2007-2009年肿瘤科医院感染监测分析

目的了解肿瘤科住院患者医院感染发病情况及分布特点,为有效控制医院感染的发生提供依据。方法采用前瞻性监测与回顾性调查相结合的方法,对2007年1月-2009年12月肿瘤科收治的2261例患者进行监测,数据采用Excel 2003和SPSS15.0软件进行统计分析。结果医院感染发生率8.9%,感染例次率10.9%;感染部位居前3位的依次为下呼吸道感染占35.63%、上呼吸道感染占31.18%及口腔感染占12.55%;3年医院感染发生率呈上升趋势,差异有统计学意义(χ2=19.071,P<0.01);医院感染病原菌以真菌为主,占54.24%。结论肿瘤科的医院感染发生率呈上升趋势,感染部位以呼吸道感染为主,应开展目标性监测,采取有效干预措施,降低医院感染率。     

2000年深圳市肠道病毒71型的监测

肠道病毒 71型 ( enterovirus type71 ;EV71 )的感染可导致多种临床症状 ,EV 71可以引起发热性疾病、手足口病、疱疹性咽峡炎、无菌性脑膜炎、脑炎、脑干脑炎、肺水肿、脊髓灰质炎样的麻痹性疾病多种疾病 ,甚至导致死亡。我们于 2 0 0 0年对深圳地区 62例疑似肠道病毒感染者进行了 EV71型的监测 ,现将有关情况报告如下。1　材料与方法1 .1　标本的收集　 2 0 0 0年 4月至 1 2月 ,收集深圳市疑似肠道病毒感染病例粪便标本 62份 ,保存于- 80℃。1 .2　标准毒株　 EV71的标准毒株采用 EV71 -SHZH98[1] ,其全基因组已提交国际核酸与蛋白数…     

2007-2009年住院患者医院感染的监测与分析

目的 了解医院感染发病基本状况和临床特点.方法 对2007-2009年54 999例住院患者中发生医院感染病例进行调查与分析.结果 发生医院感染1823例,感染率3.31％;感染部位2046例次,例次感染率3.72％,漏报率5.27％;感染部位构成以呼吸道感染居首,占64.62％,依次为术后切口感染、胃肠道感染和泌尿道感染,分别占7.09％、6.40％及5.33％病原菌以革兰阴性杆菌为主,占61.33％,革兰阳性球菌和真菌分别占22.85％、15.82％,居前5位是大肠埃希菌、真菌、铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌.结论 医院感染发生与高龄、免疫功能低下、侵入性操作、长时间住院及环境污染等因素相关;加强医院感染监测,严格执行消毒隔离制度和无菌技术操作规范,落实手卫生管理规范,合理使用抗菌药物是预防和控制医院感染的有效措施.     

The response of institutionalized Down's syndrome subjects to enterovirus infections.

In a study comparing the responses of institutionalized Down''s syndrome (DS) and non-Down''s (ND) inmates to enterovirus infections, the frequency of wild enteric viruses and the excretion patterns of oral polio vaccine (OPV) viruses were similar in both groups. Antibody titres developed to poliovirus types 2 and 3 following vaccination were similar in DS and ND vaccinees, but the response to type I virus was significantly less in DS vaccinees. As judged by the development of poliovirus antibody in non-vaccinees, the spread of virus from OPV-immunized to unimmunized subjects in the institution was not noticeably different in DS and ND subjects. An unexpected finding was that the excretion patterns of all three serotypes of poliovirus were strikingly similar for each individual, although the patterns varied considerably from individual to individual. The similarity of excretion occurred despite wide differences within an individual in the titres of neutralizing serum antibodies to the three serotypes. It is suggested that the rate at which a given individual eliminates enteroviruses may be largely determined by factors, the activities of which are not reflected in serum antibody titres.     

Hospital-acquired infections. I. Surveillance in a university hospital.

A new system of surveillance is described for detecting hospital-aquired infections. Surveillance begins on the ward where a weekly review of the nursing care plan (Kardex) is used to select high risk patients (approximately 65% of the total population) for a subsequent chart review. A nurse-epidemiologist required 16-25 hr per week to perform surveillance and 4 more hr to organize line listings of infected patients. The Kardex review was 82 to 94 percent accurate in detecting nosocomial infections when compared to prospective reviews of the charts of all hospitalized patients. The new surveillance method was more accurate than a system based on weekly chart reviews of all patients receiving systemic antibiotics and/or of all patients with fever (temperature less than or equal to 37.8 C orally). In addition, it was more accurate and offered advantages over a system in which surveillance depended primarily on the bacteriology laboratory. Over a 12-month period 1154 hospital-acquired infections were identified for a 7% annual infection rate. Data from ongoing surveillance are used to record accurate infection rates by service, to define the risk of various hospital procedures, and to monitor for common source outbreaks of infection.     

