医院建筑火灾风险评价模型研究与应用

医院建筑火灾风险是由多因素控制的,包括火灾危险指数、医院特征指数、医院抗灾指数。通过建立医院火灾风险评价模型,并结合具体实例。对医院建筑火灾风险进行评价。通过火灾风险评价模型分析表明,加强日常管理,可有效降低医院火灾风险。     

基层医院重症监护病房的医院感染特点及其对策

目的分析基层医院重症监护病房(ICU)的医院感染特点,提出相应的防范措施,以有效降低医院感染发生率. 方法以主动监测与系统回顾相结合的方法,对2003年全年入住ICU 383例患者的相关临床资料进行分析评判,并与全院住院患者进行对比. 结果 ICU的医院感染率是28.8%,显著高出同期的医院平均感染率23.6个百分点;因医院感染而导致死亡的占ICU总死亡的36%;ICU医院感染的病原菌以G-菌为主,占50%,而双重感染达78.7%;下呼吸道感染为医院感染的主要部位占61.7%,但多部位多器官感染占29.6%. 结论 ICU医院感染的特点是高发病率、高死亡率、高耐药性;其相关因素有病情重、年龄大、基础疾病多、侵入性诊疗操作多与交叉感染等.     

重症监护室医院感染与消毒现状调查

目的调查重症监护室(ICU)医院感染与消毒现状,分析ICU医院感染的影响因素。方法收集2016-2018年江苏省25家医院ICU的一般情况、ICU医院感染及相关病原体情况、ICU感染控制与消毒措施情况,单因素和多因素Logistic回归分析感染控制与消毒措施中ICU医院感染的影响因素。结果三年间ICU医院感染率差异有统计学意义(P<0.001);2016-2018年ICU医院感染病原体主要为鲍氏不动杆菌,其次为肺炎克雷伯菌和铜绿假单胞菌;护士数/床、床间距、每日消毒时长、消毒实施人员组成、消毒培训部门组成是ICU医院感染的影响因素(P<0.05)。结论 2016-2018年ICU医院感染率逐年下降,床间距的增大与每日消毒时长的延长将有助于降低ICU医院感染风险,手消毒剂消耗量与保洁人员实施消毒仍然存在问题,需进一步改进。     

浅谈综合医院的ICU管理

综合医院设立ICU不仅可节省人力物力,而且可使危重病人得到及时的救治,从而提高医院的整体水平。但是,ICU也带来一些问题:ICU管理、病人救治、与其它科室的协调。针对上述问题,提出以下观点:有多个专科ICU的医院,综合ICU可由麻醉科管理;医院只有ICU的由胸外科管理;ICU医疗管理人员最好由有关科室共同培养,特别是在胸心外科及麻醉科达到一定的水平。     

ICU患者下呼吸道感染鲍氏不动杆菌的危险因素与对策

目的了解重症监护病房(ICU)鲍氏不动杆菌医院感染的特点。方法回顾性调查2009年7-12月医院ICU患者感染鲍氏不动杆菌的情况,对ICU鲍氏不动杆菌医院感染的来源、感染率、耐药性及相关危险因素等方面进行综合分析。结果医院ICU2009年7-12月,共收治246例患者,其中有41例患者为鲍氏不动杆菌引起的下呼吸道感染,感染率为16.7%;鲍氏不动杆菌多呈多药耐药性。结论多药耐药鲍氏不动杆菌引起的下呼吸道感染在ICU占较高比例,侵入性操作和基础性疾病是鲍氏不动杆菌感染的主要危险因素。     

ICU医院感染预防控制的持续改进

重症监护病房(ICU)既是医院急危重症患者抢救的重要场所,也是医院感染的多发科室,一旦出现问题,将出现医院感染暴发.根据《医院感染管理办法》医院重症监护病房采取了以下的感染管理措施并加以持续改进,确保了ICU的医疗安全. 1 ICU现状分析 ICU是各种急危重症监护与救治的集中区域,无明确的病种分区,病区布局不合理,病区流程有待改善;ICU作为医院控制感染的重点科室,因其环境特殊,治疗对象往往病种繁多、病情危重、抗菌药物的长期使用、免疫力低下以及多药耐药菌的产生,均可导致医院感染;同时经常接受有创性检查等多种因素,所以ICU是医院感染暴发的高危区域.     

