ICU重症监护病房医院感染控制

近年来,随着现代医学的迅速发展和医疗设备的不断更新及抗生素的广泛应用,医院感染的问题也变得日趋严重和复杂.     

ICU护理干预对急性心肌梗塞患者的影响

目的重症加强护理病房的护理人员根据自身所学习的护理知识为根据对患者进行护理,通过对患者的护理提高自身的护理水平,将自身的理论知识转为实际操作。患者通过我院的治疗及护理人员的护理治疗疾病,并了解相关的护理知识以加强自身的保健知识水平。方法我院选取自2010年1月~2014年1月在我院进行治疗的急性心肌梗塞患者共146例,经过患者同意后对其进行调查研究,主要采用对患者进行个体观察的方法,了解患者的实际情况并由护理人员对患者进行有针对性的护理,定期对患者进行健康教育,使患者了解自身疾病应注意的方面以及有益减轻病痛的保健知识。结果在护理人员对急性心肌梗塞患者进行护理期间,146例患者中有135例积极配合护理人员工作,占92.5豫按时服药,对于可能影响自身疾病的因素机极力可知,在护理期间,患者恶性心律失常的发病几率减少,猝死率大大降低,患者经过优质护理,自身的身心健康均得到了较大的恢复。结论重症加强护理病房的护理干预对于减少患者急性心肌梗塞猝死率、减少恶性心律失常的效果十分明显,优质的护理对于患者的康复起着重要的作用,且护理人员在对患者进行护理的同时,也提高了自身的实际操作能力[1]。     

大型治疗设备综合维修模式的探讨

1大型治疗设备的综合维修模式 医疗设备传统的维修模式是以恢复性维修为主，即在机器发生故障后，通过现象分析原因，排除故障的维修模式。这只是设备维修的一个环节，是无计划的、被动的，不能有效解决机器的潜在故障，提高机器完好率。     

ICU危重病人的临终关怀

随着医疗技术的日臻完善，许多危重病人的生命被挽救，但对危重的晚期患者，救治回天乏力、患者面对死亡的威胁时，现代人不但要求高质量的活，而且高质量的死也逐渐受到了重视，这就是临终关怀。由于受传统医疗护理观念的影响，对临床病人的护理因病情危重，只重视抢救过程，忽视病人及家属存在的心理问题，忽视生命最后历程的生活质量。2000～2004年我院对ICU76例临终病人开展临终关怀护理，以满足其生理、心理、社会及心灵上的需要，让临终病人能舒适、安详、有尊严地走完人生最后的路程，现将护理体会介绍如下。     

综合ICU中低年资护士培训方法探讨

目的探讨为综合ICU培养合格的护理人员的方法。方法根据ICU护士应具备的素质及低年资护士的特点,采用定期集中培训、一对一带教、参加护理查房等方法,对基础理论和基本技能进行强化,重点加强了ICU专科护理知识地训练。结果通过客观考核和主观考核,效果良好。结论经过为期12个月两个时段较规范的岗位培训,低年资护士能较好的适应ICU工作。     

模糊综合评判在医疗设备评标中的应用研究

目的 科学、合理地在医疗设备招标活动中评标.方法 在医疗设备招标中应用层次分析法确定评价指标的相对权重数,建立评标评价体系,运用模糊综合评判方法进行评标.结果 模糊综合评判方法将医疗设备评标中的定性问题定量化解决,评标更加科学、合理.结论 通过实例应用,体现了医疗设备评标方法的科学性、合理性和准确性,具有实际指导意义.     

ICU院内病毒感染危险因素探讨

目的 分析ICU病房并发院内病毒感染的危险因素,以指导临床治疗.方法 对200例于ICU病房接受治疗的患者的临床资料进行回顾性分析,并将患者分为住院期间未发生院内病毒感染的未感染组(患者92例)和住院期间发生院内病毒感染的感染组(患者108例),统计两组患者临床资料,对导致院内感染的危险因素进行分析.结果 经单因素及logistic多因素分析显示,年龄＞ 60岁、住院时间＞14d、插管时间＞7d、糖尿病及低蛋白血症均为导致患者发生院内感染的危险因素(P＜0.05).而在发生院内感染的患者中,以呼吸系统感染者居多.结论 导致ICU院内感染的危险因素较多,临床应注意以上危险因素的防范.     

