ICU导管相关性血流感染危险因素分析及预防措施

目的探讨医院ICU导管相关性血流感染的风险因素及防护措施，为进一步降低血流感染发生率提供依据。方法对283例符合导管相关性血流感染诊断标准的病例进行回顾性分析。结果3年中ICU导管相关性血流感染发生率约6．29％；发生感染的283例患者中原发感染占86．4％，继发感染占13．6％；年龄〉62岁占患者50．5％；抗菌药物使用率80．6％，70．9％患者使用时间≥7d，经验性用药占60．1％；置管时间≥7d占80．1％；G‘球菌：凝固酶阴性葡萄球菌、金黄色葡萄球菌，肠球菌，G^-杆菌：鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌，真菌：念珠菌为分离出最常见菌种。结论年龄、住院时间、长期使用抗菌药物史、侵入性操作和长时间置管史均是引发导管相关性血流感染易感因素。医院应制定导管相关性血流感染的预防措施和规范的操作流程，加强医护人员的教育培训，加强控制医院感染技术的研究，以降低感染率的发生。     

基层医院母婴同室新生儿医院感染调查分析

目的：探讨基层医院母婴同室新生儿医院感染的情况。方法：回顾性调查我院12580例母婴同室新生儿医院感染的情况，并提出针对性的护理对策。结果：本组新生儿发生医院感染161例，医院感染率为1．28％。皮肤及软组织感染102例，占63．4％；胃肠道感染39例，占24．2％；呼吸道感染12例，占7．5％；眼睑膜感染7例，占4．3％；其他部位感染1例，占0．6％。其中住院时间〈7d 145例，占90．1％；住院7～14d 16例，占9．9％。结论：基层医院应充分重视母婴同室新生儿医院感染的管理，严格执行消毒隔离制度，加强新生儿护理工作，防止医院感染。     

基层医院母婴同室新生儿医院感染调查分析

目的：探讨基层医院母婴同室新生儿医院感染的情况。方法：回顾性调查我院12580例母婴同室新生儿医院感染的情况，并提出针对性的护理对策。结果：本组新生儿发生医院感染161例，医院感染率为1．28％。皮肤及软组织感染102例，占63．4％；胃肠道感染39例，占24．2％；呼吸道感染12例，占7．5％；眼睑膜感染7例，占4．3％；其他部位感染1例，占0．6％。其中住院时间〈7d 145例，占90．1％；住院7～14d 16例，占9．9％。结论：基层医院应充分重视母婴同室新生儿医院感染的管理，严格执行消毒隔离制度，加强新生儿护理工作，防止医院感染。     

ICU医院感染病原菌分析及感染管理

目的研究ICU(重症监护病房)医院感染的病原菌及耐药性，为合理使用抗生素提供依据，探讨有效的感染管理措施，预防和控制耐药菌的传播。方法对2003年送检的Icu患者各种标本分离的菌株进行分析统计。结果所有的病原菌中，G^-杆菌占58．1％，其中鲍曼不动杆菌占18．1％，铜绿假单孢菌16．4％，嗜麦芽窄单孢菌13．6％，药敏显示各菌耐药水平较高；G 球菌占27．2％，金黄色葡萄球菌10．3％，94．6％为耐甲氧西林金黄色葡萄球菌(MBSA)，表皮葡萄球菌11．9％，100％为耐甲氧西林表皮葡萄球菌(MRSE)；真菌占14．7％。结论加强ICU感染管理和对细菌耐药性的监测，合理使用抗菌药物，是减少和延缓耐药菌株产生的关键。应制定有效的对策，从而达到降低医院感染的目的。     

