加强细节管理预防与控制血透室医院感染

目的 将细节管理落实到日常医院感染管理工作中,以有效预防和控制血透室医院感染.方法 自2008年5月起科室针对血透室医院感染管理各个环节中易忽略的细节逐项评估,制定并落实具体措施,采用PDCA循环,加强各环节的细节管理,注重管理质量和管理实效,确保医疗安全.结果 2008年5月-2012年3月透析25 972例次,无医院感染发生.结论 注重细节管理对预防和控制血透室医院感染是积极有效的.     

Retrospective analysis of catheter-related infections in a hemodialysis unit.

OBJECTIVE: To compare the incidence rates of catheter-related bloodstream infection associated with different vascular access methods in patients receiving hemodialysis. SETTING: Tertiary care public hospital in Western Australia. DESIGN: Retrospective analysis of surveillance data collected by the hospital's infection control department. METHODS: The number of confirmed bloodstream infections for each type of vascular access was identified for the period from July 2002 through June 2003. The corresponding number of patient-days was determined to calculate the infection incidence rates. The serially correlated data were then analyzed using Poisson generalized estimating equations. RESULTS: A total of 32 confirmed bloodstream infections were identified. Infection rates, in number of infections per 1,000 patient-days, were as follows: 0.4 for native arteriovenous fistulae; 2.86 for synthetic arteriovenous grafts; 4.02 for permanent, tunneled, cuffed central venous catheters; and 20.2 for temporary, nontunneled, noncuffed central venous catheters. Compared with permanent catheters, the monthly infection rate associated with the temporary catheters was significantly higher (incident rate ratio [IRR], 5.025 [95% confidence interval {CI}, 1.532-16.484]; P=.008) and that of arteriovenous fistulae was significantly lower (IRR, 0.099 [95% CI, 0.030-0.324]; P=.001). The monthly infection rate for arteriovenous grafts was not significantly different from that for permanent central venous catheters (IRR, 0.702 [95% CI, 0.246-2.008]; P=.510). CONCLUSIONS: A hierarchy of infection risk associated with vascular access type is evident. Native arteriovenous fistulae should be recommended for all patients receiving chronic hemodialysis, to minimize infection.     

Staphylococcal infections in hospital

Staphylococcus aureus is a major cause of surgical sepsis and septicaemia. The prevention and control of outbreaks of hospital infection caused by methicillin-resistant strains has become increasingly important in recent years. Staph. epidermidis has also emerged as a "problem organism" often causing serious infection in patients with prosthetic implants.     

基于FMEA法在重症监护病房器械相关感染防控中的应用

目的 采用失效模式与效应分析(FMEA)法筛选出重症监护病房(ICU)医院感染及导管相关感染发生的高风险事件,为ICU制定医院感染预防控制措施提供依据.方法 通过风险识别确定20个风险因素,采用FMEA风险评估筛选出高、中高风险因素,制定相对应的感染防控措施并监督落实,比较干预措施实施前后呼吸机相关肺炎(VAP)、中心...     

基于FMEA法在重症监护病房器械相关感染防控中的应用

目的 采用失效模式与效应分析（FMEA）法筛选出重症监护病房（ICU）医院感染及导管相关感染发生的高风险事件,为ICU制定医院感染预防控制措施提供依据。 方法 通过风险识别确定20个风险因素,采用FMEA风险评估筛选出高、中高风险因素,制定相对应的感染防控措施并监督落实,比较干预措施实施前后呼吸机相关肺炎（VAP）、中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）情况。 结果 筛选出4个高风险因素,分别为感染多重耐药菌患者未遵循有效隔离措施、大剂量使用抗菌药物、床单元清洁消毒不合格、诊疗物品交叉使用;筛选出4个中高风险因素,分别为在拔管或气囊放气操作之前忽略气囊上分泌物的清除工作、手卫生依从性差、非本科室人员流通多、探视人员探视制度执行不到位。针对高、中高风险因素,实施对应的防控措施,VAP、CLABSI、CAUTI日发病率分别由2018年的7.62‰、2.99‰、1.90‰降至2019年的3.93‰、1.01‰、0.62‰;医院感染发病率、医院感染例次发病率分别由4.98%、6.89%降至2.37%、3.14%。 结论 基于FMEA法的风险评估能够发现ICU医院感染预防与控制中的薄弱点,为防控ICU医院感染提供科学有力的证据。     

Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine?

