新生儿医院感染23例分析及对策

随着新生儿事业的发展壮大,对危重新生儿的侵入性操作增多,加上新生儿身体各器官未成熟,尤其免疫系统未完善发育,抵抗力很低,属于医院感染的易发人群.为减少医院感染发生,现对我科新生儿病房23例医院感染病例进行总结.     

新生儿重症监护病房医院内感染高危因素及防治策略

随着新生儿重症监护病房(neonatal intensive care unit,NICU)诊治技术的不断发展,医院内感染逐渐增多.做好NICU院内感染的监控工作,对提高新生儿的存活率及NICU的管理水平至关重要.该文分析探讨医院内感染的原因,并讨论医院内感染的防治对策.     

新生儿医院感染23例分析及对策

随着新生儿事业的发展壮大，对危重新生儿的侵人性操作增多，加上新生儿身体各器官未成熟，尤其免疫系统未完善发育，抵抗力很低，属于医院感染的易发人群。为减少医院感染发生，现对我科新生儿病房23例医院感染病例进行总结。     

NICU医院感染及其防治

医院感染是新生儿科临床诊治和疾病管理中的难题,新生儿重症监护室(NICU)是医院感染的高危场所,不同年代、不同国家和地区NICU医院感染临床特点不尽相同。建议通过加强手卫生,合理使用抗生素,控制高危因素,有效控制NICU医院感染,提高危重新生儿救治水平。     

新生儿医院感染222例临床分析

目的　探讨新生儿医院感染的特点及防治措施。方法　回顾性分析1996年1月至1997年12月，我院收治的3070例住院新生儿医院感染发生情况。结果　总的医院感染率是7.2%。随着新生儿体重的降低，发生医院感染的相对危险度增加；不同体重组发生医院感染率有极显著性差异。新生儿医院感染发生的部位89.2%在皮肤粘膜。结论　低体重儿易发生医院感染，提示要特别注意低体重新生儿的诊疗和护理。     

新生儿皮肤黏膜感染44例临床分析

引起新生儿医院感染的因素很多，发生的部位多在皮肤黏膜，为探讨新生儿医院皮肤黏膜感染的特点及防治，现将我院NICU病房2002年5月～2003年12月医院皮肤黏膜感染44例报告如下。     

血小板动态监测在新生儿败血症中的临床价值

血小板减少在危重患儿中较常见,有文献报道在重症监护新生儿中约有22%发生血小板减少[1],其中败血症是导致血小板减少的明确因素.本研究通过动态监测在本院住院期间医院获得感染的41例败血症新生儿在感染症状出现前、感染时及感染完全控制后不同时间的外周血血小板水平,结合血培养检查及临床表现,根据血小板计数在感染过程中的变化对其临床价值作一评价.     

不同病室新生儿医院内感染的特点

目的　探讨不同病室新生儿医院内感染的特点及防治。方法　对 1996年 6月～ 2 0 0 2年 6月我院母婴同室新生儿病房及新生儿监护病房住院新生儿 5 2 8例进行医院感染的对比研究。结果　 1.5 2 8例新生儿医院内感染率为 5 .1% (2 7/5 2 8) ;母婴同室新生儿院内感染率为 5 .5 % (14 /2 5 5 ) ,高于新生儿监护病房的院内感染4 .76 % (13/2 73) (P >0 4 .76 % (13/2 73) (P >0 .0 5 )。 2 .住院 >2周的感染率 (8.5 5 % ,2 0 /2 34)高于住院 1周感染率 (2 .38% ,7/2 94 ) ;低出生体重 (<2kg)的新生儿医院内感染率为 9.6 2 % (5 /5 2 ) ,高于体重≥ 4kg新生儿院内感染率 (4.76 % ,2 /42 ) ,但两组比较无显著性差异 (P >0 .0 5 )。 3.医院内感染的病原体主要为细菌、霉菌、支原体及病毒感染。 4 .新生儿医院内感染的疾病主要有上呼吸道感染、肺炎、鹅口疮、皮肤感染、结膜炎。结论　不同新生儿病室院内感染的发生率及因素不同。母婴同室增加新生儿院内感染的机率 ,应严格限制探视和加强隔离     

新生儿医院感染323例临床分析

目的：探讨新生儿医院感染的特点及防治措施。方法：回顾性分析1999年1月-2001年12月我院收治的4832例住院新生儿医院感染发生情况。结果：总感染率为6.7%。新生儿体重越低，住院时间越长，使用抗生素种类越多，则发生医院感染的相对危险度越高。新生儿医院感染发生的部位87.3%在皮肤粘膜。主要为条件致病菌所致。结论：低体重儿易发生医院感染，提示应注重低体重新生儿的治疗与护理。缩短住院时间、合理使用抗生素、加强环境质量控制、加强洗手管理有助于降低医院感染发生率。     