呼吸科医院感染情况调查分析及对策研究

目的 了解呼吸科医院感染的基本情况。确定多种危险因素与呼吸科病人发生的相关性，为预防和控制医院感染提供依据，为进一步前瞻性研究打下基础。方法 应用回顾性调查分析方法，对医院呼吸科1999年1月-2002年6月入住患者的病例进行全面调查，并采用1：1病例对照研究分析造成医院感染的危险因素。结果 该院呼吸科医院感染发生率为17％，感染部位以上下呼吸道、胃肠道和气管切口多见，分别占总感染的43．96％、22．22％、16．91％和6．28％；感染的病原菌以铜绿假单胞菌、大肠埃希氏菌、金黄色葡萄球菌和白色念珠菌为主，分别占总菌株数的24．16％、13.79％、13．79％、13．79％：呼吸科医院感染的危险因素有联用抗生素、气管切开、侵入性诊治和住院天数等七项，其中联用抗生素是首要危险冈素。结论 呼吸科医院感染发生率较高，危险因素复杂，应采用合理使用抗生素、严格无菌操作、加强环境监测等措施来减少感染的发生。     

超广谱β-内酰胺酶(ESBLs)耐药菌株医院内感染及其细菌耐药性研究

目的 通过对β-内酰胺酶耐药菌株在院内各科室的分布及细菌耐药性分析，为临床提供可靠而科学的治疗细菌感染的依据。方法 采用法国生物-梅里埃公司生产的API系统和VITEK2系统进行细菌鉴定，采用法国生物-梅里埃公司生产的GNS-506药敏卡及双纸片协同试验法，对发生院内感染的标本中：分离出的986株革兰阴性菌作ESBLs的检测，比较亚胺培南、氨基糖苷类及喹诺酮类等14种抗菌药物对ESBLs耐药菌的体外抗菌作用。结果 产ESLBs耐药株占全部分离菌的33．6％，其中肺炎克雷伯菌占30．9％，绿浓杆菌．占24．9％，流感杆菌占18．3％，大肠埃希菌占11．3％，阴沟肠杆菌占8．1％，铜绿假单胞菌占5．6％醋酸钙不动杆菌5．3％；亚胺培南对铜绿假单胞菌外产ESBLs耐药菌均表现出最强抗菌作用；头孢西丁对产ESBLs肺炎克雷伯菌及大肠埃希菌有较好的抗菌作用，其他产ESBLs耐药菌对头孢西丁呈全部耐药；氨基糖苷类及喹诺酮类抗菌药物对产ESBLs肺炎克雷伯菌呈现出较好的抗菌作用。院内感染发生率为4．2％。感染β-内酰胺酶耐药菌株病原菌依次为肺炎克雷伯氏菌、绿浓杆菌、大肠艾希氏菌、阴沟肠杆菌、等。结论 产ESBLs革兰阴性菌所致医院内部感染不容忽视；对产ESBLs革兰阴性菌医院内部感染的治疗，亚胺培南、氨基糖苷类及喹诺酮类可作为首选。提示要重视医院内感染的监测，合理使用β-内酰胺酶类抗生素，对患者采取有效的保护性措施，防止和治疗院内感染。     

医院感染患者危险因素调查分析

目的 了解医院感染状况及危险因素，有效预防和控制医院感染。方法 对2004年1～12月住院病人中416例医院感染病例进行调查分析。结果 住院日长、基础病重、相关性侵入性操作、滥用抗菌药物是医院感染的重要危险因素。感染部位：呼吸道感染占42.51％，肠道感染占21.85％，泌尿道感染占14．01％，其它感染占11．40％，大肠埃希菌为医院感染的主要致病菌。结论 加强医务人员医院感染管理知识培训，对医院高危部门进行目标性监测，合理使用抗菌药物，控制医院感染发生。     

不动杆菌鉴定及分析

目的：探讨我院临床分离不动杆菌的分离鉴定及对抗菌药物的耐药情况。方法：2001年1月-2006年1月收集我院临床分离96株，其中鲍曼不动杆菌79株，占分离菌的81．9％，醋酸钙不动杆菌12株，占分离菌的14．8％，洛菲不动杆菌5株，占分离菌的5．2％，并对分离菌株进行药物敏感分析。结论：不动杆菌对亚胺培南最为敏感，耐药率6．7％，其次为含酶抑制剂的β-内酰胺类抗生素和妥布霉素，丁胺卡那霉素，耐药率分别为15．7％，17．0％，24．2％。耐药较高的为哌拉西林，菌必治，环丙沙星，左氧氟沙星，庆大霉素，耐药率34.7—67．7％。必须采取措施延缓耐药菌株的增长，减少此类菌在医院的流行，应积极治疗原发病，减少抗生药物的滥用，合理应用抗生素；医务人员进行诊疗操作及护理患者前后均应认真洗手，防止交叉感染；严格执行无菌操作，对医疗器诫严格消毒，以免造成严重的医院内感染流行。近年来不动杆菌感染的比例逐渐升高，有报道以升至医院感染的第一位。其中鲍曼不动杆菌的分离率占相当大的比例。近年来，不动杆菌作为条件致病菌引起感染的病例明显增加，且该菌对目前使用的多种抗生素耐药，治疗困难。     

