神经外科重症监护病房医院感染的临床调查

目的通过调查分析神经外科重症监护病房（NICU）医院感染发生情况、感染部位病原菌的构成及感染影响因素,以寻求有效的预防措施。方法通过自制调查表收集贵州省铜仁医院2008年1月至2010年5月362例NICU患者的临床资料,包括患者年龄、感染部位、感染诱发因素、病原菌种类及其耐药性、可能的影响因素等并作分析。结果医院感染发生率为18．5％,8．2例／1000床日,高于同期医院其他科室的感染率;发生医院感染的主要疾病为中枢神经系统炎症和医院获得性肺炎,分别为58．2％和34．3％;共检出病原菌220株,其中革兰阴性杆菌103株（46．8％）,革兰阳性球菌96株（43．6％）,真菌21株（9．5％）。金葡菌除对万古霉素呈敏感外．对其余测试抗菌药物的耐药率均高于80．0％,大肠埃希菌除对亚胺培南耐药率低,为1．1％外,对其余测试抗菌药物的耐药率均高于20．0％。单因素分析和多因素逐步logistic回归分析发现,患者发生医院感染与住院时间、是否机械通气、侵袭性操作、H2受体拮抗剂的使用有关。结论NICU患者中医院感染发生率高,感染部位集中,影响因素复杂,应采取综合措施控制医院感染,加强病室管理,在治疗及护理过程中应特别注意对呼吸系统和泌尿系统的无菌操作,合理使用抗生素,监测病原菌及其耐药性,减少住院期间的交叉感染等。     

我国重症监护病房医院感染研究进展

综述了我国重症监护病房医院感染概况、感染原因、传播途径以及感染的控制与预防措施。     

新生儿重症监护病房医院感染监测

目的了解新生儿重症监护病房医院感染发病情况及其危险因素。方法通过前瞻性监测方法,对入住该医院新生儿重症监护病房的患儿进行监测。结果该医院新生儿重症监护病房在调查期间共入住新生儿患者1 634例,发生医院感染61例,医院感染发生率为3.7%。感染部位以呼吸道感染为主,占70.5%;其次为皮肤感染,占14.8%。呼吸道感染患儿有86.2%实施过气管插管和吸痰操作,皮肤感染的患儿有65.7%实施过深静脉留置操作。结论新生儿重症监护病房患者医院感染主要为呼吸道感染,侵入性操作是医院感染的主要危险因素。     

综合重症监护病房医院感染目标性监测

目的监测综合重症监护病房医院感染发生率,为提高医院感染管理水平提供参考。方法用目标监测性方案,建立感染监测日志,对医院重症监护病房医院感染现状进行前瞻性监测。结果该医院重症监护病房2010年全年共收治193例重症患者,发生医院感染30例、71例次,医院感染率为15.54%、例次感染率为36.79%,调正后的病人日感染率为2.16%。呼吸机相关肺部感染率为5.04%,中心静脉导管相关血流感染率为1.17%;导尿管相关尿路感染率为0.85%。从感染病人标本中共检出致病菌271株,革兰阴性杆菌占54.98%。结论该医院重症监护病房医院感染发生率较高,通过前瞻性监测获得资料准确,便于制定有效控制措施。     

重症监护病房医院感染目标监测分析

目的了解综合性重症监护病房(ICU)医院感染的发病率及危险因素,探讨和控制医院感染的措施,降低医院感染的发生。方法对ICU 2011年1～12月843例住院患者按照医院感染目标监测的方法进行监测。结果 ICU 843例住院患者发生医院感染142例,感染率16.84%,呼吸机相关感染率17.22%,导尿管相关感染率15.38%,中心静脉置管相关感染率1.88%。病原菌共检出799株,革兰阴性菌485株,革兰阳性菌150株,真菌164株。结论 ICU患者是医院感染易感人群,院内感染率较高,通过目标性监测能及时准确获得ICU医院感染信息,为医院感染的预防、控制和管理提供科学依据。     

外科重症监护病房系统化医院感染管理

目的 提高外科重症监护病房医院感染的管理水平,以有效地降低医院感染发病率.方法 通过对1997年1月～2004年12月医院感染监测项目进行比较,评价外科重症监护病房实施系统化管理的效果.结果 外科重症监护病房进行系统化管理后感染率显著降低,消毒灭菌质量监测合格率有不同程度的提高.结论 加强系统化管理是降低外科重症监护病房医院感染率的有效措施.     

