重症监护病房医院内感染监测结果分析及管理策略

目的了解和掌控ICU医院感染的发生率及其危险因素,探讨有效防治医院感染的管理策略。方法调查我院2008年6月至2009年10月期间ICU收治的1 689例患者,分析医院感染发生率、发生部位、分离出的病原菌及药敏试验结果,分析医院感染发生的原因及防控策略。结果1 689例患者中医院感染总发生率为19.2%,主要发生部位依次为肺部感染（51.9%）、上呼吸道感染（24.1%）、泌尿道感染（11.7%）、胃肠道感染（10.5%）、血液感染（1.2%）、手术切口感染（0.6%）;呼吸机、气管切开、留置尿管、中心静脉置管等侵入性操作是发生医院内感染的重要危险因素;原发疾病中以呼吸系统疾病并发医院内感染率最高（35.4%）,其次为神经系统疾病（17.2%）,消化系统疾病（13.1%）,内分泌系统疾病（12.0%）,急性中毒（9.54%）,外伤（8.61%）;ICU医院感染的病原微生物以革兰氏阴性菌为主,占73%,革兰氏阳性菌占23.2%,真菌占3.8%;另外,革兰氏阴性菌的耐药率较高。结论ICU发生医院感染的几率高,以肺部感染为主,患者病情急重及侵袭性操作是医院感染的重要原因,医院感染的病原菌以革兰氏阴性菌为主,并且耐药率高;ICU是控制医院感染的重中之重,必须加强管理。     

ICU患者医院感染原因分析

目的 探讨重症监护室(ICU)院内感染发生的原因,为医院感染的防治提供依据.方法 对2009年1月～2009年9月收治我院ICU的94例医院感染患者的临床资料进行分析,分析医院感染的发病率、易感因素.结果 ICU医院感染发生率34.22%,年龄、基础性疾病、广谱抗菌药物的广泛使用、侵入性操作等是ICU医院感染的易感因素.结论 ICU医院感染发生率34.22%.年龄、基础疾病、广谱抗菌药物的广泛使用、侵入性操作等是ICU医院感染的易感因素.     

外科ICU医院感染临床特点和护理措施

目的分析ICU住院患者医院感染临床特点,为临床护理提供参考。方法将2011年1月至2013年6月我院外科ICU发生的116例医院感染病例作为观察组,外科住院患者发生的72例医院感染病例为对照组,采取回顾性调查方法分析医院感染危险因素,并对护理相关问题进行讨论。结果 ICU患者发生医院感染率为8.44%,同期普通病房患者医院感染率为4.43%,ICU医院感染发生率明显高于普通病房(P0.05)。无论ICU患者还是普通病房患者,呼吸道和泌尿道都是医院感染常发生部位。ICU医院感染病死率9.48%,高于外科普通病房的4.17%,P0.05。ICU和普通病房医院感染与患者年龄、住院时间、接受损伤性操作、抗菌药物或免疫抑制剂使用和意识障碍有明显关系(P0.01)。结论 ICU医院感染率明显高于普通病房,感染部位主要是呼吸道和泌尿道;医院感染与多种因素有关,关键是要建立有效的防治机制和护理措施。     

医院感染目标性监测在ICU的应用

目的 通过目标性监测,寻找导致ICU多发医院感染的危险因素,应用持续质量改进模式,探讨有效预防和降低ICU医院感染发生的对策,达到降低感染、提升综合效益的预定结果目标.方法 对2004-2005年开展前瞻性监测与2006-2007年实施目标性监测期问入住ICU、发生医院感染的患者及工作人员、工作环境进行科学的分析、比较、评估.结果 得出患者年龄大、病情重、侵入性操作不规范和室内环境、物品有污染等是导致医院感染高发的危险因素以及感染部位的聚集倾向.结论 目标性监测方法科学、可行、可靠,实施后达到预期效果.运用持续质量改进原则制定出以抓好环节控制;强调过程管理;增强护理环节管理及注重特殊治疗护理等行之有效的监控对策.     

综合性医院重症监护病房病原菌分离情况分析

目的 探讨重症监护病房(ICU)医院内感染的临床特点及病原菌种类、分布情况,为临床合理使用抗菌药物、预防和控制医院感染提供参考和依据.方法 采用前瞻性监测与回顾性调查相结合的方法,对ICU患者的临床资料进行统计分析.结果 ICU病人标本中分离出病原菌593株,得出菌种分布与感染情况.结论 重症监护病房医院内感染发生率高,以呼吸道感染为主,主要病原菌以革兰阴性非发酵菌为主,加强ICU患者感染的控制,可减少ICU医院内感染的发生.     

手卫生的落实对ICU院内感染控制的临床意义

目的 探讨医院工作人员手卫生与ICU院内感染关系.方法 A组2010年7～9月入住ICU三天以上病人,工作人员为病人操作,按照习惯进行洗手、擦手和手消毒,没有进行手卫生监督落实,科室没有配备擦手纸;B组2010年9～12月入住ICU三天以上病人,工作人员为病人操作,严格按照消毒技术规范进行洗手和手消毒,并监督落实,科室备好擦手纸和快速手消毒剂.对两组病人进行院内感染发生例次、发生菌种和住院时间进行研究.结果 医院工作人员认真落实手卫生规范,能有效控制病人ICU院内感染发生(P＜0.05),发生菌种数有减少(P＜0.05),病人住院时间缩短(P＜0.05).结论 认真落实手卫生规范,能减少ICU院内感染发生,缩短病人住院时间,减轻病人痛苦,并能为病人节约医疗费.     