沙雷菌属医院感染现状及耐药性分析

目的 了解沙雷菌属医院感染现状及耐药特点。为临床治疗提供依据。方法 对本院2003年1月-2005年12月住院病人临床标本中分离的沙雷菌属的来源部位及细菌耐药性进行统计分析。结果 120株沙雷菌属主要来自呼吸道（61．7％）、手术部位（15．0％）、泌尿道（10．8％）；其中粘质沙雷菌属占65．o％、液化沙雷菌占22．5％、深红沙雷菌占7．5％；对头孢哌酮，舒巴坦、头孢吡肟、亚胺培南、复方新诺明的耐药率较低。分别为3．3％、4．2％、5．0％、14．2％，产AmpC酶菌占10．8％（13株），同时产AmpC酶及ESBLs菌占2．5％（3株）。结论 沙雷菌属是引起医院感染的常见病原菌。以粘质沙雷菌为主；不同感染部位分离的沙雷菌有差异；沙雷菌属以产AmpC酶为主，具有多重耐药性；临床应根据药敏试验结果合理选用抗菌药物。     

526株临床感染病原菌的耐药性监测分析

目的监测福鼎市医院2005年度临床感染病原菌的耐药状况，为本地区医院感染的流行病学调查及临床合理用药提供依据。方法应用回顾性统计分析2005年度本院各临床标本中分离的病原菌对常用抗生素的耐药情况。结果共分离出病原菌526株，其中革兰阴性杆菌265株，占50．4％；真菌130株，占24．7％；革兰阳性球菌115株，占21．9％。各菌属对常用抗生素的耐药率有差异，大肠杆菌对呋喃妥因的耐药率最低为11％；克雷伯菌属对氧氟沙星的耐药率最低为31％；假单胞菌属对环丙沙星的耐药率最低为40％；不动杆菌属对头孢他啶的耐药率最低为32％；肠杆菌属对呋喃妥因的耐药率最低为29％。未发现耐万古霉素的葡萄球菌，呋喃妥因对葡萄球菌有较好的抗菌活性。结论临床常见病原菌对常用抗菌药物呈高耐药率，且有逐年增高的趋势，医院应重视细菌耐药性监测，合理使用和控制滥用抗生素。     

Hygiene of venepuncture tourniquets in Denmark

Abstract

Tourniquets are widely used to make the vein more visible prior to blood collection. Venepuncture tourniquets are however a non-sterile and potentially reusable equipment. Several studies have shown that they are colonised by a variety of pathogenic bacteria and consecutively use of the same tourniquet on multiple patients will increase the risk of a nosocomial infection. This matter is however only scarcely studied. The objective of this study was to investigate the nationwide use of disposable and non-disposable venepuncture tourniquets and the standardised procedures for cleaning the tourniquets. A questionnaire concerning use and cleaning of tourniquets was therefore sent to all major Danish clinical biochemistry laboratories (n?=?12). All but one laboratory had a local procedure for usage and handling of tourniquets, including structured procedures for cleaning. Despite this, only 75% of laboratories had a guideline for cleaning the tourniquets and only 50% had a specified cleaning program. At the hospitals using non-disposable tourniquets the handling differed considerably and at two hospitals the tourniquets were only cleaned once a week, while one laboratory did not clean the tourniquet before it was visibly stained. Of note, five of the eight hospitals using disposable tourniquets only disposed the tourniquets on a daily basis. In conclusion, there is a lack of guidelines for handling tourniquets in 25–33% of the hospitals and a number of hospitals used both types (disposable and non-disposable), which could confuse the handling of the tourniquets. A national guideline for usage and cleaning of venepuncture tourniquets is therefore strongly recommended.     