ICU住院患者医院感染及危险因素分析

目的 探讨ICU住院患者并发医院感染的发生率及其相关危险因素,提出预防ICU医院感染的对策.方法 对1314例ICU住院患者进行回顾性调查,根据医院感染诊断标准将其分为感染组(139例)和未感染组(1175例);分析ICU住院患者的医院感染率,采用单因素χ2检验、多因素逐步Logistic回归法来筛选ICU住院患者并发...     

重症监护病房医院感染目标性监测与环境监测结果相关性分析

格率分别为78.28%、90.94%及95.83%.结论 ICU患者存在渚多医院感染易感因素,应将ICU作为医院感染重点监测部门;医院感染目标性监测是确有成效的监测方法;ICU医院感染率与同期环境监测结果无显著相关性,环境卫生学监测应具有科学价值和实际意义.     

2011-2014年ICU医院感染监测分析评价

目的分析评价医院2011-2014年ICU医院感染发生率与侵入性操作的关系,并与医院感染进行比较。方法回顾性分析2011-2014年ICU监测的相关数据,分析医院感染与侵入性操作相关性,使用Excel2007建立数据库;所有数据采用统计处理使用SPSS17.0软件。结果 2011-2014年共监测ICU住院患者297例,累计住院日3 293d,其中医院感染发生率2011年为36.96%、2012年为18.92%、2013年为43.55%、2014年为18.26%;侵入性操作相关感染中发生率最高的为呼吸机相关性肺炎;4年共检出多药耐药菌82株,其中最常见的为MRSA占37.80%、多药耐药鲍氏不动杆菌占25.61%、多药耐药肺炎克雷伯菌占13.41%、多药耐药铜绿假单胞菌占10.98%、多药耐药大肠埃希菌占7.32%、其他类型占4.88%。结论 ICU医院感染率较高,特别是患者大多要接受各种侵入性操作的诊疗易发生医院感染,应继续加强对ICU医院感染的预防控制。     

ICU老年患者医院感染的特点及预防对策

ICU是医院感染的高发区,尤其老年患者,因原发病重、基础疾病多、且常伴有免疫功能低下,加之侵入性操作多、大量应用广谱抗菌药物等因素,易发生感染,使病情恶化.因此,分析ICU老年患者医院感染的特点,采取有效的防范措施,控制和减少医院感染显得越来越迫切.     

Pandemic influenza and excess intensive-care workload

In The Netherlands a major part of preparedness planning for an epidemic or pandemic consists of maintaining essential public services, e.g., by the police, fire departments, army personnel, and healthcare workers. We provide estimates for peak demand for healthcare workers, factoring in healthcare worker absenteeism and using estimates from published epidemiologic models on the expected evolution of pandemic influenza in relation to the impact on peak surge capacity of healthcare facilities and intensive care units (ICUs). Using various published scenarios, we estimate their effect in increasing the availability of healthcare workers for duty during a pandemic. We show that even during the peak of the pandemic, all patients requiring hospital and ICU admission can be served, including those who have non-influenza-related conditions. For this rigorous task differentiation, clear hierarchical management, unambiguous communication, and discipline are essential and we recommend informing and training non-ICU healthcare workers for duties in the ICU.     

Cost variation of hospitalization due to injuries: head trauma and fire arm accidents

This article proposes two linear regression models on cost variation of hospitalization (based on data from the Brazilian National Unified Health System - SUS) for two types of injuries: head trauma and related cases (n = 98,156); fire arm injuries and related cases (n = 8,970). Data were collected from the 1997 standardized Hospital Admittance Forms covering all of Brazil. Explanatory variables were gender, age, hospital administration model (public, private, etc.), region of the country, hospitalization in a capital city, use of ICU, surgery, death, duration of hospitalization, most frequent procedures, special procedures, and interaction among certain variables. The two models adjusted well, with R2 = 0.7264 for the first and 0.7663 for the second. Explanatory variables in the first model were all significant, and only three variables in the second failed to show statistical significance. The two main variables in both models were use of ICU and surgery. Diagnostics for detection of outliers, multicolinearity, model specification error, and homoscedasticity were performed.     

