血液透析中心预防医院感染的护理措施探讨

目的 探讨血液透析室医院感染的危险因素,有效预防控制医院感染的发生.方法 加强医院感染的组织管理;坚持医院感染质量管理持续改进;医院感染知识培训,提高医院感染预防与控制意识;对重点环节如:建立消毒防护感染知识健康教育指导,帮助患者和家属掌握基本预防控制感染的技巧以及对操作过程的细微控制.结果 通过有效的管理与控制,提高了医疗质量,确保了医疗安全.有效提高了透析患者的生活质量和长期生存率.结论 加强血液透析室医院感染危险因素的管理与控制,是预防血液透析室医院感染发生的关键.     

血液透析室医院感染危险因素的预防与控制

目的 探讨血液透析室医院感染的危险因素,有效预防控制医院感染的发生.方法 加强医院感染的组织管理、坚持医院感染质量管理持续改进、医院感染知识培训,提高医院感染预防与控制意识;对重点环节如:建立消毒防护感染知识健康教育指导,帮助患者和家属掌握基本预防控制感染的技巧以及对操作过程的细微控制.结果 通过有效的管理与控制,提高了医疗质量,确保了医疗安全,有效提高了透析患者的生活质量和长期生存率.结论 加强血液透析室医院感染危险因素的管理与控制,是预防血液透析室医院感染发生的关键.     

浅谈医院感染管理的体会

医院感染管理的重点是:领导重视,制度完善;加强学习增强医院感染意识;加强无菌医疗用品和消毒药械的管理;严格执行消毒隔离制度和无菌操作规程;加强抗生素的使用管理。只有加强医院感染管理,采取必要的措施,才能有效预防和控制医院感染的发生。     

血液透析室内医院感染环节质量控制管理措施分析

目的加强血透室环节质量管理,预防与控制医院感染,最大限度地降低医院感染的发生率。方法加强组织领导．注重环节质量控制;明确传染源,阻断传播途径,保护病人,预防医院感染;重视监测工作。结果加强血透室各环节的管理。规范了血液透析的医疗行为,保障了血液透析患者的医疗安全,预防了医院感染的发生。结论血透室内的环节质量管理是预防与控制医院感染的重要保障。     

加强血液净化中心感染的预防与管理

目的为保证血液净化中心医疗质量安全,加强医院感染的预防与管理,防止医院感染。方法重点从加强医院感染管理制度、医院感染控制、血液净化室管理等环节实施,制定切实有效的消毒、隔离等措施。结果通过加强血液净化中心管理,提高了医疗安全,减少了医院感染的发生。结论依据规范科学的管理,有利于血液净化中心患者和医务人员的安全、感染的预防与管理。     

加强医院门诊手术室感染的预防与管理

目的为保证医院门诊手术室医疗质量安全,加强医院感染的预防与管理,防止医院感染。方法重点从加强感染管理制度、医院感染控制、手术室管理等环节实施,制定切实有效的消毒、隔离、处理等措施。结果加强医院门诊手术室管理是提高医疗安全、防止医院感染的重要保证。结论依据规范科学地管理,有利于门诊手术室患者手术的安全、感染的预防与管理。     

胸外科手术患者医院感染控制的管理

目的 加强胸外科病房住院患者的护理管理,预防和控制医院感染的发生.方法 建立健全并落实各项规章制度,强化工作责任;加强宣传教育,提高感染控制意识;规范病区管理,包括护理人员、病区环境、医疗废物、患者及陪护人员的管理.结果病房环境得到改善,护理人员素质得到提升,医院感染的发生率有所降低.结论 建立健全并落实各项规章制度,强化工作责任,加强胸外科病房的护理管理能有效地预防和控制胸外科患者术后医院感染,从而确保患者的安全,提高医疗护理质量.     

口腔种植手术室医院感染的控制与管理

目的探讨口腔种植手术室医院感染的监控与管理措施,预防医院感染发生,提高种植手术成功率。方法根据种植手术室的工作特点,采取完善医院感染规章制度并监督落实,明确岗位职责,加强手术人员培训和管理,加强手术室环境和物品管理,定期进行消毒灭菌效果监测,严格执行无菌技术操作等措施,防止医院感染的发生。结果完善了口腔种植手术室医院感染的管理制度和各项监控措施,提高了医疗护理质量,降低了种植术后感染发生率,保障了患者安全。结论对口腔种植手术室采取严格消毒灭菌、加强感染监控和科学管理,是预防和控制医院感染、提高种植手术成功率的重要措施。     

5.12汶川大地震对都江堰市医疗机构医院感染预防控制的影响与对策

目的 了解5.12汶川大地震对都江堰市医疗机构医院感染预防控制的影响,为地震后的医院感染预防控制提供依据和对策.方法 采用表格和现场调查形式,对汶川大地震后恢复阶段初期都江堰市医疗机构医院感染管理与消毒灭菌现况进行调查.结果 全市医疗机构的医疗工作条件、医疗功能开展、医院感染管理组织、消毒灭菌方法与效果监测、职业防护、医疗废物处理等方面均因地震受到严重影响,对医院感染预防与控制提出了严峻挑战.结论 改善医疗条件、规范布局流程、加强医院感染监控管理和培训、强化消毒灭菌效果监测、抓好重点环节和重点部门的感染控制等方面工作,是预防医院感染发生的关键环节.     

