感染控制专科护士在预防ICU中心静脉导管相关性血流感染中的作用

目的 探讨感染控制专科护士在预防ICU内导管相关性血流感染(catheter-related blood stream infection,CRBSI)方面的作用和成效.方法 在ICU设立感染控制专科护士,负责引入和制订CRBSI预防相关的指南,进行相关人员的教育、培训和管理,并进行感染监测.结果 在采取一系列措施后,手卫生的依从性明显提高,手消毒液消耗量从4.1ml/患者日增加到65.2 ml/患者日;导管使用率从67.6%降低到62.8%;感染率从4.29‰降低到0.结论 感染控制专科护士的设立在制订感染控制指南和落实感染控制措施等方面发挥了重要作用,对预防CRBSI有着重要的意义.     

Proactive error prevention in the intensive care unit

Care provided in the ICU accounts for nearly 30% of acute care hospital costs and, with the aging of Americans, there is an increased demand for critical care services [1]. Critical illness reduces an individual's physical resilience. Minute-to-minute care decisions and interventions mean life or death during this acute disease phase. Critically ill patients have limited ability to defend themselves from the consequences of health care error. This patient population has the least ability to communicate symptoms to health care providers. The risk of adverse events caused by medications or equipment malfunction is higher because patients in the ICU receive twice as many medications as patients in general care units [2] and often require mechanical support of normal body functions, such as breathing, eating, and eliminating body waste. Consequently, the patient in the ICU has a higher exposure to medical error than patients in other areas of the hospital.     

Febrile respiratory illness in the intensive care unit setting: an infection control perspective

PURPOSE OF REVIEW: We have examined studies published since the severe acute respiratory syndrome outbreak that elucidate the mode of transmission of respiratory pathogens and the optimal means of interrupting their transmission, focusing on transmission in the intensive care unit. RECENT FINDINGS: The severe acute respiratory syndrome may be transmitted by the droplet, contact and occasionally the airborne route. Transmission occurred most frequently when healthcare workers failed to use standard precautions such as hand washing or personal protective equipment designed to limit droplet and contact transmission. Aerosol-generating procedures increased transmission, but incomplete use of personal protective equipment during procedures was common. Recent publications have stressed the benefits of appropriate staffing levels, the use of single occupancy rooms, the immunization of healthcare workers against influenza, and the importance of healthcare workers remaining home when ill in reducing the morbidity and mortality of respiratory infection within the intensive care unit. SUMMARY: Most respiratory pathogens can be transmitted by more than one route. Despite this, healthcare worker awareness of clinical syndromes associated with respiratory pathogens that require airborne precautions, combined with the use of standard precautions for all patients, and contact/droplet precautions for patients with undifferentiated febrile respiratory illness should be effective in interrupting the transmission of respiratory pathogens within the intensive care unit.     

Infection control in the intensive care unit

Nosocomial infections are common in many hospital departments, but particularly so on the intensive care unit, where they affect some 20 to 30% of patients. While early diagnosis and appropriate treatment are, of course, important, perhaps the greatest challenge is in the application of techniques to limit the development of such infections. This review will briefly discuss some of the background pathophysiology and epidemiology of nosocomial infection, and then focus on general and infection-specific preventative strategies individually and as part of broader infection-control programs with infection surveillance.     

护理干预在预防急诊重症监护室导管相关性感染的效果观察

目的:分析护理干预在预防急诊重症监护室导管相关性感染中的效果。方法:选择本院急诊重症监护室自2014年1月至2017年12月收治的834例患者,将其随机分为两组,对照组和观察组,每组417例。对照组给予常规护理,观察组给予综合护理措施,对两组护理效果进行比较。结果:两组呼吸机相关性肺炎、导管相关尿道感染及中心导管相关血液感染对比,差异明显(P<0.05),体现在观察组发生率均较低。观察组导管使用天数、EICU天数与对照组对比,前者均明显少于后者(P<0.05)。结论:给予急诊重症监护室留置导管者有效的护理措施,可使导管相关感染发生率降低,可以借鉴。     

