2005～2008年心胸外科住院患者的医院感染调查分析

目的 探讨心胸外科患者医院感染的相关因素.方法 回顾性分析2005年1月～2008年12月发生在心胸外科305例医院感染患者相关因素,运用有效降低医院感染的措施.结果 发生医院感染305例,心胸外科医院感染发病部位以呼吸道感染发病率最高,上呼吸道124例,占40.7%,下呼吸道127例,占41.6%;其次胃肠道感染36例,占11.8%;医院感染危险相关因素主要是患者高龄、有侵入性操作、抗菌药物联用等.结论 针对相关因素,尽可能减少侵入性操作,尽早去除各种置留管道,规范各项操作规程,合理使用抗菌药物,改善住院环境,加强病房医院感染管理.     

不同手术时机患者术后肺部感染情况

目的比较不同手术时机患者术后肺部感染情况。方法回顾性调查2014年1—12月某院住院患者中实施外科手术的患者,对患者病例资料进行调查,对手术后肺部感染患者进行比较。结果共调查外科手术患者20 343例,手术后发生肺部感染227例,术后肺部感染发病率为1.12%。术后肺部感染发病率急诊手术患者为5.13%,高于择期手术患者术后的0.70%,差异有统计学意义(χ2=307.49,P0.001)。神经外科、普外科、心胸外科组急诊手术后患者肺部感染发病率均高于择期手术患者,差异均有统计学意义(均P0.001)。急诊手术后肺部感染患者中年龄60岁、术前不合理使用抗菌药物、心脑血管疾病、高血压及气管切开患者所占比例均高于择期手术后肺部感染患者(均P0.05);肿瘤患者所占比例低于择期手术患者(P0.05)。结论急诊手术后患者肺部感染发病率比择期手术患者高,且神经外科、普外科、心胸外科的急诊手术后肺部感染发病率较高。急诊手术中合并心脑血管疾病、高血压患者是重点防护人群;对于择期手术,肿瘤患者则为重点防护人群。     

Significant reduction of endemic MRSA acquisition and infection in cardiothoracic patients by means of an enhanced targeted infection control programme

Due to increasing methicillin-resistant Staphylococcus aureus (MRSA) infection in cardiothoracic patients at St Thomas' Hospital, an enhanced infection control programme was introduced in September 2000. It was based on UK national guidelines on the control of MRSA and targeted additional identified risk factors for surgical site infection (SSI). It included recognition of the problem by senior staff and their taking responsibility for it; intensive support, education and advice from the infection control team; improved ward and theatre hygiene; pre-admission, admission and weekly MRSA screening; isolation and clearance treatment; nursing care pathways for MRSA colonized patients; and teicoplanin plus gentamicin surgical prophylaxis. The effectiveness of the programme was assessed by retrospective analysis of computerized patient data for the 16 months before and after the introduction of the programme. There was no significant change in the number of operations or the proportion of patients admitted with MRSA, although nine patients were cleared of carriage before admission. However, there were significant falls in the proportion of patients acquiring MRSA on the ward [38/1036 to 14/921, P=0.003, RR 2.4 (95%CI 1.32-4.42)] and in the rate of bloodstream MRSA infections [12/1075 to 2/956, P=0.014, RR 5.34 (95%CI 1.20-23.78)]. Sternal and leg wound infections both halved (from 28/1075 to 13/956 and 16/1075 to 7/956, respectively) but this did not reach statistical significance. These results demonstrate that an enhanced, targeted infection control programme based on the UK national guidelines, SSI prevention guidelines and local risk assessment can reduce the incidence of nosocomial MRSA acquisition and invasive infection in cardiothoracic patients in the face of continuing endemic risk.     

心胸外科住院患者术后医院感染的特征分析及预防措施

目的 探讨心胸外科住院患者术后医院感染的特征及预防措施.方法 采用回顾性调查分析统计心胸外科2005年1月-2010年12月住院患者术后医院感染率、感染部位、病原菌分布、感染危险因素.结果 1520例患者术后发生医院感染81例,感染率5.33％;其中呼吸道感染48例,占59.25％,手术切口感染19例,占23.46％.,泌尿道感染5例,占6.18％;医院感染相关危险因素是患者年龄、合并基础疾病、侵入性操作和住院时间.结论 加强医院感染管理,针对术后感染的危险因素积极采取有效措施,合理使用抗菌药物可减少医院感染的发生.     

