ICU医院感染危险因素与防治对策

目的研究ICU患者医院感染发生的特点及危险因素,制定有效的预防控制措施。方法回顾性与前瞻性调查2009年1月-2010年12月575例ICU住院患者医院感染情况。结果 ICU发生医院感染135例,医院感染率为23.5%,显著高于同期的医院平均感染率的3.3%;≥60岁老年患者居多,占74.1%;医院感染部位感染中以下呼吸道感染为主,占78.5%,其中发生呼吸机相关性肺炎有51例,占呼吸道感染的48.1%;基础疾病以糖尿病、恶性肿瘤及慢性支气管炎的感染率最高,分别为48.9%、35.6%、30.4%。结论 ICU医院感染与侵入性操作、机体抵抗力下降、不合理抗菌药物应用、医务人员缺乏医院感染控制意识等因素密切相关,加强ICU管理,遵守无菌原则及手卫生规范,提高患者机体抵抗力,合理应用抗菌药物等是预防ICU医院感染的有效防治对策。     

山东省12所综合性医院ICU目标性监测分析

目的 了解ICU患者的医院感染发生率、危险因素、预防措施,防止医院感染发生.方法 采取目标性监测方法,对12所综合性医院ICU的住院患者发生医院感染的情况进行调查,用ASA法调整医院感染发病率,并对侵入性操作相关感染进行分析.结果 2087例ICU住院患者中,发生医院感染236例,医院感染发生率为11.31%,患者日感染率为2.38%,根据病情的平均严重程度经ASA法调整后的医院感染发生率为3.57%,患者日感染率为0.67%.结论 ICU患者是医院感染易感人群,目标性监测可以有效地降低ICU患者医院感染的发生.     

早期护理干预在控制重症监护病房医院感染中的作用

目的分析重症监护病房(ICU)医院感染的危险因素,探讨有效预防与控制ICU医院感染的护理措施。方法对2004年1月～2005年12月入住ICU的患者进行前瞻性监测,根据ICU医院感染的特点及危险因素,针对其高危因素和薄弱环节,实施早期护理干预。结果ICU医院感染发病率为27.20%,其中下呼吸道感染占51.82%,居首位,其次为泌尿道占23.36%,气管切开/插管患者发生下呼吸道感染占81.69%,使用呼吸机辅助呼吸发生下呼吸道感染占74.65%,泌尿道插管患者发生泌尿道感染占75.0%,说明侵入性操作是医院感染的主要危险因素。结论加强对侵入性操作的护理和管理,及时采取有效预防控制措施,是减少医院感染发生的关键。     

唐山市某三甲医院ICU患者医院感染情况分析

目的:通过对唐山市某三甲医院ICU住院患者医院感染病例的综合分析,总结其发生的特点,分析其发生的影响因素,提出ICU医院感染的预防措施,以期减少医院感染的发生,提高该院医疗护理质量。方法:研究对象为2012年1-12月期间的ICU住院患者。统计分析法包括描述性分析、卡方检验。结果:医院ICU感染发生率为24.7%;感染部位以下呼吸道感染为主(61.8%);性别、住院天数是医院感染发生的主要影响因素(P<0.05)。结论:ICU医院感染发生率较高,医院需要在重点病人,重点发生部位、缩短住院时间等方面采取相应措施。     

重症监护病房医院感染目标性监测分析与控制对策

目的 了解重症监护病房(ICU)医院感染发病特点,针对性地采取控制措施.方法 采用目标性监测方法,对某院2009年1-12月5个ICU患者医院感染发病情况进行监测,并用患者平均病情严重程度调整感染发病率,同时对3种侵入性操作相关感染进行分析,提出具体的预防控制措施.结果 呼吸机,导尿管和血导管相关性感染发病率最高者分别为综合科ICU 7.5%、神经外科ICU 4.8%、内科3.8%、急诊科ICU 3.5%.结论 根据各ICU医院感染发生的特点针对性地进行干预以降低感染率.     

