NICU医院感染目标监测结果分析

目的 了解新生儿重症监护病房(NICU)医院感染发病率、临床特点、危险因素,为更好预防控制NICU医院感染发生提供科学依据.方法 按照卫生部《医院感染监测规范》的要求,对医院2011年1-12月入住NICU＞48 h的患儿进行目标性监测,由专职人员填写统一调查表.结果 1145例患儿中132例发生医院感染,医院感染率为11.53％,感染部位以下呼吸道为主占61.87％,侵入性操作以机械通气使用率较高,呼吸机使用总天数为1262 d,使用率为10.30％,呼吸机相关性肺炎发生率为50.71％;不同体重组医院感染发生率差异有统计学意义(X2=90.97,P＜0.01),出生体重≤1000 g,医院感染率为45.45％,＞2500 g患儿医院感染率为6.69％.结论 出生体重低、胎龄小、使用呼吸机,是NICU发生医院感染的高危因素,应重点关注;同时开展医院感染的目标性监测,有针对性地采取预防控制措施,也可有效减少医院感染的发生.     

急诊重症监护病房中心静脉导管相关感染的病原学及危险因素分析

目的了解急诊重症监护病房（ICU）中心静脉导管相关感染（CVC-RI）的病原菌特点和危险因素。方法对急诊ICU 2006年1月至2008年12月放置中心静脉导管并符合CVC—RI诊断标准,细菌学检查均阳性的103例患者进行回顾性调查分析。结果CVC—RI病原菌中革兰阳性菌（37．9％,39／103）和革兰阴性菌（42．7％,44／103）发生感染的比例差异无统计学意义。CVC—RI与使用导管腔数、置管时间、置管部位有关。锁骨下静脉置管发生感染的比例最低。结论应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,注意监测病原菌菌谱的变化。预防重点是避免导管腔内外的污染。     

急诊重症监护病房中心静脉导管相关感染的病原学及危险因素分析

目的 了解急诊重症监护病房(ICU)中心静脉导管相关感染(CVC-RI)的病原菌特点和危险因素.方法 对急诊ICU 2006年1月至2008年12月放置中心静脉导管并符合CVC-RI诊断标准,细菌学检查均阳性的103例患者进行回顾性调查分析.结果 CVC-RI病原菌中革兰阳性菌(37.9%,39/103)和革兰阴性菌(42.7%,44/103)发生感染的比例差异无统计学意义.CVC-RI与使用导管腔数、置管时间、置管部位有关.锁骨下静脉置管发生感染的比例最低.结论 应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,注意监测病原菌菌谱的变化.预防重点是避免导管腔内外的污染.     

新生儿重症监护病房医院感染病例分析

摘要:目的　分析新生儿重症监护病房（NICU）医院感染情况,为有效预防和控制NICU医院感染提供依据。方法　回顾性分析2013年1-12月NICU发生的266例医院感染病例的临床资料。结果　医院感染率为5.16%,感染例次率为5.21%;感染部位以血液为主,占72.49%,其次为胃肠道、下呼吸道和上呼吸道,分别占11.9%、7.43%和6.69%;共分离出病原菌36株,排名前4位病原菌依次为肺炎克雷伯菌60.0%,大肠埃希菌13.3%,鲍曼不动杆菌10.0%,阴沟肠杆菌7.76%;孕母有产科并发症的占49.46%,以胎膜早破为主,其次为前置胎盘和羊水混浊,分别占64.39%、8.33%、8.33%。结论　对产妇有胎膜早破的患儿、低出生体重儿应重点关注,制定综合干预措施,降低医院感染发生率。     

Guidelines for preventing catheter infection: assessment of knowledge and practice among paediatric and neonatal intensive care healthcare workers

We analysed knowledge of and adherence to guidelines for the prevention of catheter-related infection (CRI) among Spanish healthcare workers (HCWs) from paediatric and neonatal intensive care units by distributing 357 questionnaires to 31 Spanish hospitals. The overall mean scores for individual knowledge and daily practice were 5.61 and 5.78, respectively. Our results reveal room for improvement in Spanish HCWs' knowledge of prevention of CRI. Continuing education programmes and implementation of care bundles must be introduced to improve prevention and management of CRI.     