新生儿重症监护病房医院感染89例

为探讨新生儿重症监护病房(NICU)医院感染相关因素,现将我院医院感染的新生儿89例进行临床分析,现报道如下。 临床资料 我院NICU1997年11月～2002年4月收治危重新生儿723例,男426例,女297例;胎龄27～42周,日龄1～22d。采用回顾性调查,根据病历资料和医院感染登记表记录的有     

Epidemiology of nosocomial infections in neonates]

Epidemiology of nosocomial infections in neonates has to be described according to our definitions (early onset GBS diseases excluded) and according to levels of care. Nosocomial risk exists in maternity departments (3% in postnatal beds), incidence rates are 7.5-12.7% or 1.3-8.5 per 1000 days in neonatal care units and 14.2% or 11.7 per 1000 days in neonatal intensive care units (NICU). Gram-positive cocci bloodstream infections are the most common nosocomial infections in NICU but viral gastroenteritis are more frequent in neonatal care units. Risk factors are low birthweight, small gestational age and intravascular catheter in NICU, and for viral nosocomial infections, visits and winter outbreaks.     

新生儿重症监护室院内感染的影响因素

新生儿重症监护室(neonatal intensive care unit,NICU)院内感染是引起新生儿死亡的重要原因之一.文章对近年NICU院内感染的一些研究进展进行总结,对院内感染的定义、病原和发病率及主要危险因素作一简介并讨论其主要预防措施.     

Neonatal sepsis and infection control policies in Australia

The pattern of neonatal bacterial infection, its management and the types of infection control policy were ascertained in 20 neonatal intensive care units (NICU) in Australia by questionnaire survey. Group B Streptococcus and Escherichia coli were the predominant organisms responsible for perinatally acquired infection for which the most common antibiotic combination used was Penicillin and Gentamicin. Staphylococcus epidermidis and aureus (majority Methicillin resistant) were the predominant organisms responsible for nosocomial infection for which the most common antibiotic combination used was Vancomycin and Cefotaxime. A Serratia epidemic was experienced in four NICU. Lumbar and suprapubic punctures were frequently done as part of the diagnostic workup in nosocomial infections but not with perinatally acquired infections. Haematological indices considered useful as a diagnosis aid varied between NICU and acute phase reactants were rarely relied upon for diagnosis or for monitoring treatment response. Granulocyte transfusion and intravenous immunoglobulins were infrequently used in therapy. No consensus was found on infection control policies. Eight NICU required routine gowning on entry, two restricted sibling visiting and four restricted visiting by relatives and friends. Although routine bacteriological surveillance on staff or equipment was uncommon, serial cultures were carried out in infants from the body surface in six NICU and from the endotracheal aspirate in 17 NICU. Antiseptics used with technical procedures included iodine, chlorhexidine and alcohol used singly or in combination. Skin and umbilical cord care also varied between NICU. The literature was reviewed to determine the effectiveness or otherwise of some of the existing policies in the prevention or management of neonatal infection to encourage consensus towards a more rational approach to neonatal infection in Australia.     

早产儿医院感染的危险因素

目的 探讨早产儿医院感染的发病情况及危险因素,为医院感染的监控和干预提供理论依据.方法回顾性调查本院2008年1月-2010年1月本院NICU 516例早产儿的临床资料,分析医院感染的危险因素.结果 1.早产儿516例中,74例发生医院感染,发生率为14.3%,共发生医院感染98例次,平均每例发生1.32次,医院感染的住院日相关发生率为8.9‰;感染部位以呼吸道为主(51.0%),其中呼吸机相关性肺炎最为多见(占36.0%),其次为皮肤软组织(26.5%)和消化道(14.3%).2.共培养出病原菌69株,革兰阴性杆菌占71.0%,以肺炎克雷伯菌最为多见(17.4%);革兰阳性球菌占18.8%,以草绿色链球菌最为多见;真菌占10.1%,主要为白色念珠菌.3.胎龄≤32周、出生体质量≤1.5 kg、羊水胎粪污染、胎膜早破≥48 h、糖尿病母亲儿、吸痰次数≥10次、气管插管次数≥3次、机械通气时间≥3 d、置胃管、静脉营养、应用抗生素时间≥2周及住院时间≥2周与医院感染率显著相关,多元Logistic回归方程显示胎龄≤32周、静脉营养、机械通气时间≥3 d及住院时间≥2周是医院感染发生的独立危险因素.结论 NICU早产儿医院感染的危险因素众多,尽量减少侵入性操作次数、缩短静脉营养及住院的时间、合理应用抗生素可有效降低医院感染发生率.     

