口腔医院环境带菌状况调查研究

目的调查某口腔专科医院环境、医务人员手及口腔诊疗用水等的带菌状况。方法对该院手术室和病房的空气、物体表面、医务人员手及工作区周围空气、口腔诊疗用水、使用中消毒液进行采样检测。结果共采集133份样本，检测合格118份（88．72％），其中物体表面合格率为96．67％，病房空气合格率90．00％，层流手术间空气合格率60．00％，医务人员手合格率76．19％，使用中消毒液合格率100．00％，口腔诊疗用水检测均不合格。结论应加强对口腔诊疗用水、医务人员手卫生、手术室空气的监控，以减少医院感染及职业暴露的发生。     

导管室医院感染的监测与管理

目的预防和控制导管室医院感染,降低术后感染率,提高导管室的医疗管理质量。方法每月定期对导管室空气、物体表面、医护人员手、使用中消毒液进行细菌学监测。结果3年共监测标本253份,总合格率为99.6%;空气合格率98.6%,物体表面合格率100.0%,医护人员手合格率100.0%,使用中消毒液合格率100.0%。结论对导管室定期进行监测,是预防和控制医院感染的重要措施之一。     

A survey on contamination by microorganisms and the effect of handwashing by doctors and nurses at the UOEH Hospital

Handwashing is very basic and important in controlling nosocomial infection. We researched the effect of handwashing by doctors and nurses at the UOEH Hospital. One hundred and eight doctors and 114 nurses of 19 wards were examined. The number of bacteria was determined by a palm stamp check agar plate for general bacteria before and after handwashing. The difference in the condition of microorganism contamination among the wards was found by the number of bacteria before handwashing, and by comparing the number of bacteria before and after handwashing, the effect of handwashing was determined. Handwashing by water or soap is not effective in killing bacteria. Therefore, we suggest that doctors and nurses use an effective disinfectant when washing their hands before and after contact with patients. We also think that the results noted in this paper will help doctors and nurses to have a better understanding of the importance of infection control.     

Nosocomial infections in a children's hospital in Argentina: impact of a unique infection control intervention program.

OBJECTIVE: To assess the efficacy of parental education and use of parents as nursing assistants on reducing nosocomial infections. DESIGN: Prospective study. METHODS: Active surveillance for nosocomial infections was performed on two wards. On ward A, parents were educated about infection control practices and assisted nursing staff with routine tasks, so that nursing personnel could focus their efforts on procedures with higher risk of infection. Parental assistance was not sought on ward B, the comparison ward. RESULTS: From October 1990 through September 1991, 1,081 patients were admitted to wards A (470) or B (611). The over-all nosocomial infection rate was 7.1 per 100 admissions; the nosocomial infection rate was significantly higher on ward B than ward A (63/611 vs 14/470; P<.001). Multivariate analysis identified risk factors for nosocomial infection on the two wards as age <2 years (P=.01), malnutrition (P=.005), duration of hospitalization (P<.001), ward B hospitalization (P=.003), and ward cleanliness score (P=.009); the distribution of patients with these factors was similar on the two wards. CONCLUSIONS: Our data suggest that parental infection control education and recruitment to relieve nursing staff of routine low-risk procedures are economical and easily implemented measures to reduce nosocomial infections in hospitals with limited personnel resources in the developing world.     

Refurbishment works in a hospital during normal operation

Background: Construction and renovation work in hospitals pose risks of fungal airborne infections for immunosuppressed patients. If possible, reconstruction work will be postponed to periods without patient treatment. However, in many situations urgent damage demands immediate refurbishment works before the transferring of patients to other wards or closure of wards is possible. Reported here are infection control related measures and implemented procedures after two incidents of water damage which occurred on a surgical ward and an intensive care unit at the University hospital of Essen.Methods: Between January and April 2009 and between September and October 2009, respectively, concentration of air-borne particles and number of viable fungi were measured at two surgical wards and one ICU. Preventive Infection Control Measures included erection of protective walls and HEPA filtration of air from the renovation area.Results: During the renovation work on the surgical ward concentrations of moulds and particles ≥5 μm were significantly higher on the left side of the renovation area than on the right side (p=0.036 and p<0.001). Concentrations of particles ≥1 μm and particles ≥5 μm on both sides of the renovation area were significantly increased when compared with the control ward on the same floor but not when compared with the control ward on the other floor. Particles of all size were significantly elevated on the ICU during the renovation work. Aspergillus fumigatus could neither be cultured of the air of cardiac surgery intensive care unit nor of the intermediate care unit (control ward). During renovation works there was no nosocomial mould infection of patients treated on the two wards.Conclusion: Provided that the renovation area is tightly insulated from the areas of patient care on a ward, closure does not seem to be necessary during renovation works because variation of airborne fungi is similar to that of outdoor or control air. However a multidisciplinary team should be established. This team should perform risk assessment and determine necessary protective measures before starting any construction, renovation or maintenance work in health care settings.     