某三级甲等综合医院胸心外科患者手术部位感染调查

目的了解胸心外科手术部位感染现状,分析手术部位感染的特征和影响因素,为预防手术部位感染提供依据。方法采用前瞻性监测方法,调查某院2014年1月1日—2015年12月31日胸心外科手术患者的病历资料,监测患者的手术情况及手术部位感染情况等,分析手术部位感染的危险因素。结果共调查手术患者1 953例,手术部位感染31例,发病率1.59%。logistic回归分析结果显示,住院时间、恶性肿瘤、引流管留置时间和手术时长OR(95%CI)分别为8.48(1.12~63.98)、3.99(1.15~13.83)、2.54(1.07~6.02)、2.11(1.01~4.39),是手术部位感染的独立危险因素(均P0.05)。结论预防手术部位感染应针对手术部位感染的危险因素采取措施,以降低手术部位感染的发病率。     

A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections.

OBJECTIVE: We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources. DESIGN: The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes. SETTING: A large tertiary care medical center and an affiliated Veterans Affairs Medical Center. PATIENTS: A total of 3,864 surgical patients. RESULTS: The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population. CONCLUSION: Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.     

某院维吾尔族心胸外科手术患者医院感染发病率及影响因素

目的探讨某院维吾尔族心胸外科手术患者医院感染发病率及影响因素。方法回顾性查阅新疆喀什地区某医院心胸外科2010年6月-2014年6月收治的维吾尔族患者病历,记录相关临床资料,调查其术后医院感染发病率,并采用单因素及多因素logistic回归模型分析患者术后医院感染的影响因素。结果共收集779例维吾尔族患者资料,术后发生医院感染53例,医院感染发病率为6.80%。不同感染部位感染发病率由高至低依次为下呼吸道（2.44%）,消化道（1.28%）、泌尿道（1.16%）、上呼吸道（1.03%）和手术部位（0.51%）。多因素logistic回归分析结果显示,糖尿病史、 身体质量指数（BMI）≥30 kg/m2、手术时间≥160 min和侵入性操作是维吾尔族心胸外科手术患者医院感染的危险因素。结论该院维吾尔族心胸外科手术患者医院感染发病率较高,主要危险因素有糖尿病史、BMI高、手术时间长和侵入性操作。     

心胸外科患者多重耐药菌感染及危险因素分析

目的 探讨心胸外科住院患者多重耐药菌(MDRO)感染的特征及其危险因素.方法 回顾性调查632例发生医院感染的心胸外科患者,根据其是否发生MDRO感染分为MDRO组和非MDRO组,计算MDRO感染率并分析多重耐药菌株分布,筛选影响心胸外科患者MDRO感染的相关危险因素.结果 心胸外科患者MDRO感染发生率为15.19％...     

腹部手术部位感染综合干预的效果评价

摘要:目的　评估腹部手术部位感染的综合干预方案的效果。方法　采用问卷调查和现场观察法,比较干预前后手术部位感染率、医务人员防控知识知晓率和措施执行率,评价干预效果。结果　实施干预后腹部手术部位感染率由干预前5.88%下降至干预后3.72%,差异有统计学意义（χ2＝4.64,P＝0.031）。干预前医务人员手术部位感染防控知识的知晓率为60.20%,干预后知晓率为85.26%,差异有统计学意义（χ2＝240.76,P＝0.000）。干预后手卫生、无菌操作、合理用药等各项防控措施的执行率较干预前提高,差异均有统计学意义（P＜0.05）。结论　根据目标性监测数据和专家意见制定的综合干预方案,能有效推动医务人员落实各项防控措施,降低腹部手术部位感染发生率。     

Case-control study of surgical site infections associated with pacemakers and implantable cardioverter-defibrillators.