贵州省环境水体肠道病毒监测分析

目的研究贵州省环境水体中肠道病毒(Enterovirus,EV),尤其是脊髓灰质炎病毒(Poliovirus,PV)的感染和分布情况,为最终根除脊灰计划提供科学依据。方法环境水样经浓缩处理后进行病毒分离、鉴定和核苷酸序列分析。结果 22份水样中检出阳性14份,阳性率为63.6%,其中PV 3株,非脊灰肠道病毒(Non-Polio Enterovirus,NPEV)58株。结论 EV广泛存在环境水体中,分离出的3株PV均为疫苗株,未发生变异,未在环境及人群中发生循环,贵州省继续维持无脊灰状态。     

Surveillance of nosocomial infections in a neurologic intensive care unit.

OBJECTIVE: To assess data on the epidemiology of nosocomial infection (NI) among neurologic intensive care patients. DESIGN: Prospective periodic surveillance study. SETTING: An 8-bed neurologic intensive care unit (ICU). PATIENTS: All those admitted for more than 24 hours during five 3-month periods between January 1999 and March 2003. METHODS: Standardized surveillance within the German infection surveillance system. RESULTS: Three hundred thirty-eight patients with a total of 2,867 patient-days and a mean length of stay of 8.5 days were enrolled during the 15-month study period. A total of 71 NIs were identified among 52 patients. Urinary tract infections (UTIs) were the most frequent NI (36.6%), followed by pneumonia (29.6%) and bloodstream infections (BSIs) (15.5%). The overall incidence and incidence density of NIs were 21.0 per 100 patients and 24.8 per 1,000 patient-days, respectively. Incidence densities were 9.8 UTIs per 1,000 urinary catheter-days (CI95, 6.4-14.4), 5.6 BSIs per 1,000 central venous catheter-days (CI9s, 2.8-10.0), and 12.8 cases of pneumonia per 1,000 ventilation-days (Cl95, 8.0-19.7). Device-associated UTI and pneumonia rates were in the upper range of national and international reference data for medical ICUs, despite the intensive infection control and prevention program in operation in the hospital. CONCLUSION: Neurologic intensive care patients have relatively high rates of device-associated nosocomial pneumonia and UTI. For a valid comparison of surveillance data and implementation of targeted prevention strategies, we would strongly recommend provision of national benchmarks for the neurologic ICU setting.     

Surveillance of nosocomial infections in geriatric patients

Prospective surveillance of hospital-acquired infections was undertaken in the geriatric ward of the University Hospital, Utrecht, the Netherlands. The medical records of 300 patients were studied for the presence of nosocomial infections using the criteria defined by the Centers for Disease Control (CDC), Atlanta, Georgia, USA. Data were collected from patients with and without infection, which allowed for the analysis of risk factors for nosocomial infection. In 100 out of 300 patients (33·3%), a total of 126 infections was diagnosed. The incidence of nosocomial infections was 16·9 per 1000 days of stay in the hospital. The mean length of stay of patients with infection was 39 days, while that of patients without infection was 17·8 days. Infections developed after an average stay of 13·3 days in the hospital. Patients with infections were 2·6 years older than patients without infections (P = 0·005). Dehydration was shown to be a major risk factor for infection (RR = 2·1, 95% CI: 1·4–3·2). Of the infections, 58·7% were urinary tract infections (UTIs, asymptomatic and symptomatic). The most important risk factor for an asymptomatic UTI was an indwelling urinary catheter (RR = 7·3, 95% CI: 3·1–17·1). The duration of use of the indwelling urinary catheter was of significant influence in the development of a UTI. Seventy percent of the patients with an asymptomatic UTI were treated with anti-biotics. Infections of the gastrointestinal tract accounted for 19·8% of all nosocomial infections. The majority of these infections were due to an outbreak of Clostridium difficile. In conclusion, the length of stay may be prolonged by a nosocomial infection. In this study, the main risk factors for developing a nosocomial infection were age, dehydration and the presence of an urinary catheter. Our observations showed that age is a predisposing factor for nosocomial infection and that the risk increases with each year, even for geriatric patients.     

ICU患者留置导管相关感染监测分析

目的通过对ICU留置导管相关感染的监测资料进行分析,探讨降低ICU医院感染的针对性护理干预措施。方法采用目标监测法收集2012年10月-2013年6月苏北人民医院ICU住院患者709例感染监测的数据,对使用呼吸机、深静脉置管、留置尿管侵入性操作的相关感染率进行分析。结果 709例患者医院感染86例、95例次,感染率12.13%、例次感染率13.40%;其中留置导管感染60例,占69.77%;呼吸机相关性肺炎感染率为8.32‰,血管导管相关性血流感染率为4.50‰,尿管相关性尿路感染率为3.47‰;留置导管相关感染与侵入性操作、导管留置时间及导管维护等有关。结论建立留置导管患者监护档案、规范留置导管的应用、加强导管护理过程的监控等干预措施,可以有效降低ICU的医院感染率,提高患者的救治率。     