层流洁净病房患者的医院感染控制

目的　提高层流洁净病房的管理水平 ,降低医院感染率。方法　对 2 8例入住层流洁净病房的患者及层流室环境、物品的消毒质量 ,患者的处理 ,医护人员的入室程序等进行监测管理。比较建层流洁净病房前后保护性隔离患者的医院感染率。结果　建层流洁净病房前保护性隔离患者医院感染率为 4 7.0 6 % ,建层流洁净病房后为 3.5 7% ,两者之间差异有显著性 (P <0 .0 1)。结论　通过严格监测管理 ,使层流洁净病房达到了规范标准 ,有效地控制了医院感染。     

Nosocomial bacteremia in children: a 15-year experience at a general hospital in Mexico.

OBJECTIVE: To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital. DESIGN: Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared. SETTING: A public general hospital in San Luis Potosi, Mexico. PATIENTS: Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection. INTERVENTIONS: Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel. RESULTS: There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions. Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.     

Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit

Between June 1985 and March 1986, 14 cases of severe nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection, including septicemia, were observed in the intensive care unit (ICU) of a 400-bed cancer reference center. Simple control measures including contact isolation of colonized patients and reinforcement of handwashing practices among personnel were followed by a sharp decrease in the rate of infection and colonization. An epidemiological investigation showed that a single serophage variant MRSA strain was involved; peak incidence of infection was 17 per 100 ICU patient discharges; the index case was identified as a patient admitted from another hospital and the epidemic strain was then transmitted from patient-to-patient in the ICU; risk factors for acquiring infection were length of prior hospitalization, invasive procedures and number of antibiotic treatments; dissemination of the strain to other wards was only anecdotal. These results stress the effectiveness of simple measures to control outbreaks of MRSA nosocomial infections even in immunocompromised cancer patients.     

洁夫柔消毒凝胶临床使用效果观察

目的观察洁芙柔消毒凝胶临床使用消毒效果。方法按照2002年版《消毒技术规范》手消毒、采样,随机对100名医护人员使用洁芙柔消毒凝胶前、后进行检测,采用计量资料自身配对t检验方法进行分析。结果消毒后手平均菌落总数(2.22±1.69)CFU/cm2,明显少于消毒前细菌平均菌落总数(40.24±19.53)CFU/cm2,对自然菌的杀灭率为94.48%,经t检验差异有统计学意义(P0.01)。结论洁芙柔消毒凝胶除菌效果佳、作用迅速、手感舒适,临床使用效果好。     

Routine disinfection of patients' environmental surfaces. Myth or reality?

We have evaluated the need for daily disinfection of environmental surfaces not contaminated by biological fluids, in patient areas of a medical unit with two wings [North (N) and South (S)] at the University Hospitals of Geneva, Switzerland. Weekly bacteriological monitoring of surfaces was carried out at random (N = 1356 samples). In the S wing (control), we used detergent/disinfectant for daily cleaning of the floors and furniture. In the N wing we began by using a detergent for floors and furniture; after four weeks the results suggested changing to a rotation of detergent, dust attracting disposable dry mops and disinfectant. During this period the furniture was cleaned with an active oxygen-based compound. The average differences in contamination before and after cleaning floors were (mean reduction in bacterial counts and 95% confidence intervals; CI95): disposable mops: 92.7 cfu/24 cm2 (CI95; 74-112), active oxygen based compound 111.1 (90-133), and quaternary ammonium compound -0.6 (-27-26). Use of detergent alone was associated with a significant increase in bacterial colony counts: on average by 103.6 cfu (CI95 73-134). The quaternary ammonium compound was inadequate for disinfecting bathrooms and toilets but the active oxygen based compound was satisfactory. For furniture, there was a significant reduction in bacterial counts with both the methods using disinfectants. As the detergent was contaminated, by using it alone for cleaning, we were actually seeding surfaces with bacteria. A total of 1117 patients was studied and we observed no change in the incidence of nosocomial infections during the four months of the trial. In conclusion, uncontrolled routine disinfection of environmental surfaces does not necessarily make it safe for the patient and could seed the environment with potential pathogens.     

