医院感染信息监测系统的设计与应用

目的：运用计算机和网络技术,结合医院信息系统平台,建立感染信息监测系统,实现感染工作信息化管理。方法：采用Client／Server结构,Server端采用Oracle数据库,Client端采用PowerBuilder语言作为系统开发工具。结果：该系统包括医院感染监测,抗菌药物监测、药敏结果监测、感染分级预警、数据自动上报、统计分析和报表输出等功能。结论：该系统实现对感染数据实时监测,为医院感染控制与预防提供可靠依据,有利于及早发现医院感染可能存在的危险因素,降低感染发生率,同时提高了感染控制部门的工作效率和服务质量,对医院开展感染控制与预防工作具有科学的指导意义。     

四害密度监测数据管理上报系统的建立

目的 :建立四害密度监测数据管理及数据上报系统。方法 :编制四害密度监测数据库及其数据处理、管理程序 ,以电子邮件附件方式及其数据接口实现监测点与监测数据处理中心之间的数据交换传输。结果 :形成监测数据处理中心的四害密度监测数据管理系统以及具备数据上报功能的监测点的管理系统。结论 :系统的建立解决了因常规邮件造成的迟报、漏报现象 ,提高了监测数据管理水平。同时表明 ,使用电子邮件附件方式足以解决监测点与监测数据处理中心的监测数据交换问题 ,且便于基层推广使用     

医院感染监测基本数据集的建立及作用

目的建立医院感染监测基本数据集,实现医疗机构医院感染监测信息标准化,为数据在不同用户间进行交换提供规范和指南。方法依据《医院感染监测规范》《卫生信息基本数据集编制规范》等标准,在分析国内外基本数据集研究与应用现状的基础上,提出建立我国医院感染监测基本数据集的方案。结果初步建立起包括通用、自身风险、诊断信息、诊疗相关风险、实验室检验、体征相关和医院感染结果判读七大类数据的医院感染监测基本数据集。结论医院感染监测基本数据集的建立将规范医疗机构医院感染相关临床数据,保证数据抽取、转换、存储与分析的同质化,提高数据与真实情况的符合度,为信息技术人员更好地理解医院感染监测专业需求提供了指导,并为下一步研发国家/区域性医院感染监测系统奠定基础。     

应用数据挖掘技术建立智能化医院感染监控平台

目的 在医院综合管理平台上建立医院感染监控平台,实现在线全院综合性监测和目标性监测及医院感染与临床的在线反馈.方法 依据国家法规标准和医院感染监测工作流程,使用数据挖掘技术,将医院各系统中的数据集成到医院感染监控平台内,并对数据进行存储和整理分析.结果 临床可以通过该平台进行无纸化报告医院感染病例,实现在线前瞻性调查,可自动化或导入生成大量的监测记录,结果可由系统统计并在线反馈于临床.结论 使用医院感染监控平台可以以标准化的监测流程,以智能化的监测技术,提升医院的医院感染管理水平.     

基于互联网的医院感染信息实时监测与管理网络平台设计

目的规划与设计基于网络的以实时自动推送形式进行医院感染病例监测和目标性监测的网络信息系统平台。方法采用系统需求分析方法,对比分析国内外已有的医院感染网络监测系统以及我国现有医院感染监测与管理现状,从实时自动监测理念、网络硬软件需求及基本功能设置等多方面阐明医院感染实时自动监测和管理平台的设计及运行思路。结果提出医院感染信息的网络实时自动监测管理理念和监测管理平台建设的框架设计方案,其建设的基本条件包括医院内部网与外部网络间的信息传输设备、统一规范的医院感染监测报告格式、基于互联网等外部网络的信息监测和管理系统。该系统应具有3项主要功能:数据自动推送功能、数据上报分析及共享功能、决策支持及预警功能。结论医院感染信息网络实时自动监测管理平台设计思路及基本框架明确,功能强大,其运行有助于减少医院感染监测成本及促进医院感染管理工作。     

医院感染监测平台的建立与应用前景

目的充分利用医院现有的信息资源,建立医院感染监测平台,实现医院感染病例、医院感染暴发以及相关信息的预警及信息反馈。方法整合医院信息系统(HIS)、医学影像存档与传输系统(PACS)、检验信息系统(LIS)、麻醉信息管理系统(AIMS)、手术室管理系统(ORIMS)、供应室管理系统(SRIMS)等信息资源,将数据进行分类、挖掘和利用。结果利用医院感染监测平台进行感染信息实时监控和追踪、进行前瞻性监测,评价医院感染状况,降低医院感染的发生率和漏报率,预警医院感染不良事件。结论医院感染信息监测平台的建立,将优化管理流程,提高工作效率,医院感染信息监测平台的应用,将医院感染监测的关口前移,为预防控制医院感染暴发事件提供及时准确的综合信息,有广阔的应用前景。     