应用氧化电位水对物品消毒处理的研究

目的探讨酸性氧化电位水(EOW)和碱性氧化电位水(AOW)替代含氯消毒剂消毒加洗涤剂清洗消毒止血带、氧气湿化瓶等不耐高温物品的效果和可行性。方法实验组采用酸性氧化电位水浸泡消毒,加碱性还原电位水清洗的方法;对照组采用500mg/L含氯消毒剂浸泡消毒,加洗涤剂清洗的方法。清洗烘干后止血带无老化、无污垢,湿化瓶无水垢、无白斑,定期抽样检查无致病菌检出者为合格。结果实验组与对照组处理后物品均未查出致病菌,质量合格率均为100%。结论氧化电位水对不耐高温物品的清洗消毒处理,质量可靠,省时省力,并且对橡胶类物品的损害小,除垢效果好。     

三种穿刺法在早期使用动静脉内瘘中的效果观察

目的探讨动静脉内瘘早期使用的最佳穿刺方法。方法将150例早期使用内瘘的患者随机分成3组,常规穿刺组用常规穿刺法,不扎止血带组穿刺中不扎止血带,其它步骤同常规穿刺组,肢体垂吊穿刺组穿刺前先让肢体垂吊1￣3min,见内瘘充盈后不扎止血带,再持针穿刺。结果,3种穿刺方法成功率分别为96%、76%、96%,常规穿刺组和肢体垂吊穿刺组成功率高(P<0.05),但肢体垂吊穿刺组未见并发症。结论肢体垂吊穿刺法优于常规穿刺法和不扎止血带穿刺法,适合在临床推广应用。     

在充盈不佳血管中止血带对套管针穿刺的影响

对７６ 例接受套管针输液、外周静脉充盈不佳的患者进行了止血带影响套管针穿刺一针见血率与送管成功率的研究。观察组３５ 例采用分次扎止血带穿刺和送管后松止血带,与对照组４１ 例传统方法一次扎止血带穿刺和送管前松止血带进行了对照比较,结果表明：２ 组扎止血带法穿刺一针见血率相差显著（ Ｐ＜０ ．０５） ;２ 组松止血带法送管成功率有显著性差异（ Ｐ＜０ ．０１）。说明利用套管针在静脉充盈不佳血管穿刺时,行分次扎止血带和送管后松止血带可以提高穿刺成功率。     

Safety and Appropriateness of Tourniquets in 105 Civilians

Background: The United States military considers tourniquets to be effective for controlling bleeding from major limb trauma. The purpose of this study was to assess whether tourniquets are safely applied to the appropriate civilian patient with major limb trauma of any etiology. Methods: Following IRB approval, patients arriving to a level-1 trauma center between October 2008 and May 2013 with a prehospital (PH) or emergency department (ED) tourniquet were reviewed. Cases were assigned the following designations: absolute indication (operation within 2 hours for limb injury, vascular injury requiring repair/ligation, or traumatic amputation); relative indication (major musculoskeletal/soft-tissue injury requiring operation 2–8 hours after arrival, documented large blood loss); and non-indicated. Patients with absolute or relative indications for tourniquet placement were defined as indicated, while the remaining were designated as non-indicated. Complications potentially associated with tourniquets, including amputation, acute renal failure, compartment syndrome, nerve palsies, and venous thromboembolic events, were adjudicated by orthopedic, hand or trauma surgical staff. Univariate analysis was performed to compare patients with indicated versus non-indicated tourniquet placement. Results: A total of 105 patients received a tourniquet for injuries sustained via sharp objects, i.e., glass or knives (32%), motor vehicle collisions (30%), or other mechanisms (38%). A total of 94 patients (90%) had indicated tourniquet placement; 41 (44%) of which had a vascular injury. Demographics, mechanism, transport, and vitals were similar between patients that had indicated or non-indicated tourniquet placement. 48% of the indicated tourniquets placed PH were removed in the ED, compared to 100% of the non-indicated tourniquets (p < 0.01). The amputation rate was 32% among patients with indicated tourniquet placement (vs. 0%; p = 0.03). Acute renal failure (3.2 vs. 0%, p = 0.72), compartment syndrome (2.1 vs. 0%, p = 0.80), nerve palsies (5.3 vs. 0%; p = 0.57), and venous thromboembolic events (9.1 vs. 8.5%; p = 0.65) and were similar in patients that had indicated compared to non-indicated tourniquet placement. After adjudication, no complication was a result of tourniquet use. Conclusion: The current study suggests that PH and ED tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.     