OBJECTIVE: In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. DESIGN: Unmatched 1 : 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. SETTING: The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. PATIENTS: Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. RESULTS: A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P=.006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P=.02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P=.003). CONCLUSIONS: Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.     

洁力康用于伤口及创面冲洗的临床效果

目的 比较临床上使用抗菌剂的抗菌效果。方法用洁力康进行普外、妇产、小儿外科、泌尿、烧伤、骨科、心胸外科、耳鼻喉及口腔科的17206例手术患者创口冲洗。结果手术切口及创面均为甲级愈合，洁力康对创口及皮肤黏膜细菌的即时杀灭率均为100％，在术后24h换药时切口部位亦未检出细菌。结论采用具有持续杀菌作用的洁力康进行手术创口及各类创面的冲洗，对控制术后及医院交叉感染有积极意义。     

手术部位感染目标性监测效果评价

目的 了解医院手术部位感染的相关因素、围手术期抗菌药物应用情况,评价采取干预措施后的控制效果.方法 采用前瞻性调查方法,按预先设计好的表格内容,由医院感染管理专职人员每天对医院2009年5月至2010年5月的乳腺癌、胃及结肠手术的534例患者手术部位及相关危险因素进行评估并填写表格直至患者出院后30 d.结果 第1阶段手术部位感染率为0.72％,第2阶段感染率为0,其中Ⅰ、Ⅱ类切口感染率为0,Ⅲ类手术切口感染率为3.28％ (P＜0.01);围手术期抗菌药物第2阶段较第1阶段有了明显的规范,麻醉诱导期用药由第1阶段的2.17％提高到第2阶段的82.56％;术后使用抗菌药物＜24 h,由第1阶段的6.61％提高到第2阶段的30.23％;术后未使用抗菌药物由第1阶段的1.81％提高到第2阶段的8.14％;单种抗菌药物使用由第1阶段的30.07％提高到第2阶段的44.96％.结论 手术部位感染目标性监测能有效降低手术部位感染的发生;抗菌药物的围手术期预防性应用有了明显规范.     

“零缺陷”护理管理理念在小儿手术护理质量管理中应用

目的分析“零缺陷”护理管理理念在小儿手术护理质量管理中的应用效果。方法随机择取2018年1月—2019年7月于该院收治的72例小儿手术患者作为研究对象,根据随机数字表的方法,将其划分成对照组与实验组,各36例。对照组运用常规护理方法,实验组采取“零缺陷”护理管理理念,比较两组的护理缺陷率与护理满意度。结果对照组切口感染1例,异物残留1例,手术部位错误6例,实验组切口感染1例,异物残留0例,手术部位错误1例,实验组的护理缺陷率(5.56%)明显低于对照组(22.22%),差异有统计学意义(P<0.05)。对照组相当满意20例,满意3例,不满意1例,极不满意12例,实验组相当满意30例,满意2例,不满意3例,极不满意1例,实验组的护理满意度(88.89%)高于对照组(63.89%),差异有统计学意义(P<0.05)。结论“零缺陷”护理管理理念在小儿手术护理质量管理中应用效果优良,护理缺陷率大幅度降低,小儿家属的满意度也提升,因此,该种护理理念在临床中具有较大的推广价值,应获得人们的高度重视。     

Risk of nosocomial infections and effects of total cholesterol,HDL cholesterol in surgical patients

BACKGROUND AND AIMS: Changes of lipoprotein pattern in plasma occur in many acute infections. The aim of this study was to analyse the role of total cholesterol and HDL cholesterol in postsurgical patients with nosocomial infection. METHODS: Four hundred and eighteen patients admitted to our department and operated on for various diseases are included in this prospective study. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and HDL-cholesterol (HDL-C) levels were measured. RESULTS: In our study, the most frequent infection was surgical site infection. There was an increased association between low HDL-C level and nosocomial infections such as surgical site and pulmonary infections. HDL levels may be used as predictive parameter for surgical nosocomial infections. CONCLUSIONS: HDL-C levels seem to be one of the risk factors for postoperative nosocomial infection. Although total cholesterol level was not significantly increased, it may be also associated with the infection risk. Screening of lipoprotein pattern in patients undergoing operation may be useful for ascertaining of risk for nosocomial infection.     

Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy.

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.     

Surgical wound infection in patients treated with hip arthroplasty

This is an epidemiological non concurrent cohort study on surgical site infections after hip arthroplasties, based on the information contained in 305 records of patients operated at the "Santa Casa de Belo Horizonte" Hospital. The goals were to determine the incidence rates of surgical site infection in patients, aiming at verifying the association between the surgical site infection and some risk factors and at identifying the time for the manifestation of surgical site infection and the microorganisms involved. The prevalent microorganism was the Staphylococcus aureus. A 8.5% accumulated incidence rate of surgical site infection was found. The risks factors associated to infection were patient's clinical condition (ASA); pre and post-operative hospitalization time; type of surgical procedure; anesthesia and hospitalization unit.     

普通外科手术部位感染目标性监测研究

目的通过对徐州医学院附属医院普通外科手术部位感染（SSI）的目标性监测研究,探讨影响手术部位感染的危险因素。方法采用前瞻性目标研究的方法,由医院感染专职人员对普通外科所有手术患者切口情况进行观察,并于手术后1个月进行电话回访,了解手术切口愈合情况。结果1 589例次手术患者中,155例次手术部位发生感染,感染率为9.75%;不同手术类别相同危险指数的手术以剖腹探查手术和结肠手术感染发生最高;有56例患者在出院后发生手术部位感染,随访感染占总感染例数的36.13%,随访感染以Ⅰ、Ⅱ类手术为主;经单因素及多因素Logistic回归分析得出,白蛋白及血红蛋白值异常、急诊手术、失血、切口类型、引流为手术部位感染的危险因素。结论手术危险指数越高,切口污染越严重,SSI发生率就越高;加强手术患者出院后的追踪随访,有助于了解SSI的真实情况;普外科SSI存在着多种危险因素,采取针对性的措施进行目标性监测,才能有效降低SSI的发生率。     

外科病房病原菌的分布及感染现状

目的 探讨外科病房感染性疾病病原菌分布及感染状况,为临床预防患者发生感染提供参考.方法 对2010年1月-12月外科病房送检的标本进行细菌培养,用VITEK细菌鉴定及药敏分析系统对病原菌进行菌种鉴定,对不同科室及标本中病原菌的分布与检出率进行分析.结果 共检出病原菌693株,革兰阴性杆菌498株、革兰阳性球菌132株、真菌63株,分别占71.9％、19.0％、9.1％,大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌位于检出菌的前3位,不同科室病原菌检出率及主要感染部位有所不同,神经外科与心胸外科以呼吸道感染为主,泌尿外科以尿路感染为主,骨科及普通外科以创口感染为主,肝胆外科则以胆道感染为主.结论 外科病房中主要发生革兰阴性杆菌感染,呼吸道、泌尿道及手术创口等部位,在外科病房中较易发生感染,感染部位与手术科室的专业特点有一定关系.     

An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing

Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.     

Paediatric cardiology in a sub-regional cardiothoracic unit

The aim of this study was to examine the pattern of referrals the number of admissions, cardiac catheterisations and surgical procedures-including outcome-in infants and children referred to a sub-regional cardiothoracic unit during a 6-year period. The unit is served by one paediatric cardiologist and four general cardiothoracic surgeons, two of whom undertake paediatric surgery. Referrals were received from within the Trent Regional Health Authority, and from three other health Regions. During the study period 2,097 infants and children were admitted to the unit with cardiac disease, and 730 underwent cardiac surgery. The proportion of admissions undergoing surgery increased significantly with time, as did the neonatal and infant surgical procedures and infant surgical procedures. Overall, the surgical mortality did not alter with time, and was comparable to the national average. The results show an increase in the demand for cardiac investigations and surgery, and this was most evident in infants, particularly for open procedures. This unit serves a large population with proven needs, and the number of children treated falls within the range of existing supra-regional centres. The combination of available expertise, and a cost-effective patient outcome measure, should place such units in a category of high priority for resource allocation.