医院感染信息预警监测系统的设计与实施

目的建立与医院信息管理系统连接的医院感染信息预警监测系统，实现对医院感染的实时监测、过程管理和数据上报。方法根据国家相关法规及医院感染管理工作经验，利用面向对象语言Power Builder和Oracle数据库技术，开发医院感染信息系统。结果系统对所有住院患者进行实时监控，动态预警，具有查询、统计和上报功能。结论与医院信息系统连接的医院感染信息系统操作简便，监测准确、及时，覆盖面广，可为医院感染的控制与预防提供可靠依据。     

医院感染实时监控系统的开发与应用

目的 解决医院感染在线、实时监测问题,实现感染病例智能化识别与预警,并进行实时干预-反馈,提高监测效率,全面提升预防控制水平.方法 依据《医院感染监测规范》和《医院感染诊断标准》等标准,结合实际工作经验,借鉴国内外监测系统的优点,利用计算机网络技术,设计并开发医院感染实时监控系统(RT-NISS).结果 RT-NISS通过数据访问中间件技术,采集医院信息管理系统(HIS)、实验室信息管理系统(LIS)、电子病历管理系统(EMR)等相关数据,建立起动态的感染信息基础数据库,实现了对患者从入院到出院全过程在线监测;通过嵌入专业筛查策略,实现了疑似感染病例智能识别,并进行个案预警,方便专职人员判别;通过建立交互平台,实现了感染病例实时推送、精确诊断、干预与反馈,使专职人员与临床医师共同参与感染诊断与预防控制;通过建立暴发预警机制,实现了暴发隐患的及时发现;通过规范的监测流程和计算方法,进行全院综合性监测和目标性监测,并实现了全面、准确统计分析结果的输出;通过先进的计算机技术,实现了系统的可操作性、高效性、安全性和开放性.结论 RT-NISS是高效率的医院感染监测与预防控制系统,通过准确、高效的预警机制和临床干预-反馈机制,实现了感染全过程监测和感染预防控制“关口前移”,开创了医院感染监测与预防控制工作新模式.     

医院感染监测预警分析系统与HIS接口的设计与实现

目的：通过医院信息系统与感染监测预警分析系统的互联,实现与HIS的全面接轨,对信息资料实施自动采集、储存和统计功能,实现医院感染网络化监控和管理.方法：根据国家相关法规及医院感染管理工作的经验,采用SQL Server数据库、PB开发平台与HIS全面整合的网络版信息化系统进行设计.结果：实现了信息的采集、储存与传输应用手段的自动化及信息综合分类与加工处理方式的集约化.结论：该系统使医院感染信息系统操作简单,监测准确、及时,覆盖面广,为医院感染的控制与预防提供了可靠的依据.     

医院感染信息系统的建立与应用

目的建立与医院信息系统连接的医院感染信息系统，实现对医院感染的实时监测和过程管理。方法根据国家医院感染管理相关法规及某院医院感染管理工作经验，利用面向对象语言Power Builder和Microsoft SQL Server数据库技术，研究开发医院感染信息系统。结果该系统实现了对所有在院患者的实时监控，具有查询、统计、分析功能；可对医院感染病例、环境卫生学指标及抗菌药物合理应用等形成准确、全面的监测报表。结论与医院信息系统连接的医院感染信息系统操作简便，监测准确、及时，覆盖面广，可为医院感染的控制和预防提供可靠依据，具有较好的管理效果。     

医院感染管理软件的开发与应用

目的利用医院计算机网络系统,对医院感染信息进行分析处理,提高医院感染管理工作质量和效率。方法开发建立医院感染管理软件,对住院患者医院感染相关资料进行监测、查询、分析和统计,制作图表。结果开发建立的软件可用于医院感染病例的管理、住院患者医疗信息查询、医院感染危险因素监测与分析、抗菌药物临床应用调查与评价。结论此次开发建立的医院感染管理软件功能灵活,使用方便,获取信息及时、快捷,对提高医院感染管理工作效率有很大帮助。     

Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany

Neonates are at high risk of nosocomial infections and surveillance has been shown to be valuable for the reduction of nosocomial infections. The National Nosocomial Infections Surveillance (NNIS) system established in the US has a special surveillance component for neonatal intensive care units (NICUs) with some fairly specific methods. However, there are no specific definitions of nosocomial infections in this patient group. When creating a surveillance component for NICUs in Germany we therefore decided not to adopt merely all Centers for Disease Control and Prevention definitions and NNIS methods, but also to develop our own surveillance methods for this patient group. For this process four steps became necessary: (1)development of modified definitions for nosocomial infections and their evaluation; (2)testing the NNIS method in three NICUs with infection control nurses; (3)a pilot project for a surveillance component within the national surveillance system in Germany; and (4)establishment of a surveillance component within our national surveillance system.The system is now established in 33 hospital departments and 66 NICUs participate in the surveillance system. We have an overview of 3357 neonates in three birthweight groups. This article explains the reasons for the various steps, and the advantages and disadvantages of modification of the original NNIS methods and definitions.     

Device-associated, device-day infection rates in an Israeli adult general intensive care unit

Surveillance is an essential element of hospital infection control programs. Previous studies have shown that interhospital comparison of intensive care unit (ICU) nosocomial infections (NI) may be best made by comparing ICU-type-specific, device-associated infection rates and that these adjusted rates vary by ICU type. The aim of this study was to evaluate whether significant structural improvements introduced in an adult general ICU were associated with changes in the NI rates in this unit. In addition, we compared these rates with those of ICUs reported by the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Diseases Control and Prevention. During a 12-month period 337 patients were surveyed. There were 20 ventilator-associated pneumonias (VAP)/1000 ventilator (VEN)-days, 12 bloodstream infections (BSI)/1000 central vascular catheter (CVC)-days and 14 urinary tract infection (UTI)/1000 indwelling urinary catheter (IUC)-days. Structural changes and reduction in device utilization ratios were not followed by change in NI rates in this unit. VAP and BSI rates were comparable to those reported for neurosurgical and burn ICUs, respectively, in the NNIS System, despite a much higher device utilization ratios. The present study provides specific surveillance data for further interhospital comparison with similar types of ICUs.     

湖北省25所医院ICU医院感染目标性监测结果分析

目的 了解湖北省医院重症监护病房（ICU）患者医院感染现状特点,为医院感染防控措施的制定提供依据。方法 采用前瞻性调查方法对湖北省25所医院ICU患者进行医院感染目标性监测,数据录入全国医院感染监测与数据直报系统,采用Excel 2010进行统计学分析。结果 共监测24 957例患者,医院感染发病率为3.71%,医院感染部位以下呼吸道为主,占73.41%。呼吸机相关肺炎（VAP）、血管导管相关血流感染（CRBSI）、导尿管相关尿路感染（CAUTI）发病率分别为11.36‰、1.23‰、1.29‰。926例感染患者共分离出950株病原菌,以革兰阴性菌为主（76.53%）。前5位病原菌依次为鲍曼不动杆菌(22.63%)、肺炎克雷伯菌（17.26%）、铜绿假单胞菌(11.79%)、金黄色葡萄球菌(8.95%)、大肠埃希菌（6.21%）。结论 侵入性操作是ICU患者医院感染的高风险因素,其中以VAP感染发病率最高。医院感染病原菌耐药情况较重,应持续监测并采取相应干预措施控制医院感染。     

The national nosocomial surveillance network in Hungary: results of two years of surgical site infection surveillance

In 2004, a secure web-based national nosocomial infection surveillance system was established in Hungary. The system, named NNSR (Nemzeti Nosocomiális Surveillance Rendszer), is based on the US National Nosocomial Infection Surveillance System (NNIS). Surgical procedures, definitions, surveillance methodology and patient risk indices are those established by NNIS. In this paper, we present the results of the first two years of the surgical patient component of our system. During this period, 41 hospitals participated and selected 11 surgical procedures for surveillance. Altogether 15812 procedures were surveyed and 360 resulting surgical site infections (SSI) were recorded. The overall SSI rate was 2.27%. The most commonly selected procedures and corresponding SSI rates were caesarean section (1.31%), herniorrhaphy (2.09%), cholecystectomy (1.52%) and hip replacement (2.91%). Standardised infection ratios (SIR) were calculated for chosen surgical procedures in order to compare against NNIS published rates. SSI rates for colonic surgery, caesarean section and mastectomy were lower than expected according to the NNIS data but higher for cholecystectomy, herniorrhaphy and hip prosthesis infection rates. We intend to recruit more participating hospitals, leading to a robust national database that can be used to target infection control interventions for patients in Hungary.     