综合性重症监护病房医院感染目标性监测

目的了解综合性重症监护病房医院感染现状,分析感染特点,以便加强防控。方法通过目标性监测,对本医院综合重症监护病房住院患者医院感染状况进行了监测。结果本医院重症监护病房2009-2011年3年期间共入住患者1 796例,发生感染患者296例次,例次感染率为16.48%,日感染率9.53‰。在接受侵入性操作患者中,静脉插管相关性血流感染率5.34‰、呼吸机相关性肺部日感染率3.86‰、留置导尿管相关性泌尿道日感染率3.31‰。从感染病人标本中共检出397株病原菌,革兰阴性菌占52.4%。结论本医院综合重症监护病房医院感染发生率较高,主要危险因素为血管内插管、机械通气和泌尿道插管等侵入性操作,必须有针对性地制定有效干预措施。     

重症监护病房52例医院感染分析

ICU是医院感染的高发区.作者于2004年2月对本院ICU 52例医院感染病例进行分析,报道如下.     

新生儿重症监护病房医院感染的因素探讨及防控对策

目的探讨新生儿重症监护病房医院感染的原因及对策。方法采用回顾性调查研究的方法,对2007年1月至2008年12月我院新生儿重症监护病房收治的981例患儿的病例资料进行统计学分析。结果发生医院感染23例,感染率2.33%,感染部位以胃肠道为主,其次为呼吸道、皮肤黏膜、口腔、其他等,病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主。结论采取严格的消毒隔离制度,合理使用抗生素,尽量缩短住院时间等相应措施可有效减少新生儿医院感染的发生。     

Cerebral desaturation events in the intensive care unit following cardiac surgery

Purpose

Patients may be at high risk for hemodynamic instability in the early postoperative period, with subsequent poor cerebral perfusion and the development of postoperative cerebral oxygen desaturation events (CDEs). Intraoperative CDEs have been associated with postoperative adverse events. However, none of these studies examined the incidence of early postoperative cerebral desaturations. This study was designed to identify the incidence of CDEs (defined as a decrease in SctO₂ to less than 60% for at least 60 seconds) in the immediate postoperative period following cardiac surgery.

Methods

Fifty-three moderate to high-risk patients undergoing elective cardiac surgery were enrolled in this observational study. Cerebral oximeter monitors were placed on all patients prior to induction of anesthesia and remained in place for 6 hours or until the patients were extubated postoperatively, whichever occurred first. Data were recorded from the cerebral oximeter, physiologic monitor and ventilator during the study period. Data were analyzed to identify the incidence of early postoperative CDEs, as well as association with subsequent clinical events.

Results

The incidence of early postoperative CDEs was 53%. Sixty-four percent of these CDEs lasted for more than 1 hour. Patients with postoperative CDEs were more likely to have had intraoperative CDEs (P < 0.0001). Five out of 28 patients who experienced CDEs in the intensive care unit died while none of the patients without postoperative CDEs died (P = .053).

Conclusion

A high incidence of CDEs (53%) was found in the early post-cardiac surgery period. Larger studies are needed to determine whether postoperative CDEs are correlated with various physiologic events or are associated with adverse patient outcomes.     

重症监护病房多发伤患者医院感染分析

目的 分析重症监护病房(ICU)多发伤患者医院感染的特点,探讨其易感因素和防范措施.方法 回顾性调查137例ICU多发伤患者,分析医院感染的部位、病原菌的种类分布状况及医院感染,原菌的变迁情况.结果 ICU多发伤患者医院感染率为62.8%,医院感染最常见的类型是下呼吸道感染(34.3%)及创口感染(24.8%);医院感染以革兰氏阴性菌为主,占67.8%,多为大肠埃希菌、铜绿假单胞菌、克雷伯菌属、鲍曼不动杆菌;革兰氏阳性菌占32.2%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主;克雷伯菌属、铜绿假单胞菌的检出率逐年上升.结论 ICU多发伤患者医院感染的发生率高,应积极采取相应的防范措施以降低感染的发生率.     