实时监测干预重症医学科医务人员手卫生效果评价

目的评价应用信息化系统实时监测干预重症医学科(ICU)医务人员手卫生依从性效果。方法选择2017年11月-2019年5月武汉市中心医院综合ICU医护人员为观察对象,在ICU安装手卫生信息化管理系统,实时监测、记录医务人员手卫生指征和手卫生行为。观察、比较安装前后医务人员手卫生依从率和各项医院感染管理指标的变化规律。结果信息化系统安装后ICU医务人员手卫生依从率从77.23%上升到96.22%,差异有统计学意义(P<0.001);不同岗位医务人员包括医生、护士和其他人员手卫生依从率均提高(P<0.001);手卫生用品消耗量上升,从每床日(40.57±4.62)ml提高到每床日(51.59±5.12)ml(P<0.001);信息化系统安装前后医院感染率、血管内导管相关血流感染发病率、呼吸机相关肺炎发病率、导尿管相关泌尿系感染发病率和多药耐药菌检出率比较,无统计学差异。结论实时反馈信息化系统对医务人员手卫生行为有良好的干预效果,能够显著提高医务人员的手卫生依从性。     

Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit.

OBJECTIVE: To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU). DESIGN: Open trial. SETTING: A level-III NICU in a teaching hospital. PARTICIPANTS: Nurses, physicians, and other healthcare workers in the NICU. INTERVENTIONS: A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed. RESULTS: Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014). CONCLUSIONS: Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU.     

综合重症监护病房医护人员手卫生干预效果分析

目的对某院重症监护病房(ICU)医护人员手卫生进行干预,评估医护人员手卫生依从性及其影响因素。方法选取某三级甲等教学医院ICU37名医护人员作为调查对象,采用直接与间接法对其干预前后的手卫生情况进行观察、分析。结果手卫生监测第一阶段中,基线调查期手卫生依从率(46.96%)和干预后观察期(63.30%)比较,差异有统计学意义(χ~2=7.344,P=0.007);手卫生监测第二阶段中ICU手卫生依从率从57.85%上升至88.58%。手卫生依从率与平均每床日手卫生用品消耗量呈正相关(r=0.725,P0.001),与医院感染发病率、例次发病率均呈负相关关系(r值分别为-0.983、-0.990,均P0.001),使用含乙醇免洗手消毒剂手卫生依从率与平均每床日手卫生用品消耗量呈正相关(r=0.391,P0.001)。结论手卫生依从性监测和干预需要长期连续性进行,直接观察法与间接手卫生产品消耗评估法相结合,可以对医护人员手卫生依从性进行有效的监测和干预。     

Epidemiology of nosocomial bacterial infections in a neonatal and pediatric Tunisian intensive care unit

OBJECTIVE: The authors had for aim to describe the epidemiology of nosocomial bacterial infections in the neonatal and pediatric intensive care unit of the Tunis children's hospital. DESIGN: A prospective surveillance study was made from January 2004 to December 2004. All patients remaining in the intensive care unit for more than 48 h were included. CDC criteria were applied for the diagnosis of nosocomial infections. RESULTS: 340 patients including 249 (73%) neonates were included. 22 patients presented with 22 nosocomial bacterial infections. The incidence and the density incidence rates of nosocomial bacterial infections were 6.5% and 7.8 per 1,000 patient-days, respectively. Two types of infection were found: bloodstream infections (68.2%) and pneumonias (22.7%). Bloodstream infections had an incidence and a density incidence rate of 4.4% and 15.3 per 1,000 catheter-days, respectively. Pneumonia had an incidence and a density incidence rate of 2% and 4.4 per 1,000 mechanical ventilation-days, respectively. The most frequently isolated pathogens were Gram-negative bacteria (68%) with Klebsiella pneumoniae isolates accounting for 22.7%. The most common isolate in bloodstream infections was K. Pneumoniae (26.7%), which was multiple drug-resistant in 85% of the cases, followed by Staphylococcus aureus (20%). Pseudomonas aeruginosa was the most common isolate in pneumonia (28.6%). Associated factors of nosocomial infection were invasive devices and colonization with multiple drug-resistant Gram-negative bacteria. CONCLUSIONS: The major type of nosocomial bacterial infections in our unit was bloodstream infection and the majority of infections resulted from Gram-negative bacteria. Factors associated with nosocomial bacterial infections were identified in our unit.     

新生儿重症监护病房医院感染危险因素的调查

目的调查新生儿重症监护病房(NICU)医院感染的发生情况,探讨其危险因素,为更好预防控制NICU医院感染提供科学依据。方法对医院2010年2-12月入住NICU>48 h的患儿进行目标性监测,填写统一调查表。结果 218例患儿中21例(9.6%)发生医院感染,共计23例次,例次感染率10.6%;感染部位以下呼吸道居多占34.8%;发生医院感染的相关危险因素为产妇重度先兆子痫、出生体重≤1500 g、胎龄≤30周、使用呼吸机、脐静脉插管、PICC插管和经鼻口腔吸痰(P<0.05);医院感染率分别随出生体重、胎龄和Apgar 1 min分值的增加而下降(P<0.05)。结论对产妇重度先兆子痫、出生体重低、胎龄小的患儿应重点关注,并慎用侵入性操作,可减少NICU医院感染的发生,同时开展医院感染的目标性监测,也可有效减少医院感染的发生。     

Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers.

We conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.     

重症监护室手卫生效果监测与分析

目的 监测重症监护室医务人员手卫生效果,并对相关因素进行分析,为今后改进手卫生工作提供依据.方法 对某院综合ICU、NSICU、NICU、CCU、RICU的医务人员手卫生后,进行诊疗活动或其他无菌操作前进行采样.根据GB 15982-1995《医院消毒卫生标准》要求医务人员手卫生的标准,统计不同医务人员、不同手卫生方法和不同重症监护室手卫生效果监测结果.结果 监护护士的手卫生监测合格率为92.42％,其次是医生和实习护士,合格率最低的是医技人员；快速手消毒剂效果较洗手液流动水洗手效果更好；手卫生效果监测合格率与工作量有密切关系.结论 医院感染管理者将医技人员作为医院感染知识培训和控制医院感染监测、考核的重点人群;监护室快速手消毒剂的广泛应用和合理的人员配备是落实手卫生的重要保证.     

18所医疗机构医务人员手卫生知识与依从性调查分析

目的了解某地区各级医疗机构手卫生相关知识掌握程度,医务人员手卫生依从性状况,为进一步提高手卫生培训及依从性提供依据。方法 2015年9月-2016年6月期间以问卷的方式,对医务人员手卫生相关知识进行调查;由经过统一培训的人员对重点科室医务人员,进行手卫生依从性现场观察,记录并填写调查表。结果共调查18所医疗机构,一级、二级、三级机构各6所;三级医院手卫生知识的正确率为56.57%,二级医院为49.23%,一级医院为52.14%;不同级别的医疗机构、不同岗位、不同工作年限医务人员对手卫生知识的掌握无显著差异;三级医院医务人员手卫生依从率为32.35%,二级医院为24.24%,社区医院手卫生依从率仅为20.66%;医师和护士手卫生依从率分别为27.73%和26.12%;不同级别的医疗机构、不同岗位的医务人员手卫生依从率无显著差异;医务人员在脱手套后不做手卫生的为40.27%,医务人员在工作中不更换手套的为51.68%。结论医护人员对手卫生知识欠缺,手卫生依从率较低,各级医院应加强手卫生知识培训,制定可行的干预措施,提高医务人员手卫生知识及依从性。     

MRSA Pediatric clone expressing ermC plus lnuA genes causing nosocomial transmission and healthcare workers colonization in a neonatal intensive care unit

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of both nosocomial and community-acquired infections. We describe an outbreak caused by the MRSA Pediatric clone expressing an unusual lincosamide resistant phenotype. Between January and May 2006, an MRSA outbreak was detected at the Neonatal Unit of Hospital Interzonal General de Agudos “Evita”, Buenos Aires Province, Argentina that affected ten patients. Seven isolates from seven patients plus five MRSA recovered from health care workers (nasal carriage) were studied. Two phenotypes were observed: (i) ELCi (10), resistance to erythromycin and lincomycin and inducible resistance to clindamycin; (ii) ELiCi (2), resistance to erythromycin and inducible resistance to lincomycin and clindamycin. All 12 MRSA were resistant to oxacillin, erythromycin and gentamicin. Isolates expressing the ELCi-phenotype showed lincomycin MIC values between 16 and 32 mg/L, while the remaining 2 isolates with ELiCi-phenotype presented a MIC value of 0.5 mg/L. No differences were observed between the clindamycin MIC values in both phenotypes, ranging 0.25–0.5 mg/L. Isolates showing ELCi-phenotype harbored ermC plus lnuA genes, and the other two only ermC gene. All 12 isolates were genetically related and belonged to the Pediatric clone (ST100) harboring a new variant of SCCmecIV. This is the first MRSA outbreak expressing an unusual ELCi phenotype due to a combination of ermC plus lnuA genes.     

新生儿重症监护病房医务人员手卫生依从性多中心干预研究

目的通过采取一系列干预措施提高我国新生儿重症监护病房(NICU)医务人员手卫生依从性。方法以多中心研究的方式,选取全国9个省及直辖市17所三级甲等医院,采用世界卫生组织(WHO)手卫生调查方法,每月对医务人员进行手卫生依从性调查。2013年10月1日—2014年3月31日为干预前;2014年4月1日—9月30日采取及时反馈与强化培训等干预措施,即为干预后。结果医务人员手卫生依从率干预前为80.29%,干预后为80.85%,干预前后比较,差异无统计学意义(P0.05)。不同规模NICU医务人员手卫生依从率干预前后比较,差异均有统计学意义(均P0.05),其中20张、20~30张床位的NICU医务人员手卫生依从率干预后均高于干预前(均P0.05),30张床位的NICU医务人员手卫生依从率干预后低于干预前(P0.001)。保洁人员手卫生依从率由干预前的58.82%提高至干预后的68.09%,差异有统计学意义(P0.05);不同手卫生指征中除清洁或无菌操作前,其他手卫生指征医务人员手卫生依从率干预前后比较,差异均有统计学意义(均P0.05)。结论我国NICU医务人员的手卫生依从性处于较高水平,采取强化培训、及时反馈等干预措施对不同规模NICU、不同岗位医务人员、不同手卫生指征的手卫生依从性有一定影响。     