综合病房医院感染调查

目的 了解综合病房医院感染状况。方法 用前瞻性方法，对1998年4月-2000年5月期间收治的2602例住院患者进行调查。结果 医院感染率为6．42％，例次感染率8．15％；≥60岁患者分别占77．25、80．66％；部位分布为呼吸道(66．04％)、胃肠道(12．26％)、泌尿道(8．49％)；高发时段为住院时间＞20d；主要基础病为各种肿瘤、心脑血管病患者；常见病原菌主要为铜绿假单胞菌(34．65％)、嗜麦芽寡养单胞菌(11．81％)等。结论 以中老年患者为主的综合病房医院感染应受到重点关注。     

Activity of a dry mist hydrogen peroxide system against environmental Clostridium difficile contamination in elderly care wards

Clostridium difficile causes serious healthcare-associated infections. Infection control is difficult, due in part to environmental contamination with C. difficile spores. These spores are relatively resistant to cleaning and disinfection. The activity of a dry mist hydrogen peroxide decontamination system (Sterinis((R))) against environmental C. difficile contamination was assessed in three elderly care wards. Initial sampling for C. difficile was performed in 16 rooms across a variety of wards and specialties, using Brazier's CCEY (cycloserine-cefoxitin-egg yolk) agar. Ten rooms for elderly patients (eight isolation and two sluice rooms) were then resampled following dry mist hydrogen peroxide decontamination. Representative isolates of C. difficile were typed by polymerase chain reaction ribotyping. C. difficile was recovered from 3%, 11% and 26% of samples from low, medium and high risk rooms, respectively. In 10 high risk elderly care rooms, 24% (48/203) of samples were positive for C. difficile, with a mean of 6.8 colony-forming units (cfu) per 10 samples prior to hydrogen peroxide decontamination. Ribotyping identified the presence of the three main UK epidemic strains (ribotypes 001, 027 and 106) and four rooms contained mixed strains. After a single cycle of hydrogen peroxide decontamination, only 3% (7/203) of samples were positive (P<0.001), with a mean of 0.4 cfu per 10 samples ( approximately 94% reduction). The Sterinis((R)) hydrogen peroxide system significantly reduced the extent of environmental contamination with C. difficile in these elderly care rooms. This relatively quick and user-friendly technology might be a more reliable method of terminally disinfecting isolation rooms, following detergent cleaning, compared to the manual application of other disinfectants.     

RICU手卫生质量持续改进与医院感染管理的相关性研究

目的探讨RICU医务人员手卫生质量持续改进与医院感染率之间的关系。方法通过阶段性目标监测RICU医务人员洗手液和手消毒剂消耗用量、手卫生执行情况及医院感染发生率,研究医务人员手卫生依从性对医院感染发生率的影响。结果连续监测4个月,RICU医务人员洗手液和手消毒剂的每床日消耗用量由16．57ml提升至26．30ml;总体手卫生依从率有55．30％上升到91．04％,差异有统计学意义（P〈0．01）,其中使用洗手液和手消毒剂的手卫生依从率分别由21．18％、34．12％上升至38．81％、52．23％,差异均有统计学意义（P〈0．01）;RICU医院感染率由10．26％下降至2．63％（P〈0．05）;总体手卫生依从率和医院感染发生率呈负相关,有显著统计学意义（P〈0．05）。结论持续性改进手卫生质量,可以提高RICU医务人员手卫生依从率,有效降低医院感染发生率,保证了医院感染管理质量。     

Relationship between environmental fungal contamination and the incidence of invasive aspergillosis in haematology patients.

