通手术室,产房、婴儿室,急诊室。外科门诊换药室、内外科普通病房、重症监护病房等科室的空气、医护人员手、     

某综合性医院消毒效果现状

医院环境消毒效果质量控制是院内感染管理的重要内容,消毒效果的监测是了解医院消毒与灭菌质量、评价消毒方法是否合理的主要手段.对医院环境进行微生物学监测,可发现造成医院感染的危险因素,为了进一步提高河南省某综合性医院消毒质量和消毒效果,减少医源性感染,笔者于2006年1-12月对该院重点科室(供应室、手术室、新生儿监护病房、重症监护病房、产房、内镜中心、血液净化室)环境消毒效果监测结果进行了统计分析.     

Cost improvements through the establishment of prudent infection control practices in a Brazilian general hospital, 1986-1989.

OBJECTIVES: To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control. DESIGN: Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices. PARTICIPANTS: The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986-1989). RESULTS: Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars). CONCLUSIONS: During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.     

运用PDCA模式管理手术室医院感染的预防与控制

目的 探讨手术室医院感染预防与控制的管理模式,提高手术室医院感染管理的质量.方法 导入PDCA循环原则,加强全员教育,对重点环节实施标准化、规范化、系统化、科学化管理.结果 导入PDCA循环后,加强了手术室医院感染预防和控制重点环节的督导和监控,使手术室医院感染管理质量明显提高.结论 导入PDCA循环,促进各项工作严格执行标准化、规范化及科学化管理,是提高手术室医院感染管理质量行之有效的好方法.     

Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.

OBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization. DESIGN: Surveillance and cohort study. SETTING: A 470-bed tertiary trauma-referral community hospital. PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization greater than or equal to 48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for greater than or equal to 72 hours during the epidemic period who had no X maltophilia-positive culture). RESULTS: Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk = 1.3, p = .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient's room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel's hands. Related environmental and clinical isolates were serotype 10. CONCLUSIONS: Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.     

目标监测对ICU医院感染控制的影响

目的探讨目标监测对ICU院内感染控制的应用效果。方法对2009年1月至2011年12月入住ICU的患者,实施目标监测前后的医院感染率进行比较。结果实施目标监测后,医院感染发生率明显下降,与实施前相比差异具有统计学意义（P〈0．01）。结论应用科学的监测管理方法,提高全员对医院感染的防控意识,规范医疗行为,重视医院感染监测及时掌握ICU医院感染变化情况,制定有效的控制预防措施,从而有效地降低医院感染的发生率。     

重症监护病房医院感染病原菌分布及耐药性分析

目的分析重症监护病房(ICU)医院感染的病原菌分布及其耐药现状,为临床合理用药和控制医院感染提供依据。方法对2001-2004年从ICU医院感染患者的各类标本中分离出的病原菌,采用K-B纸片扩散法进行敏感试验,对致病菌耐药率进行分析。结果以呼吸道标本的分离率最高为60.77%,病原菌以革兰阴性杆菌为主占47.69%、真菌37.69%占第2位、革兰阳性球菌14.62%;细菌的耐药率普遍较高,耐甲氧西林葡萄球菌(MRS)检出率为81.82%;大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为75.00%和57.14%。结论ICU是医院感染的高发科室,主要致病菌常为多重耐药菌;加强其病原菌分布及耐药率监测,对指导临床合理用药、减少多重耐药菌产生、降低医院感染率,具有重大意义。     

Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA.

After the introduction of routine treatment for every nasal carrier of methicillin-resistant Staphylococcus aureus, active follow-up surveillance for nosocomial methicillin-resistant S. aureus infection was conducted for 5 years in an intensive care unit of a tertiary-care teaching hospital. There was a significant decrease in the incidence of nosocomial methicillin-resistant S. aureus infection during the later years of follow-up. Decolonization of nasal carriers of methicillin-resistant S. aureus is probably associated with such findings.     

Case-control study of pediatric cardiothoracic surgical site infections .

A retrospective case-control study was performed to determine the risks and outcomes associated with pediatric cardiothoracic surgical site infection. Undergoing more than 1 cardiothoracic operative procedure, having preoperative infection, and undergoing surgery on a Monday were significant risk factors. Cardiothoracic surgical site infection increased hospital and pediatric intensive care unit length of stay. Deep surgical site infection significantly increased mortality.     

Propagation of methicillin-resistant Staphylococcus aureus due to the overloading of medical nurses in intensive care units

Morbidity and mortality due to nosocomial infections are on the increase. The effectiveness of infection control has become an important indicator of the quality of hospital work, as well as contributing towards cost reduction. The aim of this three-year prospective study was to investigate the daily workload of medical nurses to see if there was a correlation with the spread of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in a surgical intensive care unit (SICU) using a Therapeutic Intervention Scoring System (TISS). Although this SICU pays great attention to continuing education, the incidence of MRSA is still high. By means of the TISS, it was estimated that nurses in the SICU are overloaded by an average of 57%. Infections with MRSA occurred during periods when nurses were, on average, overloaded by more than 25%. During the study period, 47 new cases of MRSA infection were detected. These results suggest that adequate human resource management, particularly with respect to nursing care staff in SICUs, could contribute towards infection control.     

使用呼吸机与重症监护病房患者下呼吸道感染的相关性分析

目的:分析使用呼吸机与重症监护病房患者下呼吸道感染的相关性。方法:本次实验研究将2018年1月~2019年1月在本院重症监护病房接受治疗并使用呼吸机的患者32例作为实验组,将同期本院重症监护病房收治未使用呼吸机的患者32例作为对比组,比较两组患者下呼吸道感染发生率以及导致实验组患者出现下呼吸道感染的相关危险因素。结果:实验组患者下呼吸道感染发生率明显高于对比组患者(P<0.05);实验组不同机械通气时间、基础疾病数量以及插管方式患者之间出现下呼吸道感染的概率存在显著差异(P<0.05);导致实验组患者出现下呼吸道感染的病菌种类为革兰阴性菌概率显著高于革兰阳性菌与真菌(P<0.05)。结论:使用呼吸机与重症监护病房患者下呼吸道感染的出现呈正相关,且导致其出现下呼吸道感染的危险因素包括机械通气时间、基础疾病数量以及插管方式,革兰阴性菌为主要的致病菌,应该通过针对性预防措施的制定减少下呼吸道感染的出现。     

加强ICU护理管理有效预防控制ICU医院感染

目的探讨强化护理管理在预防控制ICU医院感染中的作用。方法分析引起ICU医院感染的内源性及外源性因素,并采取针对性的措施加强护理管理,然后比较加强护理管理前后ICU患者的医院感染率。结果通过一系列措施加强护理管理后,ICU医院感染率从第四季度的7.69%下降到第三季度的1.82%,下降了5.87%。结论 ICU是医院感染的高发科室,加强监护室内环境及物品、呼吸机及管路、人工气道、胃管和口腔等的护理管理,及时采取干预措施,能有效预防医院感染的发生。