OBJECTIVE: To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit. DESIGN: A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit. SETTING: A hemodialysis unit treating an average of 90 patients. PATIENTS: A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient. RESULTS: HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit. CONCLUSIONS: The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.     

血液透析医院感染预防与控制的环节管理

目的 探讨血液透析医院感染预防与控制的环节管理.方法 对血液透析的房屋布局、流程、环境、制度、消毒隔离、职业防护等环节进行全方位的管理.结果 抓好血液透析各个环节管理,从房屋布局、标准化流程、清洁环境、管理体制、消毒隔离、有效监测、职业防护等重点环节进行有效管理,同时三级质量监控网对重点环节进行督查,严把质量关,可以有效防止血液透析医院感染的发生.结论 通过对血液透析各个环节的管理,能最大限度降低血液透析医院感染的发生.     

重症监护病房耐药菌感染防控模式的临床应用

鉴于重症监护病房(ICU)危重患者感染具有高发生率、高耐药性、高传播性和高死亡率等特点,如何针对耐药菌感染进行科学防控及诊治已成为当今全球公共卫生领域共同关注的重点及亟待解决的临床重大问题。有效预防ICU患者耐药菌交叉传播及各常见部位感染发生是首要关键环节。聚焦感染防控的关键问题,通过实施主动筛查、隔离、消毒、患者转运、依从性评估等关键防控环节措施,形成重症医学科耐药菌全程规范化感染防控模式,有效降低临床危重患者耐碳青霉烯类革兰阴性杆菌(CRO)定植/感染发生率。     

Hospital infection prevention in an intensive care unit

Aim of the study was to evaluate the efficacy of the hospital infection preventive procedures adopted in the intensive care unit (ICU) of the "S. Camillo-Forlanini" hospital in Rome. First the following prevention protocols were analysed: invasive procedures (intubation, CVC and urinary catheter), surveillance cultures, infection management and antimicrobial prophylaxis. Comparison with international guidelines was carried out and protocols enforcement by the personnel was verified. Secondly a one year longitudinal surveillance study was performed in order to monitor the following site-specific infection rates: pneumonia (PNE), blood stream infections (BSI), urinary tract infections (UTI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 302 patients (191 men and 111 women) were admitted; age 55.1 +/- 20.7 years (mean), SAPS II 42.4 +/- 16.2 (mean) and average ward stay 12.5 +/- 21.7 days. Crude mortality was 15.9%. Results showed a total of 37 infection episodes (20 PNE , 7 BSI, 8 UTI and 2 SSI) in 33 patients (10.9%). Infection and mortality rates were among the lowest registered in other italian ICU's. Standardized infection rates associated to invasive procedures were: Ventilator-associated PNE rate (7.8/1000), central venous catheter-associated BSI rate (2.2/1000), urinary catheter-associated UTI rate (2.1/1000). The first (PNE) was higher than the NNIS mean rate, whwreas BSI and urinary catheter associated rates were minor than the mean rates reported by NNIS. Gram-negatives were 61.7%, gram-positives 27.6% and Candida spp. 10.6%. The results confirm the ICU successful preventive strategy.     

AMS对消化内镜围操作期预防性使用抗菌药物的干预效果

 目的 探讨抗菌药物科学化管理（AMS）策略对消化内镜诊疗操作患者围操作期抗菌药物预防使用的干预效果。方法 以某附属医院2019年1—6月行消化内镜诊疗操作的1 006例患者为研究对象,采用AMS策略对患者围操作期预防使用抗菌药物进行管理和干预,措施包括成立组织、完善制度、优化信息系统、宣教与培训、持续干预和监督等。以2017年1—6月行消化内镜诊疗操作的822例患者为对照组,对比分析两组患者围操作期预防性抗菌药物使用率、抗菌药物使用强度（AUD）、抗菌药物品种、联合用药以及用药时长的变化;同时比较预防性抗菌药物不合理应用情况以及术后感染情况。结果 干预前预防性抗菌药物使用率为24.82%（204/822）,干预后为17.10%（172/1 006）,干预前后比较,差异具有统计学意义（P<0.001）;AUD方面,干预后为2.18,低于干预前的14.95;联合用药比例、用药时长与干预前相比亦明显下降。AMS策略实施后,抗菌药物预防性应用的不合理率低于实施前（P<0.001）;而操作后感染发生率则无明显变化（P>0.05）。结论 AMS策略能够优化消化内镜围操作期预防性抗菌药物的应用。     