重症监护病房医院感染因素分析及干预

[目的]探讨重症监护病房(ICU)患者医院感染特点,为有效预防与控制ICU医院感染提供可靠依据。[方法]采用回顾性调查的方法,对2008年2月～2009年2月于我院ICU住院治疗的380例患者进行医院感染因素分析。[结果]380例患者中发生医院感染112例次,例次感染率为29.47%;不同基础疾病院内感染发生率不同,其中以脑血管疾病和呼吸系统疾病医院感染发生率最高;感染的部位以下呼吸道感染最多占54.46%,其次为泌尿道及消化道;住院时间、侵入性操作与医院感染关系密切。[结论]ICU患者医院感染发生率高,明确ICU医院感染相关危险因素,有利于进一步采取有效措施,减少ICU患者医院感染的发生。     

重症ICU中的医院感染风险因素评估

目的分析医院感染风险因素评估在重症ICU中的应用,探讨重症ICU病房医院感染率发生趋势。方法对重症ICU病房医院感染风险因素进行评估,并对风险级别采取相应的防控措施,将我院2013年2~12月和2014年2~12月收治ICU的患者的感染情况和目标性监测进行比较。结果 2013年2~12月收治745例ICU住院患者中发生医院感染83例(11.14%),97例次(13.02%),日感染率为18.68‰;经风险因素评估应用后,2014年2~12月收治862例ICU住院患者中发生医院感染51例(5.92%),65例次(7.54%),日感染率为8.91‰。结论通过对重症ICU病房高、中、低医院感染风险因素的评估,掌握其医院感染特点和发展规律,进行有目的地预防和控制,结合目标性监测的医院感染数据分析,充分说明医院感染风险因素评估在重症ICU中的应用,可降低医院感染率,值得临床推广和进一步探讨。     

重症监护病房患者院内感染的调查与分析

目的 了解重症监护病房(ICU)患者的医院感染特点,探讨其病原菌和耐药性,为控制院感提供依据.方法 对本院自ICU成立以来25个月所发生的医院感染的患者的临床资料采取前瞻性调查和回顾性调查相结合进行整理分析.结果 ICU患者医院感染率为21.76%;医院感染发生的部位以呼吸道最多(55.14%);医院感染的病原菌以革兰氏阴性菌为主(52.8%);医院感染的发生与侵入性操作相关;病原菌对抗菌药物耐药率均较高.结论 ICU是医院感染的多发科室,应重点监测;严格执行无菌技术,合理使用抗生素;针对高危因素和薄弱环节,采取积极有效的综合管理措施,以降低ICU患者医院感染的发生.     

重症监护病房住院患者医院感染状况调查

目的分析综合性重症监护病房(ICU)住院患者医院感染状况及特点,为降低医院感染率提供依据。方法选取山东省某三级甲等医院2004年1月-2009年12月入住ICU患者1 719例,进行目标性监测,由感染科和ICU护士分别记录患者在ICU发生的感染和转出ICU48 h内发生的感染情况。结果 1 719例患者中,发生医院感染530例,医院感染率为30.95%;住院天数共计25 980 d,其中尿管留置率68.93%;动静脉导管留置率为35.65%;呼吸机留置率为44.53%;感染部位以下呼吸道为主,占67.25%;感染病原菌以革兰阴性杆菌中铜绿假单胞菌感染为主,占13.61%,其次是金黄色葡萄球菌,占9.52%。结论 ICU患者是医院感染的易感人群,应加强对ICU的目标性监测,根据监测结果采取针对性干预措施,降低感染发生率,提高医疗质量。     

重症监护患者医院感染监测及预防

目的分析重症监护病房(ICU)医院感染的特点及发生医院感染的危险因素,探讨有效预防和降低其医院感染发病的对策. 方法对2001～2003年入住ICU,发生医院感染患者的临床资料,采取前瞻性监测与回顾性调查相结合的方法进行整理分析.结果 ICU患者医院感染率为24%,显著高于同期医院平均感染率4.34%;发生感染的病例平均住院日为43.78 d,发生感染的病例平均费用为67 369.30元,均明显高于非感染病例;医院感染部位的分布以下呼吸道感染最多,占55.26%;医院感染的病原菌以革兰阴性杆菌、真菌为主. 结论 ICU是医院感染的高发科室,应作为重点监测部门;其收治的患者基础病严重、侵入性操作多、大量使用抗生素、老年患者免疫功能低下等均是导致发生医院感染的易感因素;积极采取有效的综合防范措施,是降低其医院感染发病率的关键.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.