2016~2018年某院ICU 医院感染目标性监测及干预

目的 分析我院ICU医院感染现状,为医院感染管理提供依据。方法 制定ICU医院感染目标性监测方案,采用前瞻性监测方法对我院2016~2018年ICU患者进行目标性监测,每季度根据监测结果进行实时干预。结果 通过监测及干预,连续三年ICU医院感染发病率、医院感染例次发病率、日感染发病率、调整医院感染发病率、调整医院感染例次发病率以及调整日感染发病率均呈逐年下降趋势（P＜0.05）。神经系统和呼吸系统疾病类ICU住院患者的医院感染发病率分别为10.83%、3.31%。ICU医院感染部位以呼吸道为主,占70.67%。呼吸机、导尿管、中心静脉导管的使用率分别为33.90%、71.92%、22.73%,三管相关发病率分别为10.00‰、1.49‰、1.81‰。呼吸机使用率与VAP发病率有相关性（r=1.00,P＜0.001）。医院感染前3位病原菌分别为肺炎克雷伯菌（占30.23%）、鲍曼不动杆菌（占23.26%）、铜绿假单胞菌（占10.47%）。结论 持续开展ICU医院感染目标性监测,有利于针对高危因素及薄弱环节及时采取干预措施,从而有效降低医院感染发病率。神经系统疾病类和呼吸系统疾病类患者是院感防控关注的重点人群,器械相关性感染（特别是VAP）、多重耐药菌感染是干预的重点环节。     

ICU术后病人医院感染的回顾性分析及预防控制

ICU是当前发生医院感染的高危科室之一，开展ICU医院感染的监测，了解ICU感染发病率及其危险因素，有效预防和控制ICU医院感染的发生，对于提高抢救成功率具有积极的意义。新乡医学院第一附属医院ICU自2005年1月～2007年8月收治外科术后病人842例，现就感染病例回顾性分析如下。     

口腔门诊的医院感染护理管理

目的 探讨口腔科门诊的医院感染的护理管理.方法 对口腔门诊工作中的消毒灭菌和护理管理制度加以完善,规范技术操作程序及医护行为,对医院感染知识进行培训,使其提高认识.结果 提高护理人员对医院感染的认识,避免或降低医院感染发生.结论 护理工作在医院感染中起着非常重要的作用,护理人员与患者、家属及其他医务人员接触频最繁也是最密切的,是医院感染管理的一个重要部分.     

深圳市某街道医院2005～2009年医院感染调查分析

目的 了解深圳市某街道2005~2009年住院患者医院感染情况.方法 对某街道医院2005~2009年间82168例全部住院患者病历资料进行回顾性调查.结果 2005~2009年,医院感染发病率依次为1.32%、0.65%、0.74%、0.61%、0.65%、0.76%;感染率最高的科室为脑外(1.49%);医院感染发病年龄段第一位的是>60岁年龄段的病人;下呼吸道(23.63%)为最常见的感染部位;5月份(1.05%)医院感染率最高;男女患者之间的医院感染率有显著差异.结论 2005~2009该街道医院感染率呈下降趋势,重点应针对脑外科室、>60岁年龄的病人、下呼吸道部位和每年5月份采取相应预防措施,可进一步降低医院感染的发生.     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Experience in adult population in dengue outbreak in Delhi

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.     

Changes in the hypothalamic nuclei in in experimental allergy

Summary In rabbits subjected to prolonged sensitization and in which the Arthus phenomenon was induced there was a marked reaction of the hypothalamic nuclei. Staining by Gomori's method indicated a cellular swelling, loss of granules, and protoplasmic vacuolization in the supraoptic nucleus. There was a considerable increase in the size of the cross-sectional area of the cells. The same effects were much less well shown in the paraventricular nucleus. These results show that marked signs of increased neurosecretion developed in the animals at the height of the Arthus phenomenon.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten Éksperimental'noi biologii i Meditsiny, Vol. 55, No. 4, pp. 110–113, April, 1963.     

Intestinal helminthiasis in school children in Haiti in 2002

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.     

Cerebellar noradrenergic systems in aging: studies in situ and in in oculo grafts

Age-related changes in noradrenergic function in the rat cerebellum were examined using electrophysiological and electrochemical techniques. Sprague-Dawley and Fischer 344 rats showed subsensitivity to norepinephrine (NE) locally applied onto cerebellar Purkinje neurons. The modulatory actions of NE on Purkinje cell-evoked activity was also examined. In young rats NE preferentially inhibits spontaneous activity more than evoked excitations when compared to control. These modulatory actions of NE are not seen in senescent Fischer 344 rats. The intrinsic vs. extrinsic influences determining the loss of efficacy to NE were examined using three groups of rats with in oculo cerebellar grafts. The first group had young grafts grown in young hosts and these grafts showed a potent response to perfused NE. The second group, old grafts in old hosts, showed a diminished responsiveness to NE with respect to the first group. The third group consisted of young grafts in old hosts. These grafts demonstrated a responsiveness to NE that was indistinguishable from those in the first group. The integrity of the presynaptic NE fibers was examined in the grafts using electrochemical techniques. No difference in the release of NE was observed in the old grafts. Taken together, these results suggest a loss of postsynaptic NE function that is intrinsically determined. The change in NE modulation could influence information processing within the aged cerebellar cortex. This deficit could underlie behavioral changes seen in senescence.