ICU和非ICU病房多重耐药菌检出及耐药性差异

目的了解重症监护病房(ICU)和非ICU多重耐药菌(MDRO)的检出情况及耐药性差异。方法分析某院2015年1月—2016年12月住院患者细菌培养标本检出的菌株,目标性监测6种MDRO检出情况,并对ICU和非ICU的6种MDRO检出及耐药情况进行比较。结果目标性监测的6种MDRO共检出1 013株,检出率为13.13%。ICU MDRO检出率为24.60%,高于非ICU的5.47%(P0.001)。检出的6种MDRO中主要为CRAB,占69.40%;不同病原菌中CRAB检出率最高,为55.75%。ICU检出的MDRO以CRAB为主(76.32%),非ICU也以CRAB为主(48.62%);ICU在监测的目标病原菌中MDRO检出率(47.95%)高于非ICU(8.02%),差异有统计学意义(P0.001)。ICU检出的大肠埃希菌对替卡西林/克拉维酸、头孢曲松、头孢噻肟、头孢吡肟、亚胺培南、美罗培南、阿米卡星、庆大霉素的耐药率均高于非ICU,对哌拉西林的耐药率低于非ICU,差异有统计学意义(均P≤0.05);ICU检出的肺炎克雷伯菌对除哌拉西林外的其他常用抗菌药物的耐药率均高于非ICU(均P0.05)。ICU检出的鲍曼不动杆菌和铜绿假单胞菌对常用抗菌药物的耐药率均高于非ICU(均P0.05)。ICU检出的金黄色葡萄球菌对苯唑西林、环丙沙星、四环素、利福平的耐药率高于非ICU(均P0.05),而屎肠球菌对喹奴普丁/达福普汀和四环素的耐药率低于非ICU(均P0.05)。结论 ICU的MDRO检出率高,对大部分抗菌药物的耐药率也高于非ICU,应加强ICU MDRO的监测,制定针对性的预防控制措施。     

Feeding practices of severely ill intensive care unit patients: an evaluation of energy sources and clinical outcomes

OBJECTIVE: The quantity of nutrition that is provided to intensive care unit (ICU) patients has recently come under more scrutiny in relation to clinical outcomes. The primary objective of this study was to assess energy intake in severely ill ICU patients and to evaluate the relationship of energy intake with clinical outcomes. DESIGN: Prospective cohort study. SUBJECTS/SETTINGS: Seventy-seven adult surgery and medical ICU patients with length of ICU stay of at least 5 days. STATISTICAL ANALYSES PERFORMED: Student's t test and chi2 tests were used to examine ICU populations. To determine the relationship of patient variables to hospital length of stay and ICU, length of stay regression trees were calculated. RESULTS: Both groups were underfed with 50% of goal met in surgical ICU and 56% of goal met in medical ICU. Medical ICU patients received less propofol and significantly less dextrose-containing intravenous fluids when compared to surgical ICU patients (P=0.013). From regression analysis, approaching full nutrient requirements during ICU stay was associated with greater hospital length of stay and ICU length of stay. For combined groups, if % goal was > or =82%, the estimated average value for ICU length of stay was 24 days; whereas, if the % goal was <82%, the average ICU length of stay was 12 days. This relationship held true for hospital length of stay. CONCLUSIONS: Medical and surgical ICU patients were insufficiently fed during their ICU stay when compared with registered dietitian recommendations. Medical ICU patients received earlier nutrition support, on average more enteral nutrition, with fewer kilocalories supplied from lipid-based sedatives and intravenous fluid relative to surgical ICU patients. Based upon length of stay, the data suggest that the most severely ill patient may not benefit from delivery of full nutrient needs in the ICU.     

A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization.