Chromobacterium violaceum nosocomial pneumonia in two Japanese patients at an intensive care unit

Chromobacterium violaceum is sensitive to temperature and the infection is usually confined to tropical or subtropical regions. Since Japan has a warm climate, C. violaceum has been scarcely isolated from clinical specimens. With global warming, however, the geographical distribution of C. violaceum infection is likely to change. We report two cases of C. violaceum nosocomial pneumonia that occurred at an intensive care center in Japan. C. violaceum was first detected from a patient in the same center as a pathogenic organism of pneumonia. Later, the organism was isolated from sputum and a ventilator circuit tube of another patient in the center. The two patients were admitted to the center in nearby beds for several days. All of the pathogens were confirmed to be C. violaceum by the nucleic acid sequence of the 16S rRNA gene and were proven to be genetically identical organisms by pulsed field gel electrophoresis. Both patients were managed with well-humidified and heated oxygen using a venturi mask and ventilator to promote excretion of sputum. It was thought that the medical respiratory care devices that provide a humid and warm environment, an optimal condition for proliferation of C. violaceum, can contribute to C. violaceum infection in a hospital environment.     

Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey

Objective To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU).Design Prospective incidence survey.Setting An adult general ICU in a university hospital in western Turkey.Patients All patients who stayed more than 48 h in ICU during a 2-year period (2000–2001).Measurements and results The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillin-resistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26–32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41–66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34–45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47–5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10–30.20; P=0.04) and APACHE II scores 10–19 (OR: 10.80; 95% CI: 1.10–106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001).Conclusion These data suggest that, in addition to underlying clinical conditions, some invasive procedures can be independent risk factors for nosocomial infection in ICU.     

重症监护病房患者下呼吸道院内感染细菌及其耐药性分析

目的探讨重症监护病房患者院内感染细菌分布特点及耐药情况。方法回顾性总结2004年5月至2006年6月本院重症监护病房103例院内感染(nosocomial infection,NP)患者的临床资料、感染病原菌谱及耐药性,并对相关因素进行分析。结果103例感染患者共分离出细菌117株,以G-杆菌为主(占68.4%),球菌比例较低(占21.4%)。G-杆菌中铜绿假单胞菌占第一位(31.6%),其次为大肠埃希氏菌(18.8%)、肺炎克雷伯菌(17.1%)。球菌主要为金黄色葡萄球菌,其中耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)占46.2%。G 菌占35.2%,真菌占18.3%。结论ICU患者下呼吸道感染的病原菌以G-杆菌为主,病原菌显示多重耐药,G-杆菌对亚胺培南敏感性较好,而G 菌对万古霉素敏感应根据药敏选择抗菌素。     

重症监护病房医院感染病原菌特点及耐药性分析

目的了解重症监护病房（ICU）医院感染病原菌及其药敏特征,为临床抗感染治疗提供依据。方法对我院2008年1月至2009年6月在ICU发生的感染送检标本所分离的细菌及药敏特征进行回顾性分析。结果 ICU的医院感染病原菌以革兰阴性菌为主,占76.5%,其中大肠埃希菌42株,占第一位（30.00%）;革兰阳性菌20株,占10.93%,以金黄色葡萄球菌为主;真菌23株,占12.57%,以白色假丝酵母菌为主;大肠埃希菌和克雷伯菌属产超广谱β内酰胺酶（ESBLs）株分别为29株和13株,各占20.71%和9.29%。未发现产ESBLs株对亚胺培南的耐药株。耐甲氧西林金黄色葡萄球（MRSA）6株,占54.54%;凝固酶阴性葡萄球菌8株,耐甲氧西林凝固酶阴性葡萄球菌（MRSCON）6株,耐药率75.0%。未检出耐万古霉素菌株（VRE）。结论 ICU感染以革兰阴性杆菌为主,但革兰阳性球菌仍是重要的致病菌。碳青霉烯类抗生素仍是目前耐药性最低的一类抗生素。尽早行细菌培养,根据药敏结果及时选用敏感抗生素是减少耐药性的有效方法 。     