Invasive aspergillosis (IA) is a major opportunistic infection in haematology patients. Spore inhalation is the usual route of Aspergillus infection, suggesting a determining role of environmental contamination by spores in the epidemiology of IA. We prospectively examined the relationship between environmental contamination by Aspergillus and other fungal species and the incidence of invasive nosocomial aspergillosis (INA) in a bone marrow transplantation unit and two haematology wards. During a four-year period, levels of air and surface fungal contamination were determined bi-monthly in patients' rooms (some equipped with HEPA filters and LAF systems), and various common sites in each ward (corridors, nursing stations, etc.). Results were compared to the incidence of INA. A total of 3100 air and 9800 surface samples were collected, and 79 cases of IA were diagnosed, of which 64 were probably or possibly INA. Patterns of fungal contamination were comparable in the three wards, with a gradient ranging from high levels in common sites to a virtual absence in rooms equipped with HEPA filters and LAF systems. Using a regression model, a significant relationship was found between the incidence of INA and the degree of fungal contamination of air and surfaces in conventional patient rooms (not equipped with HEPA) and common sites. This study shows that in a non-epidemic setting, there is a significant relationship between environmental fungal contamination in haematology wards and the incidence of INA. Our findings underline the importance of environmental surveillance and strict application of preventive measures.     

Molecular epidemiology of nosocomial infection associated with multi-resistant Acinetobacter baumannii by infrequent-restriction-site PCR

Acinetobacter baumannii was considered endemic in a university-affiliated tertiary hospital. A significant increase was noted in the proportion of nosocomial infections associated with this micro-organism from 1996 to 1999, although no apparent clusters could be found. Between July 1998 and February 2000, 58 nosocomial isolates of A. baumannii were collected and characterized by antibiotyping and a genotyping method, infrequent-restriction-site PCR (IRS-PCR). High resistance to the 14 antimicrobial agents examined was observed among the isolates. Of the 13 antibiograms detected, eight were multi-resistant to gentamicin and almost all of the traditional and extended-spectrum beta-lactams. These multi-resistant strains consisted of 41 isolates (71%), distributed amongst different wards and intensive care units (ICUs). By IRS-PCR, 23 types were obtained, with one major type found among 28 (48%) isolates. All of these 28 isolates were collected from surgical ICUs. It appears that a single strain of multi-resistant A. baumannii was responsible for the prevalence of nosocomial infection amongst surgical patients, clearly differentiating this outbreak from the previous endemic situation. An efficient molecular typing method played a vital role in making this discrimination.     

重型病毒肝炎患者院内肺部感染的特点和防治

目的探讨重型肝炎患者院内肺部感染的临床特点和防治对策。方法用回顾性调查方法,调查１９９５年９月～１９９７年８月同一病房住院的重型肝炎患者院内肺部感染的发生率、病死率、深部痰细菌培养结果及肺部感染与其他部位感染、多器官功能衰竭的关系。结果两年内同一病房６８例重型肝炎患者中４０例（５８．８２％）发生院内肺部感染。２５例行深部痰细菌培养者２０例获阳性结果,其中１３例为多种细菌感染。菌种以条件致病菌为主,其中真菌、嗜麦芽假单胞菌、肠球菌、金葡菌较多见,耐药率高。不同时期发生肺部感染者痰菌的主要菌种有所不同。伴有肺部感染者亦常见其他部位感染,特别是原发性腹膜炎、胆道感染、肠道感染、败血症及合并真菌感染较多见,肝性脑病和肝肾综合征的发生率高,治疗效果差,病死率（８２．５％）明显高于无肺部感染的重型肝炎（５３．５７％）。结论重型肝炎患者常见院内肺部感染,病原菌以条件致病菌为主。肺部感染常与其他部位感染和并发症并存,病死率高。预防和治疗院内肺部感染需采取综合措施。     