重症监护室医务人员手卫生状况及干手措施对洗手效果的影响

目的了解重症监护室（ICU）医务人员手卫生状况及干手措施对洗手效果的影响。方法选择2013年2-4月某院ICU医务人员210人次,将其随机分为ABC三组,A组采用干手纸巾法、B组采用干手器法、C组采用个人小毛巾法干手,分别对其洗手前、洗手后和干手后进行手卫生现场采样检测。结果A、B、C 3组医务人员接触患者后洗手前手部菌落数分别为(29.10±15.08) CFU/cm2、(31.42±14.76)CFU/cm2和(30.36±15.52) CFU/cm2,3组比较,差异无统计学意义（F=0.048,P＞0.05）;按六步洗手法洗手后湿手采样,医务人员手部菌落数分别为(3.26±0.61) CFU/cm2、(2.98±0.59) CFU/cm2和(3.87±0.67) CFU/cm2,与洗手前比较,差异均有统计学意义（均P＜0.01）。采用不同的干手方式干手后,3组医务人员手部菌落数比较,差异有统计学意义（F=1.892,P＜0.05）;A组菌落数［(1.29±0.58) CFU/cm2］低于B、C组,B组［(9.51±0.73) CFU/cm2］低于C 组［(22.76±4.11) CFU/cm2］;A组合格率（90.00%）高于B、C组,B组合格率（68.57%）高于C 组（47.14%）。医务人员手分离病原菌居前5位的是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和凝固酶阴性葡萄球菌,与2013年度该院ICU分离居前5位的多重耐药菌高度一致。结论ICU医务人员进行各种诊疗护理操作后,手部污染严重;若干手方法不当,会导致手二次污染;其手分离的病原菌与患者分离的多重耐药菌高度一致。及时、正确地洗手和干手是保证手卫生质量的关键环节,对降低ICU患者多重耐药菌感染具有重要意义。     

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.     

ICU医院感染目标性监测分析

目的 分析重症监护病房(ICU)医院感染的发生率及危险因素,探讨预防措施,减少ICU医院感染的发生.方法 采取目标性监测方法,对2008年9月-2009年3月ICU收治的1262例患者发生医院感染情况进行调查.结果 1262例患者中发生医院感染92例次,例次感染率为7.29％,日感染率为39.4‰,日感染率调整率为11.29‰;感染部位以肺部为主,占67.39％;分离的病原菌主要为金黄色葡萄球菌、铜绿假单胞菌及肺炎克雷伯菌,分别占20.76％、15.23％及12.46％.结论 ICU医院感染以肺部为主,病原菌以金黄色葡萄球菌为主;应加强病区消毒隔离制度,严格无菌技术操作,加强气道管理,合理应用抗菌药物,为患者提供营养支持,从而有效减少医院感染的发生.     

Impact of a five-year surveillance of central venous catheter infections in the REACAT intensive care unit network in France

Central venous catheter (CVC)-related infections (CRIs) are a key target for infection control in intensive care units (ICUs). The aim of this study was to describe temporal trends of CRI incidence in a network of volunteer ICUs in Northern France. During a 4 month surveillance period each year, all CVCs in place for more than 48h were prospectively followed until removal or patient discharge. Standard clinical and microbiological criteria were used to define colonization and CRI. The standardized incidence ratio (SIR) was estimated by dividing the number of observed CRIs by the number of expected CRIs, which was computed using a logistic regression model including risk factors for CRI. CRI incidence and SIR were fed back to ICUs as a benchmark at the end of each period. From 2001 to 2005, 135 ICUs participated for at least one surveillance period. Overall, 11 703 CVC in 9182 patients (122 495 CVC-days) were included. CRI incidence was 2.8 per 1000 CVC-days. Among 35 ICUs that participated for three or more consecutive periods, CRI incidence decreased significantly by 58.6%. SIR also decreased significantly from the first to the third surveillance period in these ICUs. These results suggest that surveillance programmes have a significant impact on CRI risk in ICUs and remain an important strategy for combating nosocomial infections in these settings.