PDCA在新生儿重症监护病房医院感染防控中的应用

目的 分析PDCA管理模式应用于新生儿重症监护病房（NICU）医院感染管理中的效果。方法 选取某院NICU收治的新生儿为研究对象,对照组为2018年1-6月收治的新生儿,试验组为2018年7-12月收治的新生儿。试验组应用PDCA循环方案进行医院感染管理质量改进,比较PDCA实施前后两组新生儿医院感染发生情况,并对PDCA实施前后医务人员的手卫生情况进行监测。结果 对照组共1 254例新生儿,其中早产儿228例;试验组共1 368例新生儿,其中早产儿304例。PDCA实施后NICU新生儿医院感染例次发病率（4.09%）低于PDCA实施前（6.30%）,差异有统计学意义（χ²=6.521,P<0.05）。PDCA实施后早产儿医院感染例次发病率（4.28%）低于PDCA实施前（8.77%）,差异有统计学意义（χ²=4.526,P<0.05）。PDCA实施后医生、护士的手卫生合格率均高于实施前,差异有统计学意义（均P<0.05）。PDCA实施前,NICU每床日手消毒剂使用量16.94 mL,每床日洗手液使用量15.41 mL;PDCA实施后,NICU每床日手消毒剂使用量25.95 mL,每床日洗手液使用量17.81 mL。结论 应用PDCA管理模式可提高NICU医院感染管理质量,降低医院感染发病率,值得临床推广应用。     

Incidence hepatitis C virus seroconversion after the implementation of a prevention and control program at a hemodialysis unit

This study aimed at reporting the incidence of the hepatitis C virus as well as the prevention and control measures adopted in an hemodialysis unit. It is a prospective study developed with patients attended from September 1996 to December 1998 in an hemodialysis unit. The consultations from September 1996 to December 1996 were considered the control group and the ones from January 1997 to December 1998 the intervention group. Regarding the period of the control group, the routine of the unit was organized based on the regulation 2042 that systematizes the services of renal therapy. In the subsequent period, complementary measures were implemented. From 1997 to 1998, authors observed the reduction in the number of cases of hepatitis C.     

风险管理在重症监护病房导管相关感染防控中的应用

目的探讨风险管理在重症监护病房（ICU）导管相关感染防控中的应用效果。方法对2013年1月-2014年12月入住某院ICU的患者实施风险管理,2013年为实施风险管理前组,2014年为实施风险管理后组。观察呼吸机、留置导尿管及中心静脉导管的使用率及相关感染发病率,并进行统计分析。结果2013年1月-2014年12月共监测ICU患者481例,实施风险管理后,2014年的呼吸机、留置导尿管及中心静脉导管的使用率较2013年均降低（38.73%、81.49%、54.10% vs 55.31%、82.87%、61.37%,均P＜0.05）,2014年ICU患者呼吸机相关肺炎（VAP）、导尿管相关尿路感染（CAUTI）及导管相关血流感染（CRBSI）发病率均较2013年降低（9.79‰、1.30‰、0.84‰、vs 10.15‰、2.84‰、1.92‰,均P＜0.05）。结论实施风险管理可以有效降低ICU患者导管使用率及相关感染发病率,有利于针对性地做好医院感染防控工作。     