Effectiveness of an informative report on the prevention of nosocomial bloodstream infections in a neonatal intensive care unit]

OBJECTIVE: Few studies have evaluated the impact of an information and prevention process specifically aimed at neonatalogists and nurses working in a neonatal intensive care unit (NICU) towards the prophylaxis of nosocomial bloodstream infections. Our objective was first to analyze nosocomial infections within our unit, and secondly to evaluate the impact of a monthly report providing information related to the number and characteristics of such infections. PARTICIPANTS AND METHODS: A prospective study was performed in the NICU of Angers University Hospital during 2 six-month periods. All cases of nosocomial bloodstream infections and their characteristics were analyzed. We then published a nosocomial infections report every month during the second period, in order to inform the medical staff and nurses of the results. The impact of the information and prevention process was evaluated by comparing the results between the 2 periods. We also assessed the staff's interest by questionnaire. RESULTS: Two hundred and fifty-four (first period) and 240 (second period) patients were included. A decrease in the specific incidence rate and density of catheter related bloodstream infections was observed between the 2 periods, especially for preterms with a birth weight<1000 g and gestational age<28 SA (P<0.01). Coagulase negative Staphylococcus was identified in 82.3% and 62.5% of cases respectively. 54% of the members of staff expressed their concerns related to the findings and were very interested to read about the observations made during the study. CONCLUSION: This original process seems to be both effective and inexpensive, and can be easily reproduced to decrease the frequency of bloodstream infections in NICU. However, its long-term impact still needs to be evaluated.     

Prävention nosokomialer Infektionen bei intensivmedizinisch behandelten Frühgeborenen

Background

Premature infants in neonatal intensive care units (NICU) face an increased risk of nosocomial infections which are partly caused by nosocomially transmitted pathogens.

Prevention

In order to avoid nosocomial infections maximum use of all preventive strategies has to be made. This requires certain structural, organizational, functional and staff prerequisites which are a central issue of recent Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO, commission for hospital hygiene and prevention of infections) guidelines.     

Endotracheal aspirate cultures in predicting sepsis in ventilated neonates

Nosocomial infections are the most common complications encountered in the neonatal intensive care unit (NICU). They are associated with high mortality and prolonged duration of hospitalization in the survivors, contributing to an increased cost of health care. In this article, we review the literature on the value of routine endotracheal aspirate cultures for the prediction of neonatal sepsis and provide guidelines to prevent nosocomial infections. Upon reviewing the literature it appears that the practice of routine cultures of endotracheal aspirate and cultures obtained from multiple body sites is an expensive proposition with low yield. The sensitivity of this test is at best 50% and all studies report a very low positive predictive value. The specificity of this test is 80%, hence its role is mainly limited to identifying infants who are at low risk for sepsis. As we do not have any reliable test for early diagnosis of neontal sepsis and also to dientify infants at high risk for sepsis, our main emphasis should be towards preventing nosocomial infections. Guidelines for reducing nosocomial infections are described.     

重症监护病房新生儿皮肤管理指南(2021)

新生儿皮肤屏障功能弱,极易受损而导致局部或全身感染,增加死亡风险.保护新生儿皮肤完整性、预防皮肤损伤是新生儿重症监护病房管理的重要内容之一.该指南基于国内外相关证据,采用证据推荐分级的评估、制定与评价方法进行证据分级,制定新生儿重症监护病房新生儿皮肤管理指南,对皮肤常规管理、医源性皮肤损伤的预防及处理给出推荐意见,旨在...     

新生儿重症监护室患儿院内感染病原菌分布及院内感染的危险因素分析

目的：了解新生儿重症监护室(NICU)患儿院内感染病原菌分布及院内感染的危险因素。方法：回顾性分析NICU 145例发生院内感染患儿的临床资料。结果：145例院内感染患儿中,肺炎克雷伯杆菌感染41例（28.3%),大肠埃希菌感染39例（26.9%）,表皮葡萄球菌感染10例（6.9%）,其他病原感染55例（37.9%）。Logistic回归分析显示胎龄≤ 32周、出生体重<1500 g、住院时间、机械通气和肠外营养是肺炎克雷伯杆菌所致院内感染的主要危险因素（OR值分别为5.57、6.95、1.23、14.12、3.01）;这5个因素也是大肠埃希菌所致院内感染的主要危险因素（OR值分别为3.42、6.73、9.96、0.55、2.13）。肺炎克雷伯杆菌和大肠埃希菌对β-内酰胺类抗生素有较高的耐药率,而对左氧氟沙星、美洛培南则比较敏感。结论：肺炎克雷伯杆菌、大肠埃希菌及表皮葡萄球菌是NICU患儿院内感染的主要病原菌,它们对β-内酰胺类抗生素耐药率高。机械通气和住院时间分别是院内肺炎克雷伯杆菌和大肠埃希菌感染影响最大的危险因素。     

Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants

We report a nosocomial outbreak with group B streptococci (GBS) in a level two neonatal intensive care unit (NICU) at Sachs’ Children and Youth Hospital, Stockholm, Sweden, in 2014. There were five very preterm infants with severe late‐onset septicaemia, and 10 further infants were colonised. Pulsed‐field gel electrophoresis and multilocus sequence typing genetic characterisation showed that one GBS strain was the cause: serotype Ia, sequence type 23, clonal complex 23. The NICU environment cultures revealed GBS reservoirs on surfaces near sick and colonised patients. We identified workflows and guidelines that could increase the risks of nosocomial infections. Conclusion: This nosocomial GBS outbreak among preterm infants demonstrates that GBS can be harboured in the NICU environment.