Prevention of nosocomial infections in intensive care patients*

Background: Changes in patient profile, and in the health care environment, altering socioeconomic conditions and advances in science and information technology challenge the nursing profession, in particular intensive care nursing. All these changes will undoubtedly affect the way we will practice in the (near) future. A comprehensive understanding of these factors is therefore essential if nursing is to meet the challenges presented by tomorrow's critical care environment. Precisely because of the often expensive high‐tech evolutions that have occurred at a rapid pace and are to be further expected, a continued focus on the basics of nursing, the core role of care, as well as maintaining confidence in the capacity to deliver safe, high‐quality, and evidence‐based patient care will increasingly be a challenge to critical care nurses. In particular, basic nursing skills and knowledge remain a key prerequisite in the prevention of nosocomial infections, which is a continuing major complication and threat to intensive care unit patients. However, critical care nurses' knowledge about the evidence‐based consensus recommendations for infection prevention and control has been found to be rather poor. It has nevertheless been demonstrated that a meticulous implementation of such preventive bundles may result in significantly better patient and process outcomes. Moreover, many preventive strategies are considered to be easy to implement and inexpensive. As such, a first and critical step should be to increase critical care nurses' adherence to the recommendations of the Centers for Disease Control and Prevention. Aim: In this article, an up‐to‐date assessment of evidence‐based recommendations for the prevention of nosocomial infections, with special focus on catheter‐related bloodstream infections and strategies relevant for nurses working in critical care environments, will be provided. Additionally, we will detail on a number of approaches advocated to translate the internationally accepted consensus recommendations to the needs and expectations of critical care nurses, and to consequently enhance the likelihood of successful implementation and adherence. These steps will help critical care nurses in their striving towards excellence in their profession. Summary: Intensive care nurses can make a significant contribution in preventing nosocomial infections by assuming full responsibility for quality improvement measures such as evidence‐based infection prevention and control protocols. However, as general knowledge of the preventive measures has been shown to be rather poor, nurses' education should include supplementary support from evidence‐based recommendations.     

重症监护病房医院感染的防治要点

目的了解综合性医院ICU患者的医院感染率及特点。方法监测2012年3—8月收治的ICU患者医院感染率,以患者平均病情严重程度评分（ASIS）调整感染率。观察3种侵袭性操作导致的感染和病原菌的分布情况。结果3700例患者中发生医院感染357例,感染率为9．65％;日感染率为30．34％。;呼吸机相关性肺炎日感染率为49．10‰、导管相关血流感染日感染率为13．86％o、导管相关尿路感染日感染率为1．09％o。共检出688株病原菌,以革兰阴性杆菌为主（82．70％）,前3位病原菌为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌。结论ICU是医院感染的重点科室,应重视对该科室医院感染的监测。     

2017—2020年青海省人民医院综合ICU医院感染目标监测分析

目的分析青海省人民医院综合重症监护室（ICU）医院感染目标性监测结果,为高原地区ICU医院感染目标预防策略提供依据。 方法对2017—2020年青海省人民医院综合ICU目标监测结果和器械污染所致相关医院感染情况进行回顾性分析。 结果共监测综合ICU患者6283例,医院感染发病率为6.20%,医院感染例次发病率为6.94%;感染类型以呼吸系统感染为主,占58.68%,其次为泌尿系统感染,占17.58%;呼吸机相关性肺炎（VAP）发病率为8.88‰,导尿管相关泌尿系感染（CAUTI）发病率为2.53‰,血管导管相关血流感染（CLABSI）发病率为0。日感染发病率2017年为15.09‰,2020年为8.38‰。 结论青海省人民医院综合ICU日感染发病率降低,持续开展ICU医院感染目标性监测,及时发现危险因素并采取干预措施,可有效降低ICU医院感染发病率。