Umbilical Negative Pressure Dressing for Transumbilical Appendectomy in Childern

Methods:This study was a retrospective chart review of 1377 patients (2–20 years) undergoing laparoscopic appendectomy for acute appendicitis in 2 tertiary care referral centers from January 2007 through December 2012. Twenty-two different operative technique/dressing variations were documented. The 6 technique/dressing groups with >50 patients were assessed, including a total of 1283 patients.Results:The surgical site infection rate of the 220 patients treated with TULAA and application of an umbilical vacuum dressing with dry gauze is 1.8% (95% CI, 0.0–10.3%). This compares to an infection rate of 4.1% (95% CI, 1.3–10.5%) in 97 patients with dry dressing without vacuum. In the 395 patients who received an umbilical vacuum dressing with gauze and bacitracin, the surgical site infection rate was found to be 4.3% (95% CI, 2.7–6.8%).Conclusions:Application of an umbilical negative-pressure dressing with dry gauze lowers the rate of umbilical site infections in patients undergoing transumbilical laparoscopic-assisted appendectomy for acute appendicitis.     

整体及重点部位护理预防白血病患者化疗期感染的效果

目的探讨整体护理合并重点部位护理预防白血病患者化疗期间感染的效果。方法将2008年4月至2013年4月收治的190例患者按就诊时间分为对照组和试验组,对照组采用白血病化疗传统护理,试验组采用整体护理合并重点部位护理。比较两组患者的感染率、感染部位和焦虑量表(SAS)评分。结果对照组患者总感染率显著高于试验组,分别为26.31%和9.47%,差异有统计学意义(P<0.05)。两组患者感染率最高的部位为呼吸道,其次为口腔、胃肠道和肛周。对照组各部位感染率均显著高于试验组(P<0.05)。SAS评分显示,对照组患者焦虑程度显著高于试验组(P<0.05)。结论整体护理合并重点部位护理能够显著降低白血病化疗患者的感染率,减轻患者身心痛苦,提高患者的生活质量,值得临床推广。     

Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control

ObjectivesSuccess of methicillin-resistant Staphylococcus aureus (MRSA) decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme.MethodsTwo sampling schemes for screening MRSA patients of a single study cohort at a German tertiary-care hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2 and 3. Swabs were analysed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15% noninferiority margin.ResultsOne hundred sixty patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs, with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (−0.082, 0.131) for the nose and 0.006 (−0.102, 0.114) (95% confidence interval) for the pharynx as calculated with McNemar's test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day swabs and 27% lacking third-day swabs from the nostrils.ConclusionsThe better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard.     

Extensive severe fever with thrombocytopenia syndrome virus contamination in surrounding environment in patient rooms

ObjectivesSevere fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease in Korea and China. Although there is previous evidence of person-to-person transmission via direct contact with body fluids, the role of environmental contamination by SFTS virus (SFTSV) in healthcare settings has not been established. We therefore investigated the contamination of the healthcare environment by SFTSV.MethodsWe investigated the possible contamination of hospital air and surfaces with SFTSV transmission by collecting air and swabbing environmental surface samples in two hospitals treating six SFTS patients between March and September 2017. The samples were tested using real-time RT-PCR for SFTS M and S segments.ResultsOf the six SFTS patients, four received mechanical ventilation and three died. Five rooms were occupied by those using mechanical ventilation or total plasma exchange therapy in isolation rooms without negative pressure and one room was occupied by a patient bedridden due to SFTS. SFTSV was detected in 14 (21%) of 67 swab samples. Five of 24 swab samples were obtained from fomites including stethoscopes, and 9 of 43 were obtained from fixed structures including doorknobs and bed guardrails. Some samples from fixed structures such as television monitors and sink tables were obtained in areas remote from the patients. SFTSV RNA was not detected in five air samples from three patients' rooms.ConclusionsOur data suggest that SFTSV contamination was extensive in surrounding environments in SFTS patients' rooms. Therefore, more strict isolation methods and disinfecting procedures should be considered when managing SFTS patients.     

胆道术后患者多重耐药菌感染情况分析及护理干预

目的通过对胆道术后患者多重耐药菌感染的情况进行总结分析,针对性地给予护理干预,控制感染。方法对2012-2013年我科胆道术后患者中多重耐药菌感染的病例进行调查,搜集整理感染患者的一般资料、标本种类、病原菌种类。结果 8例多重耐药菌感染患者的病原菌以耐甲氧西林的金黄色葡萄球菌和多重耐药的鲍曼不动杆菌多见。结论加强多重耐药菌感染患者的管理,切实完善消毒隔离措施,认真执行手卫生规范,加强抗菌药物的合理使用,对患者的术后康复及控制多重耐药菌感染起着重要的作用。