循征医学在新生儿重症监护病房感染控制中的应用

目的 应用循征医学的方法建立新生儿重症监护病房（NICU）感染控制流程.方法 通过对NICU感染控制相关资料的调查,确定存在的问题,利用医学文献数据库（Medline）等相关医学网站检索相关文献,进行评价整合证据,以系统科学的方法建立NICU感染控制流程.结果 对照组和观察组对比：奶瓶奶嘴清洁消毒合格率,空气、物体表面、保温箱湿化水监测以及两组医护人员洗手依从性,各项监测指标差异均具有统计学意义（P＜0.05或P＜0.01）.结论 应用循征医学的方法建立NICU感染控制流程,是科学、有效的方法.     

Prevention of infection in the intensive care unit

PURPOSE OF REVIEW: Infections remain an important threat for critically ill patients, and the emergence of antibiotic resistance is increasingly hampering successful treatment. In this review, new aspects of the diagnosis and prevention of ventilator-associated pneumonia and of strategies of antibiotic use to limit the development and spread of resistance are described. RECENT FINDINGS: Prevention of ventilator-associated pneumonia is cost effective, but the most optimal preventive measure (or set of measures) remains controversial. There is growing evidence that antibiotic prophylaxis reduces the occurrence of ventilator-associated pneumonia and improves patient outcome. Moreover, antibiotic use can be reduced by increasing the specificity of diagnosing ventilator-associated pneumonia and by limiting the duration of antibiotic treatment. SUMMARY: Recent developments in diagnosis, treatment, and prevention of ventilator-associated pneumonia and strategies to reduce emergence of antibiotic resistance have been reviewed. Whether changes in antibiotic policy will reduce the emergence of antibiotic resistance remains to be determined. In this area, methodologic problems that have been overlooked in many studies have been addressed recently. These issues must be clarified to provide reliable data on the effects of interventions in hospital settings.     

Infection control in the neonatal intensive care unit

Healthcare-associated infection (HCAI), also known as nosocomial infection, is one of the main causes of adverse events in the neonate. Despite current infection control policies and practices and ongoing education programmes for healthcare workers, HCAI infection rates within the neonatal intensive care unit (NICU) continue to increase, often with devastating results. This review of the literature aims to increase awareness of some of the many issues that contribute to high HCAI rates in the NICU, thereby highlighting many more interventions that can be carried out by the healthcare worker to reduce these rates. This literature review is limited because it considers only the contribution that healthcare workers make to HCAI rates.     

The acquired immunodeficiency syndrome: impact on the pediatric intensive care unit

Increasing numbers of infants and children with AIDS are being admitted to the PICU, especially in certain geographic areas. Clear diagnostic criteria are available to aid in the diagnosis. As many as 50 per cent of these patients may be first diagnosed with AIDS during their PICU stay. Most patients are admitted because of ARF, but septic shock and CNS disorders are also common. Acute PICU mortality is in excess of 80 per cent, and presently the long-term mortality for this syndrome stands at 100 per cent. The economic impact of this epidemic is enormous and may become catastrophic if a national strategy to deal with these costs is not developed promptly. The PICU has an important role both in terms of resource use and cost containment. Awareness of unique stresses on medical and nursing staff caring for these children, as well as the unique psychoemotional needs of the patients themselves, is vital. Specific infection control, nutritional, and medical-legal strategies will facilitate safe, effective delivery of care to these infants and children in the PICU. The appropriate long-term role of the PICU in the care of children with an ultimately terminal disease has yet to be determined.     

Clinical review: impact of emergency department care on intensive care unit costs

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.     

Clostridium difficile in the intensive care unit: management problems and prevention issues

Several patients hospitalized in our 12-bed medical ICU were found to have Clostridium difficile associated colitis. Stool cultures of all patients identified eight cases (three culture positive, and five culture and cytotoxin positive), seven of which were geographically and temporarily clustered within a 2-wk period. At least one patient appeared to contract the disease after hospitalization and in the absence of antibiotic therapy or other known major risk factors. The outbreak highlights the problem of C. difficile in the ICU. We believe that a heightened awareness of the multiple risk factors and preventive measures, along with consideration of possible nosocomial transmission, will be necessary to prevent or arrest future clusters of cases in the ICU. The diagnosis of one patient with this infection in a unit should prompt a review of all other patients within the unit.     