老肯科技CSSD方案将亮相第65届CMEF

近年来,医院感染问题日益突出,它不仅严重影响医院的医疗质量,增加患者的负担与痛苦,而且已成为现代医学发展的桎梏,预防医院感染已成为医院提高医疗效果和经济效益,节约医疗资源的重要措施。而消毒供应室的高效管理,是加强医院感染的监测、预防和控制感染扩散的重要一环,将直接影响医疗与护理质量。     

社区与院内获得性多药耐药细菌感染的分布及耐药性调查

目的 了解社区与院内获得性多药耐药细菌(MDROs)感染的变化趋势,为临床合理使用抗菌药物和控制措施提供依据.方法 对2006-2010年门诊及住院患者细菌培养出金黄色葡萄球菌、肠球菌属、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌的患者进行监测,分析多药耐药细菌感染的特点及其变化的趋势.结果 监测上述细菌5768株,检出MDROs 1867株,检出率为32.37％;社区感染MDROs的检出率为30.15％,院内感染MDROs的检出率为46.18％,院内MDROs感染显著高于社区MDROs感染(P＜0.05);2006-2010年社区感染MDROs和院内感染MDROs的检出率均呈显著上升(P＜0.05),院内感染MDROs中耐甲氧西林金黄色葡萄球菌与产超广谱B-内酰胺酶的肺炎克雷伯菌的检出率均呈显著上升(P＜0.05).结论 社区多药耐药菌感染与医院多药耐药菌感染日趋严重,控制MDROs感染要从预防、控制及管理等多方面进行.     

结核分枝杆菌医院感染现状及预防控制措施研究

目的 探讨结核分枝杆菌医院感染预防控制对策.方法 通过分析结核分枝杆菌医院内流行现状和影响结核分枝杆菌医院内传播流行的因素,提出结核分枝杆菌医院感染的预防控制对策.结果 预防控制结核分枝杆菌的医院感染,需要加强人员管理和环境的监控、控制医院内空气流动方向、加强医护人员呼吸道防护和结核患者的管理.结论 预防控制医院内结核分枝杆菌感染,必须采取综合性防控措施.     

规范医疗器械管理控制医院感染

目的加强医疗器械的规范化管理,控制医院感染。方法以卫生部颁发的新版《消毒技术规范》要求为准则,规范医疗器械清洗、消毒、包装和灭菌、监测,优化工作流程,完善医疗器械的管理。结果医疗器械的清洗、消毒、包装、灭菌质量合格,确保手术安全顺利实施,降低了手术切口感染率,保障手术患者的医疗安全,有效控制医院感染。结论医疗器械的规范化管理是医疗安全和医疗质量的重要保证。     

Costs associated with hospital-acquired bacteraemia in a Belgian hospital

Studies from around the world have shown that hospital-acquired infections increase the costs of medical care due to prolongation of hospital stay, and increased morbidity and mortality. The aim of this study was to determine the extra costs associated with hospital-acquired bacteraemias in a Belgian hospital in 2001 using administrative databases and, in particular, coded discharge data. The incidence was 6.6 per 10000 patient days. Patients with a hospital-acquired bacteraemia experienced a significantly longer stay (average 21.1 days, P<0.001), a significantly higher mortality (average 32.2%, P<0.01), and cost significantly more (average 12853 euro, P<0.001) than similar patients without bacteraemia. At present, the Belgian healthcare system covers most extra costs; however, in the future, these outcomes of hospital-acquired bacteraemia will not be funded and prevention will be a major concern for hospital management.     

Surveillance for hospital-acquired infections on surgical wards in a Dutch university hospital.

OBJECTIVES: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. METHODS: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and vascular, thoracic, orthopedic, and general gynecologic and gynecologic-oncologic surgery of the University Medical Center Utrecht, the Netherlands. Data were collected from patients with and without infections, using criteria of the Centers for Disease Control and Prevention. RESULTS: The infection control team recorded 648 hospital-acquired infections affecting 550 (14%) of 3,845 patients. The incidence density was 17.8 per 1,000 patient-days. Patients with hospital-acquired infections were hospitalized for 19.8 days versus 7.7 days for patients without hospital-acquired infections. Prolongation of stay among patients with hospital-acquired infections may have resulted in 664 fewer admissions due to unavailable beds. Different specialties were associated with different infection rates at different sites, requiring a tailor-made approach. Interventions were recommended for respiratory tract infections in the thoracic surgery ward and for surgical-site infections in the orthopedic and gynecologic surgery wards. CONCLUSIONS: Surveillance in four surgical wards showed that each had its own prominent infection, risk factors, and indications for specific recommendations. Because prospective surveillance requires extensive resources, we considered a modified approach based on a half-yearly point-prevalence survey of hospital-acquired infections in all wards of our hospital. Such surveillance can be extended with procedure-specific prospective surveillance when indicated.     