护理管理在血透室院内感染控制中的作用

目的：探讨护理管理在血透室院内感染控制中的作用。方法：将2013年1-12月在本院血透室进行治疗的210例患者随机数字表法分为对照组和实验组,两组的患者均为105例,对照组患者给予常规护理,实验组患者在给予常规护理的基础上给予护理管理。比较两组患者的感染率和卫生指标。结果：实验组患者的感染率（0.95%）较对照组（5.71%）明显降低,比较差异有统计学意义（P〈0.05）;实验组患者使用仪器合格率、手部卫生合格率、空气质量合格率、消毒液合格率较对照组患者明显提高,比较差异具有统计学意义（P〈0.05）。结论：针对血透室院内感染采用护理管理,可以取得良好的护理效果,降低院内感染的发生,保证患者的安全。护理管理对血透室院内感染控制具有十分重要的意义,临床值得推广应用。     

北京一所老年病医院住院病人医院感染情况分析

目的：调查分析住院患者的医院感染情况。方法：对2000年期间住院病房收治的12418例患者进行回顾性调查。结果：发生医院感染者378例,医院感染发病率为3．045,不同性 、年龄医院感染发病率差异有显著性,男性高于妇性,随着年龃牟增长,医院感染和发病率增高,医院感染部位主要为下呼吸道（35．99％）、上呼吸道（22．95％）、泌尿道（17．63％）和胃肠道（10．39％）,其中主要为白色念珠菌（15．78％）、铜绿假单胞菌（13．15％）、肠球菌（11．84％）、医院感染致病菌为革兰氏阴性杆菌占46．03％,革兰氏阳性球菌占23．685,真菌占15．78％,医院感染致死率为14．295。结论：A杂与性别、年`产室和侵袭性操作等密切相关,应加强医院感染的防治。     

A study on the incidence of nosocomial infections in a large University hospital

The results of a study on the incidence of nosocomial infections in a 1800 bed University hospital are reported. The study, carried out over a 9 months period, included: 1) continuous microbiological surveillance, and 2) a clinical and epidemiological survey. On the basis of the microbiological data collected and analyzed by a computer data system, developed and employed for the control of nosocomial infections, a weekly bed-to-bed survey was carried out by the staff of the Institute of Infectious Diseases. Among 2777 suspected nosocomial infections, as revealed by microbiological monitoring, 701 were confirmed after the bed-to-bed survey. The nosocomial infection rate was 6.75 per 100 discharges. It was higher in the surgical than in the medical wards (7.3 and 6 per 100 discharges, respectively).Nosocomial urinary tract infections were the most frequent (74.2%). The urinary infection rate was higher in the surgical than in the medical wards (5.3 and 4.6 per 100 discharges, respectively). Escherichia coli (19.4%), Pseudomonas aeruginosa (19.3%), Proteus spp. (18.4%) were the pathogens most frequently associated with nosocomial infections. They were followed by Klebsiella pneumoniae (7.8%) and Staphylococcus aureus (6.5%) in frequency.Among the risk factors, involved in nosocomial infections, the importance of catheterization was confirmed: among our patients with nosocomial urinary tract infections; 73.4% and 79.5% — in the medical and surgical wards, respectively -underwent urological instrumentation, mainly catheterization.An analogous and more detailled study is now in progress and will be extended in the next years.Corresponding author.     

艾条熏蒸空气消毒降低痴呆病房医院感染发生率的调查研究

目的观察艾条熏蒸空气消毒对医院感染控制的效果。方法利用艾条燃烧产生的烟雾状气体扩散到房间进行熏蒸消毒,观察熏蒸消毒对医院感染发生情况的影响;分析痴呆病房患者的医院感染病例数及抗菌药物使用情况。结果观察组使用艾条熏蒸空气消毒后,医院感染率为10.52%,明显低于对照组医院感染率为18.18%(χ^2=23.449,P=0.000),且2组患者常见的感染部位均以呼吸系统、泌尿系统和消化系统为主;观察组从104例院内感染患者中分离致病菌为23株,明显低于对照组分离出69株致病菌(χ^2=13.348,P=0.000),且2组患者的常见感染病菌均以大肠埃希菌和金黄色葡萄球菌为主;观察组在抗菌药物使用方面也明显低于对照组,上述差异均有统计学意义(P<0.05)。结论采用艾条熏蒸对病房空气进行消毒,能降低痴呆病房感染发生率,也可以有效减少临床抗菌药物的使用。