试用综合指数法对我院病房工作效率的分析与评价

病房工作是医院工作的一个重要环节,而病房工作效率的高低是评价医院工作的一个重要指标。我院自1994年以来,经过11年的发展,在病房工作效率方面是怎样的呢?本文试用综合指数法对此进行了探讨。1资料来源与方法收集我院1994-2004年统计年报的主要数据:病床使用率、平均病床工作     

综合护理干预对ICU患者意外拔管的效果观察

目的观察综合护理干预措施对ICU患者意外拔管的效果。方法将70例带管患者随机分为干预组和对照组各35例,对照组进行常规护理,干预组在常规护理基础上采取综合护理干预措施,比较两组UEX例数。结果干预组患者UEX发生率明显低于对照组,两组比较有显著性差异（P<0.01）。结论综合护理干预措施可有效降低ICU患者UEX的发生率。     

目标监测法对ICU感染控制的效果

目的 分析重症监护病房（ICU）感染控制中应用目标监测法的临床价值。方法 选取2018年1月~12月入住我院ICU 134例患者设为观察组,将2017年1月~12月入住ICU的126例设为对照组。观察组采取目标监测法管理方式,对照组采取常规感染管理方式,比较两组ICU感染率及ICU入住时间、费用。结果 观察组总感染率为7.46%,低于对照组的15.87%,差异有统计学意义（P＜0.05）。观察组ICU入住时间为（5.26±0.87）d,短于对照组的（7.15±1.38）d;观察组住院费用为（2.51±0.62）万元,低于对照组的（2.02±0.54）万元,差异有统计学意义（P＜0.05）。结论 ICU感染控制中应用目标监测法可有效降低感染率、缩短患者ICU入住时间,减轻患者经济负担。     

Analysis of Risk Factors for Ventilator-Associated Pneumonia in a Multidisciplinary Intensive Care Unit

 A prospective study was conducted to determine the incidence, risk factors and pathogens of ventilator-associated pneumonia (VAP) in 198 patients requiring mechanical ventilation for more than 48 hours. VAP occurred in 67 (33.8%) patients. Risk factors associated with VAP were admission APACHE II score >20 (odds ratio [OR] 4.77, 95% confidence interval [CI] 2.04–11.27, P<0.001), mechanical ventilation >10 days (OR 44.4, 95% CI 2.16–26.7, P<0.0001), ICU length of stay >10 days (OR 9.4, 95% CI 3.55–25.65, P<0.0001), and admission PaO₂/FiO₂ ratio <200 mmHg (OR 3.4, 95% CI 1.00–11.41, P<0.05). Logistic regression analysis showed a relationship between VAP and length of stay in ICU, duration of fever and presence of catheter-related infection. The pathogens isolated were predominantly gram-negative bacteria (83.2%), with a high proportion of Acinetobacter spp. (35%) resistant to commonly used antimicrobial agents. The mortality rate was not influenced by VAP.     

Measurement of muscle strength with handheld dynamometer in Intensive Care Unit

Background:Intensive Care Unit (ICU) acquired weakness is a common complication in critically ill patients affecting their prognosis. The handheld dynamometry is an objective method in detecting minimum muscle strength change, which has an impact on the physical function of ICU survivors. The minimal change in the force can be measured in units of weight such as pounds or kilograms.Methodology:Three upper and three lower limb muscles force measured with handheld dynamometer during ICU stay. Data were analyzed using repeated measures ANOVA to detect changes in force generated by muscle on alternate days of ICU stay.Results:There was a reduction in peripheral muscle strength from day 3 to day 5 as well from day 5 to day 7 of ICU stay (P < 0.01). The average reduction in peripheral muscle strength was 11.8% during ICU stay.Conclusion:This study showed a progressive reduction in peripheral muscle strength as measured by handheld dynamometer during early period of ICU stay.     