Acinetobacter baumannii infection in patients with hematologic malignancies in intensive care unit: risk factors and impact on mortality

Purpose

We investigated the characteristics of Acinetobacter baumannii infection in critically ill patients with hematologic malignancies.

Materials and Methods

The prospectively collected data of patients with hematologic malignancies admitted to a medical intensive care unit of a university hospital from 2007 through 2010 were reviewed retrospectively.

Results

One hundred twenty-eight patients were included in the study, among whom 35 (27%) developed 39 A baumannii infections. Pneumonia was the most common infection site of A baumannii. Presence of neutropenia, underlying hematologic malignancy, and the disease status did not affect the acquisition of the infection. Advancing age, prior exposure to aminoglycosides, central venous catheterization, and presence of nasogastric tube were the independent risk factors for the development of A baumannii infections. The mortality rate was higher in patients with A baumannii infections compared with the ones without (P = .009). However, in multivariate analysis, low Glasgow coma scale, prior immunosuppressive treatment, neutropenia, invasive mechanical ventilation, and severe sepsis were independently associated with mortality, whereas presence of A baumannii infection was not.

Conclusions

Despite the high mortality rate in critically ill patients with hematologic malignancies, presence of A baumannii infection was not an independent risk factor for mortality.     

Bacterial colonization and infection in an intensive care unit

One hundred and one patients, nursed in an intensive care unit for at least 24h, were monitored for bacterial colonization and infection. The infection rates were similar to those in other reports. Patients were not generally colonized with common environmental strains in the unit. Bacterial dissemination between patients was uncommon. No gentamicin resistant gram negative or Staphylococcus aureus strains were observed, nor methicillin resistant Staphylococcus aureus strains. the hypothesis that these favourable conditions are partly related to the excellent isolation and barrier nursing facilities in the unit cannot be fully substantiated.     

重症监护病房多重耐药鲍曼不动杆菌感染暴发调查与控制

目的对神经外科重症监护病房（ICU）下呼吸道多重耐药鲍曼不动杆菌感染暴发进行调查与分析,为控制医院内感染提供依据及对策。方法对我院ICU于2010年8月6～17日陆续发生的5例鲍曼不动杆菌下呼吸道感染开展流行病学调查,查找感染源、传播途径,采取干预措施控制感染。多重耐药鲍曼不动杆菌感染患者予以隔离,改用与中心供氧配套的蓝心管,湿化液使用小包装灭菌注射用水,加强医务人员手卫生,加强环境物表与医疗设备的清洁消毒并根据药敏结果选用抗菌药物治疗。结果经核实院内感染诊断,查找感染源、传播途径,取5例患者痰培养及进行环境卫生学监测,推断为暴发。5例患者分离的鲍曼不动杆菌对亚胺培南全部敏感,部分对氨曲南及环丙沙星中度敏感,余11种抗菌药物基本耐药。结论 感染患者未及时隔离,蓝心管与中心供氧出口不配套使用胶布固定增加污染机会,湿化液使用大包装灭菌蒸馏水24小时内未及时更换,医务人员手卫生依从性差,是造成此次多重耐药鲍曼不动杆菌感染暴发的原因。     

监护病房高钠血症发生的危险因素和防治

目的：探讨监护病房高钠血症发生的可能危险因素及防治措施。方法：回顾分析43例患者的临床及辅助检查资料。结果：监护病房内神经系统疾病患者发生高钠血症的比例约为27．1％，住院时间越长发生高血钠的比较越高，其发生主要与临床高渗脱水剂的应用，意识障碍，中枢病变部位及伴发的高热，高血糖有关。结论：高钠血症是监护室常见并发症，应重视并对各种危险因素加以预防。