2014年贵州省某三甲医院医院感染横断面调查分析

摘要:目的　了解医院感染现状,为医院感染防控措施的制定提供依据,并评价实时监控系统的灵敏性及特异性。方法　采用横断面调查和病历调查相结合方法进行医院感染横断面调查。结果　2014年医院感染现患率为3.47%,感染例次率为4.15%。科室分布以ICU感染率最高,为47.37%;感染部位以下呼吸道占首位,为55.56%;医院感染病原菌以革兰阴性菌为主,主要病原菌为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌及鲍曼不动杆菌等。结论　对医院感染现患率高的科室,应提高医务人员医院感染控制意识,加强对医院危险因素及重点环节的管理,有效降低医院感染的发生;对医院感染误报率高的科室应提高医院感染正确诊断水平;我院使用的实时监测系统对于医院感染病例的监测有良好的敏感性和特异性。     

Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres

To understand the impact of hospital-acquired infections on mortality and medical costs in modern medical care systems in different healthcare settings, we performed a case-control study at a medical centre and two community hospitals. A total of 144 and 129 adult case-control pairs who received care in a 2000-bed tertiary referral medical centre and two 800-bed community hospitals, respectively, between October 2002 and December 2002 were enrolled. Prolongation of hospital stay, extra costs and complications associated with hospital-acquired infections were analysed. Patients in the medical centre had more severe underlying disease status (P < 0.001), more malignancies (P < 0.001), more multiple episodes of hospital-acquired infection (p = 0.03), and more infections with multidrug-resistant bacteria (P < 0.001) than patients in community hospitals. The additional length of hospital stay and extra costs were similar for patients with hospital-acquired infections in the community hospitals and the medical centre (mean 19.2 days vs. 20.1 days, P = 0.79; mean 5335 US dollars vs. 5058 US dollars, P = 0.83; respectively). The additional length of hospital stay and extra costs in both the medical centre and the community hospitals were not related to the sites of infection or the bacterial pathogens causing hospital-acquired infections, although medical costs attributable to hospital-acquired fungal infections due to Candida spp. were much higher for patients in the medical centre. Prevalence of hospital-acquired-infection-related complications, such as adult respiratory distress syndrome, disseminated intravascular coagulation, organ failure or shock, was similar between the two groups, but patients in the medical centre had a higher mortality rate because of their underlying co-morbidities.     

新生儿医院感染特点与危险因素

目的 探讨新生儿医院感染特点和危险因素.方法 采用目标性监测方法,对2007年1月-2010年12月入住新生儿病房的6699例患儿进行监测.结果 4年共监测新生儿6699例,发生医院感染146例,感染率2.18％;监测以新生儿病房搬迁前医院感染率较高;感染部位以呼吸道为主,占50.00％,其次为皮肤黏膜占19.18％,口腔占10.27％,胃肠道占7.54％,其他占13.01％;新生儿医院感染易感因素主要与新生儿的出生体重、住院天数、有侵入性操作及使用抗菌药物有关.结论 空气及环境污染致呼吸道感染率高是医院感染特点;低体重儿、住院天数长、不合理使用抗菌药物以及侵入性操作是新生儿医院感染的危险因素.     

Impact of contact and droplet precautions on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus infection.

OBJECTIVE: To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. DESIGN: Before-after study.Setting. A 439-bed, university-affiliated community hospital. METHODS: To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, "non-ICU areas"), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed. RESULTS: The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P=.03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P=.43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P=.02). CONCLUSION: The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.     

Problems and solutions in hospital-acquired bacteraemia

Despite infection control efforts, bacteraemia remains one of the most frequent and challenging hospital-acquired infections and is associated with high attributable morbidity and mortality and additional use of healthcare resources. Prevention and control of hospital-acquired blood-stream infection requires improved detection methods, better definition of patient populations at risk, more refined guidelines for the interpretation of positive blood cultures and a better discrimination between sporadic contaminants and true bacteraemia. These issues are addressed in the current review together with those related to the diagnosis, management and recent advances in the prevention of cathether-related bacteraemia, the leading cause of hospital-acquired blood-stream infection. Finally, the reasons and perspectives for blood-stream infection surveillance are briefly discussed.