OBJECTIVE: To evaluate the predictors of prolonged Intensive Care Unit (ICU) stay and the impact on resource utilization. DESIGN: Prospective study. SETTING: Adult medical/surgical ICU in a tertiary-care teaching hospital. STUDY PARTICIPANTS: All admissions to the ICU (numbering 947) over a 20-month period were enrolled. Data on demographic and clinical profile, length of stay, and outcome were collected prospectively. The ICU length of stay and mechanical ventilation days were used as surrogate parameters for resource utilization. Potential predictors were analyzed for possible association with prolonged ICU stay (length of stay > 14 days). RESULTS: Patients with prolonged ICU stay formed only 11% of patients, but utilized 45.1% of ICU days and 55.5% of mechanical ventilation days. Non-elective admissions, readmissions, respiratory or trauma-related reasons for admission, and first 24-hour evidence of infection, oliguria, coagulopathy, and the need for mechanical ventilation or vasopressor therapy had significant association with prolonged ICU stay. Mean APACHE II and SAPS II were slightly higher in patients with prolonged stay. ICU outcome was comparable to patients with < or = 14 days ICU stay. CONCLUSIONS: Patients with prolonged ICU stay form a small proportion of ICU patients, yet they consume a significant share of the ICU resources. The outcome of this group of patients is comparable to that of shorter stay patients. The predictors identified in the study can be used in targeting this group to improve resource utilization and efficiency of ICU care.     

ICU建设的实践与思考

针对ICU的建设,面向医院管理者提出以下思考:1、营造全院办ICU的氛围,加强领导者和医务人员重视ICU的意识;2、在收容政策、医疗设备、经济分配方面给予ICU强有力的政策导向;3、通过优化人才结构、配备充足的医务人员、进行在职培训等方式加大ICU人才建设力度;4、正确处理ICU与专科的关系;5、准确把握ICU的模式;6、深入开展ICU的经济学研究。     

洁净ICU病房人物流管理与医院内感染发生的研究分析

[目的]通过规范空气层流洁净病房内人员流动与物质流动,探讨洁净ICU区域人物流管理对医院内感染发生率的影响。[方法]制定ICU人物流进出的相关制度并严格执行,每月两次不定期对洁净ICU病区进行空气培养,与采取传统模式管理的专科ICU病区的空气培养进行对比分析。[结果]2009～2010年对洁净ICU及普通ICU各进行48次的空气培养,每月2次,洁净ICU细菌超标1次,合格率97.9%;普通ICU细菌超标7次,合格率85.4%两组的合格率相比差异有统计学意义(χ2=5.79,P﹤0.05)。[结论]规范的人员流动与物质流动管理能有效降低层流洁净环境的空气污染程度,控制或降低医院内感染发生。     

Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness

Skeletal muscle wasting in the intensive care unit (ICU) has been associated with mortality, but it is unclear whether sarcopenia, defined by skeletal muscle mass and function, is useful for detailed risk stratification after ICU discharge. In this cohort study, 72 critically ill patients with an ICU stay of ≥48 h were identified. Skeletal muscle mass was assessed from the muscle thickness (MT) of the patients’ quadriceps using ultrasound images before ICU discharge. Skeletal muscle function was assessed from the patients’ muscle strength (MS) before ICU discharge according to the Medical Research Council sum score. A diagnosis of sarcopenia in the ICU was made in patients with low MT and low MS. The study endpoint was 1-year mortality. Sarcopenia in the ICU was diagnosed in 26/72 patients (36%). After adjusting for covariates in the Cox regression, sarcopenia in the ICU was significantly associated with 1-year mortality (hazard ratio 3.82; 95% confidence interval, 1.40–10.42). Sarcopenia in the ICU, defined by low skeletal muscle mass and function, was associated with 1-year mortality in survivors of critical illness. Skeletal muscle mass and function assessed at the bedside could be used to identify higher-risk patients in the ICU.     

基于O＊NET三问卷综合ICU护理岗位工作分析

目的分析三甲医院综合ICU护理岗位的工作信息,明确ICU护理人员的任职资格要求,为ICU护理人员的科学管理提供参考与依据。方法采用O＊NET工作分析系统中的工作情境、工作技能和工作能力3套问卷对125名ICU护理人员进行问卷调查。结果工作情景、工作技能、工作能力三问卷的各维度得分均高于3分,其中,人际关系、基本技能和认知能力分别是三问卷得分最高的维度。结论应制定符合ICU护理岗位特征的工作说明书,以确保选拔出的ICU护理人员符合岗位要求,进而提高医院及患者的安全。