糖尿病足患者实施《图文式感染防范手册》宣教对感染的预防效果评价

目的探讨《图文式感染防范手册》对糖尿病足患者感染的预防控制效果,为临床治疗提供参考依据。方法选取2011年3月-2016年3月在医院内分泌科住院治疗的糖尿病足患者486例,随机分为对照组和观察组,各243例,对照组患者给予常规宣讲,观察组患者给予患者版的《图文式感染防范手册》教育宣讲,宣讲7d后,比较两组患者继发性感染率、对糖尿病足患者感染相关知识的掌握程度、足部干预行为的改变、统计糖尿病足患者主要感染病原菌的分布以及继发感染病原菌的分布。结果观察组患者的继发感染率为0.8%,显著低于对照组的6.6%;观察组溃疡面愈合时间(19.7±5.1)d和住院时间(21.9±4.8)d均显著短于对照组,差异均有统计学意义(P<0.05);对照组继发感染病原菌以革兰阴性菌为主,12株;观察组继发感染病原菌2株,均为革兰阴性菌;观察组患者的感染相关知识的评分高于对照组;观察组患者足部干预行为改变的比例高于对照组,差异均有统计学意义(P<0.05)。结论将《图文式感染防范手册》应用于糖尿病足患者感染的预防控制过程中,可以有效地降低继发感染、缩短住院时间、提升感染相关知识评分以及改变日常足部干预行为,值得临床推广。     

医院牙科综合治疗台水路微生物污染和感染防控研究进展

探讨近年来国内外牙科综合治疗台水路(Dental Unit Waterline,DUWL)相关感染报道以及微生物污染情况,对DUWL的感染防控干预措施现状进行总结和阐述。研究显示由于牙科治疗及牙科综合治疗台结构的特殊性,实际工作中DUWL水路微生物污染情况普遍存在,医院感染防控中采取物理和化学消毒等多种方法降低微生物污染,但仍需根据国家规范和医院感染管理要求,源头上做好水质的管理,对单个牙椅治疗台的管路和气路做好细节管理,制定合理的消毒和感染防控综合方案,开展水质持续监测,有效降低医院DUWL的感染风险。     

血液透析患者中心静脉置管的感染因素分析及对策

目的分析血液透析患者中心静脉置管的感染因素分析及对策。方法医院2009年7月-2011年6月共行中心静脉置管术112例,对其发生感染患者进行分析。结果 112例行中心静脉置管术患者中,22例发生医院感染,感染率为19.6%;股静脉感染率为21.9%,稍高于颈内静脉的17.1%及锁骨下静脉的15.4%,然而感染率差异无统计学意义;置管<10d患者的感染率为11.5%,低于置管10～20、>20d患者的17.4%及27.5%,差异有统计学意义(P<0.05);糖尿病肾病患者的感染率为31.6%,显著高于其他基础疾病(P<0.05);中心静脉置管血流通畅患者感染率为17.9%,血流不通畅感染率为22.2%,差异无统计学意义。结论为减少感染发生,首选颈内静脉或锁骨下静脉置管应作为中心静脉置管的部位,尽可能缩短导管留置时间;要严格无菌操作,提高护理质量能有效预防感染发生。     

Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit

Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the H?pital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P<0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P<0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries.     

血液透析患者医院感染危险因素分析及预防对策

目的探讨血液透析患者医院感染的危险因素,并制定相关的预防策略,降低感染的发生。方法对医院2010年3月-2011年3月120例血液透析患者的临床资料进行回顾性分析,探究其发生医院感染的危险因素。结果 120例血液透析患者中有65例发生医院感染,感染率为54.2%;其中,感染部位主要为呼吸系统、泌尿系统、消化系统、循环系统、血管通路及其他,分别占30.8%、24.5%、18.5%、12.3%、7.7%、6.2%;年龄>60岁、住院时间>20d、血液透析时间>1年、伴有糖尿病、血红蛋白<60g/L、血白蛋白<30g/L和伴有心力衰竭以及伴有静脉插管等均是影响感染的危险因素。结论血液透析患者发生医院感染的危险因素较多,临床中应加强对患者基础疾病的治疗,增强其机体的免疫力,规范整个操作过程,避免交叉感染,提高整体的预防效果。     

Treating fluid noncompliance in the hemodialysis population using unit wide contests

Our dialysis unit observed fluid noncompliance over a wide variety of patients. The consequences of fluid abuse that can include systemic and cardiovascular overload are a frequent clinic complication of hemodialysis patients. In spite of all our attempts, our dialysis unit continued to have a substantial group of patients who could not adhere to their fluid restriction. Our dialysis unit needed a novel program to help motivate patients to comply with diet/medication fluid regimens. A method that seems to work well in our dialysis unit is playing unit-wide games. We developed “The Fluid Game,” an original patient education idea, for providing renal patients with a fun incentive to keep their interdialytic weight gains within acceptable limits.