急诊监护病房肺部感染的临床研究

目的探讨急诊监护病房（EICU）最常见肺部感染痰菌分布特点及耐药性。方法对125例EICU肺部感染患者痰培养结果及药物敏感试验进行分析。结果共检出致病菌109株,以革兰阴性杆菌（G-菌）为主,共71株（65.1%）,前四位分别为铜绿假单胞菌22株（20.2%）,其中嗜麦芽寡养单胞菌14珠（12.8%）,肺炎克雷伯菌10株（9.2%）,鲍氏不动杆菌9株（8.3%）;革兰阳性菌（G＋菌）28株（25.7%）,其中金黄色葡萄球菌16株（14.7%）;真菌10株（9.2%）,其中白色念珠菌占5.6%。药物敏感试验显示铜绿假单胞菌对抗生素多重耐药率较高,嗜麦芽寡养单胞菌对环丙沙星耐药率较低,肺炎克雷伯菌和鲍氏不动杆菌仍然对碳青酶烯类敏感。结论该组EICU肺部感染以G-杆菌为主;MRSA和真菌感染的比例较高,应根据药敏试验合理使用抗菌药物。     

Epidemiology of Yeast Colonization in the Intensive Care Unit

 In order to investigate the epidemiology of colonization and possible transmission of yeasts among patients and healthcare workers in adult intensive care units (ICUs), 194 patients were followed for a mean of 9±11 days and 63 healthcare workers were followed for a mean of 132±52 days. Among the patients, 142 (73%) were colonized by yeast, with Candida albicans being the species most commonly recovered. Most patients (65%) were already colonized with yeast upon admission to the intensive care unit; only 17% became colonized after admission. Persistent colonization occurred in 51 (55%) of 92 patients who had more than three cultures performed; in 75% of them, colonization persisted with the same strain of Candida albicans or Candida glabrata. Bacterial infection in the month preceding entry into the ICU was the only risk factor significantly associated with yeast colonization. Among the healthcare workers, yeasts were isolated from 42 (67%). Candida albicans was most frequently recovered from the oropharynx (19% of occasions), and Candida parapsilosis was most frequently found on hands (8% of occasions). Persistent colonization of the oropharynx occurred in only six healthcare workers, and none had persistence of yeasts on hands. In this non-outbreak setting, 5 (4%) of 123 patient/healthcare worker interactions that were linked epidemiologically yielded the same strain of Candida albicans, providing evidence for possible cross-transmission. No similar link was found between healthcare worker-patient interactions and colonization with Candida glabrata or Candida parapsilosis.     

Association between a prolonged corrected QT interval and outcomes in patients in a medical Intensive Care Unit

Introduction:

Patients admitted into a medical Intensive Care Unit (ICU) have varying illnesses and risk factors. An electrocardiogram (ECG) is a useful tool to assess the cardiac status. The aim of the study was to determine the prevalence of QT prolongation of the ECG in patients admitted to a medical ICU in a tertiary hospital, to assess outcomes in terms of mortality, cardiovascular events, and duration of ICU stay.

Materials and Methods:

Prospective observational study, 6 months duration, assessing the prevalence of prolonged corrected QT interval (QTc) at admission into a medical ICU. A QTc calculated by Bazett''s formula, of >440 ms for males and >460 ms for females was considered prolonged. Details of illness, clinical and lab parameters were monitored.

Results:

The total number of patients screened was 182. There was a high prevalence of prolonged QTc (30%) on admission to the ICU. This reduced to 19% on day 3 (P = 0.011). In patients with a prolonged QTc the odds ratio of adverse outcome from ICU was 3.17 (confidence interval [CI]: 1.52–6.63) (P = 0.001) and of adverse outcome for hospital stay was 2.27 (CI: 1.11–4.66) (P = 0.014). In the study, 35% of all patients received drugs with QT prolonging action. Of patients with a prolonged QTc at admission 18 (35%) received a QT prolonging drug.

Conclusions:

We found that prolonged QTc is common (30%) in our medical ICU at admission and a large proportion (35%) received drugs capable of prolonging QT interval. These patients with QTc prolongation have a higher odds ratio for adverse outcomes.