The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons

Background

The “Stop the Bleed” campaign in the United States advocates for nonmedical personnel to be trained in basic hemorrhage control and that “bleeding control kits” be available in high-risk areas. However, it is not clear which tourniquets are most effective in the hands of laypersons.

Die Wirkung von Methylprednisolon auf den Verlauf des experimentellen Tourniquet-Schock des Hundes

In experiments in dogs rubber tourniquets were tied around both hind limbs as close to the hip as possible, and a 4-h acute ischemia was induced. With the removal of the tourniquets the tourniquet-shock was produced. In a control group no therapy of the shock was carried out. The animals were observed for 6 h. In a second group, methylprednisolone 40 mg/kg BW was given immediately after revascularisation. In a third group, methylprednisolone 40 mg/kg was given prophylactically 10 min before the tourniquets were applied and therapeutically as soon as the blood circulation was opened. Hemodynamic parameters and renal function were measured to examine the pharmacological effect of methylprednisolone in acute tourniquet-shock. The mortality rate in the control group was 90%, while it was 50% by therapeutic and/or prophylactic application of methylprednisolone. The prophylactic application of methylprednisolone reduced development of metabolic acidosis, hemoconcentration, and hyperkaliemia during ischemia so that a mitigated course of shock was observed.     

工作流程优化在门急诊输液中心的应用

目的探讨工作流程优化在门急诊输液中心的应用效果,提高门急诊患者输液服务质量,保证患者输液安全。方法分析输液中心工作流程中潜在的安全隐患,对原有的工作流程进行优化和再造,比较流程优化前后患者满意度及间接护理时数情况的差异。结果流程优化后,患者满意度由优化前的92？5%上升至94？5%;输液患者接诊时间及止血带处理时间均较优化前缩短（P＜0？001或P＜0？05）。结论优化后的流程应用于临床,提高了工作效率,保证患者在输液中心得到高效、安全的治疗和护理。     

Tourniquet use and sickle cell hemoglobinopathy: how should we proceed?

The use of tourniquets for upper and lower extremity operative procedures is controversial in patients with sickle cell hemoglobinopathies. The authors used Ovid and MEDLINE?, PubMed, and CINAHL? to detect English-language reports of any surgical procedure where a tourniquet was used on a patient with sickle cell disease or trait. Four papers met the search criteria and were reviewed. These studies included 96 patients with hemoglobin SS, SC, and sickle cell trait (AS). The investigations differed in tourniquet type, perioperative care, operative procedure, and patient genotype distribution. Twelve of 96 sickle cell patients (12.5%) experienced postoperative complications (8 SS/SC and 4 AS) detailed in two of the four studies. Nonetheless, the available limited evidence suggests that with proper perioperative management and necessary precautions, tourniquets can be used with relative safety in most patients with sickle cell disease.     

PCR与培养鉴定法在口腔厌氧菌检测中的应用与对比

目的探讨聚合酶链式反应（PCR）检测口腔厌氧茼的优势。方法培养方法对口腔厌氧菌的培养与鉴定分析;PCR方法扩增口腔厌氧菌16SrDNA序列和七种厌氧菌特异性序列;同时采用厌氧菌标准菌株作对照。结果PCR和培养方法具有相同的厌氧菌检出率,均为100％（标准菌株为5／5,标本为18／18）;PCR和培养方法具有不同的鉴定准确率,标准菌株分别为100％（5／5）和40％（2／5）;标本PCR为66．7％（12／18）培养方法不易界定;两种方法鉴定结果一致率低,只有5．6％（1／18）。结论PCR在口腔厌氧菌检出和鉴定方面明显优于培养方法。