Surveillance of healthcare-associated infections in Indonesian hospitals

A cross-sectional surveillance of healthcare-associated infections (HAIs) and exposure to risk factors was undertaken in two Indonesian teaching hospitals (Hospitals A and B). Patients from internal medicine, surgery, obstetrics and gynaecology, paediatrics, a class department and intensive care were included. Patient demographics, antibiotic use, culture results, presence of HAI [phlebitis, surgical site infection (SSI), urinary tract infection (UTI) and septicaemia] and risk factors were recorded. To check for interobserver variation, a validation study was performed in Hospital B. In Hospitals A and B, 1,334 and 888 patients were included, respectively. Exposure to invasive devices and surgery was 59%. In Hospital A, 2.8% of all patients had phlebitis, 1.7% had SSI, 0.9% had UTI and 0.8% had septicaemia. In Hospital B, 3.8% had phlebitis, 1.8% had SSI, 1.1% had UTI and 0.8% had septicaemia. In the validation study, the prevalence as recorded by the first team was 2.6% phlebitis, 1.8% SSI, 0.9% UTI and no septicaemia, and that recorded by the second team was 2.2% phlebitis, 2.6% SSI, 3.5% UTI and 0.9% septicaemia. This study is the first to report on HAI in Indonesia. Prevalence rates are comparable to those in other countries. The reliability of the surveillance was insufficient as a considerable difference in prevalence rates was found in the validation study. The surveillance method used is a feasible tool for hospitals in countries with limited healthcare resources to estimate their level of HAI and make improvements in infection control. Efficiency can be improved by restricting the surveillance to include only those patients with invasive procedures. This can help to detect 90% of all infections while screening only 60% of patients.     

深圳市2004年肠道病毒71型和柯萨奇病毒A16型的监测

目的了解深圳市肠道病毒的感染情况,为制定预防和控制肠道病毒感染策略提供依据。方法采用逆转录聚合酶链反应(RT-PCR)方法,对深圳市96例疑似肠道病毒感染者粪便标本进行肠道病毒71型(EV71)和柯萨奇病毒A16型(CoxA16)RNA的检测。结果共检出11份EV71阳性标本,阳性率为11.46%,其中8例临床表现为手足口病(HFMD);男女发病率分别为11.94%(8/67)和10.34%(3/29);18例为CoxA16阳性标本,阳性率为18.75%,其中17例临床表现为手足口病;男女发病率分别为19.40%(13/67)和17.24%(5/29)。结论CoxA16和EV71的发病率无性别差异;CoxA16在每年的5~8月份有一个发病高峰;CoxA16和EV71是引起儿童手足口病的主要病原体,要加强对CoxA16和EV71的的鉴别诊断。     

Work-related injuries among Iowa farm operators: An analysis of the Iowa Farm Family Health and Hazard Surveillance Project

In 1994, the Iowa Farm Family Health and Hazard Surveillance Project carried out a two-stage, stratified, cluster survey of Iowa farms using a mail survey. With data from this representative sample of Iowa farmers, we examined the associations between farm-work–related injuries and possible risk factors for 390 principal farm operators. Forty (10.3%) of these operators reported being injured while doing farm work. We developed a logistic regression to assess associations between potential risk factors and injury. We found three factors significantly associated with injury: younger age (odds ratio [OR] = 3.1, confidence interval [CI] = 1.1–9.3), having an impairment or health problem that limits work (OR = 2.4, CI = 1.5–3.8), and hand or arm exposure to acids or alkalis (OR = 2.6, CI = 1.1–5.9). In the univariate analysis, safety training did not seem to protect farmers from injuries. Am. J. Ind. Med. 33:510–517, 1998. Published 1998 Wiley-Liss, Inc.     

Surveillance of surgical wound infections following open heart surgery.

OBJECTIVE: To define accurate wound infection rates for the cardiac surgery service based on site of infection and characterization as "deep" or "incisional" and to determine whether a correctable cause for an apparent increase in deep wound infection rates existed. DESIGN: Observational. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: All adults undergoing open heart surgery in 1988 and 1989. INTERVENTIONS: Changed from razor to clipper preoperative hair removal in January 1989. RESULTS: Deep sternotomy wound infections decreased significantly from 1.2% in 1988 to 0.2% in 1989 (p = .010) and deep venectomy (vein donor site) wound infections declined from 1.6% to 0.4% (p = .014) during the same time period. Incisional wound infection rates did not change. Patients with deep infections more likely required readmission or operation to treat their infection than those with incisional wound infections. The percentage of gram-negative organisms causing wound infections decreased from 56.3% in 1988 to 34.7% in 1989 (p = .017). CONCLUSIONS: Preoperative hair removal using a clipper appears to have decreased the risk of deep wound infection compared with razor preparation. The dichotomous wound classification of "deep" and "incisional" distinguished between patients who required additional interventions for treatment of wound infections.