Nosocomial infections in heart surgery patients: active surveillance in two Italian hospitals

In Italy no nosocomial infection surveillance database has been established despite the fact that a decrease of nosocomial infection rates was one of the priorities of the Italian National Health Plan 1998--2000. Heart surgery operations are the most frequent high risk procedures in western countries. Active surveillance was performed at the heart surgery wards of two Italian hospitals (Rome and Catania, Southern Italy) in accordance with the methods described for the National Nosocomial Infections Surveillance (NNIS) System of the USA. In both hospitals surgical site infections (SSIs) were the most frequently encountered type of nosocomial infections, accounting for 57.2% in Rome and 50% in Catania, and SSI rates in coronary artery bypass grafts with both chest and donor site incisions, calculated by risk index equal to 1, were above the 90th percentile for the NNIS System. The urinary catheter-associated urinary tract infection (UTI) rate (5.8%) in Catania exceeded the 90th percentile for the NNIS System, while the device-associated UTI (1.6%), bloodstream (4.1%) and pneumonia (8.0%) rates, from the hospital in Rome, did not. All device utilization ratios were lower than the 10th percentile for the NNIS System. Our study demonstrated that the NNIS methodology is applicable to Italian hospitals, although with some limitations mainly regarding the minimal surveillance duration required for significant interhospital comparison, and highlighted the need of a national comparison of surveillance data as benchmark.     

医院感染监控软件的研制

目的研制开发医院感染监控管理系统,实现医院感染管理动态监测,预防医院感染和传染病暴发流行,杜绝医院感染恶性事件发生。方法采用C／S＋B／S架构,与军卫一号信息工程接轨,以Delphi和NET为开发工具,结合Java Script＋ASP＋XML＋web Service等先进开发技术,对HIS中医院感染相关信息进行提取、整合、分析及预警。结果该系统解决了医院感染统计中数据的复杂逻辑关系问题,简化了工作流程,减少了前瞻性干预控制的盲目性,提高了工作效率。结论借助该系统对医院感染各环节及高危因素进行前瞻性监测,能有效降低医院感染发病率,减少漏诊、漏报。     

A survey of methods used to detect nosocomial legionellosis among participants in the National Nosocomial Infections Surveillance System.

OBJECTIVE: To help define the scope of nosocomial legionnaire's disease (LD) and to assess use of recommended diagnostic methods and transmission control practices. METHODS: We surveyed 253 hospitals participating in the National Nosocomial Infections Surveillance (NNIS) System. The anonymous survey included questions about episodes of nosocomial LD, environmental sampling practices, maintenance of hospital water systems, and diagnostic techniques. RESULTS: Of 192 hospitals that responded, 29% reported at least one episode of nosocomial LD from 1990 through 1996, and 61% of these reported at least two episodes. Of 79 hospitals with transplant programs, 42% reported nosocomial LD, compared with 20% of hospitals without transplant programs. Environmental sampling had been conducted by 55% of hospitals, including 79% of those reporting nosocomial LD. Legionella were isolated in 34% that sampled potable water and 19% that sampled cooling system reservoirs. Supplemental potable-water decontamination systems were installed in 20% of hospitals. Only 19% routinely performed testing for legionellosis among patients at high risk for nosocomial LD. CONCLUSIONS: Nosocomial LD is relatively common among NNIS hospitals, especially those performing organ transplants. Environmental sampling for Legionella is a common practice among NNIS hospitals, and Legionella often are isolated from sampled hospital cooling towers and hospital potable-water systems. Hospitals have responded to suspected nosocomial LD infection with a variety of water sampling and control strategies; some have not attempted to sample or decontaminate water systems despite identified transmission.     

Active surveillance of nosocomial infections in heart surgery patients: implementation of the American National Nosocomial Infections Surveillance (NNIS) System in a large hospital in Rome

The authors present the implementation of the American NNIS System method for active surveillance in the heart surgery and its intensive care unit (ICU) of a large hospital in Rome (almost 1.000 beds). This surveillance was based on full time infection control professionals. Device-associated infection rates were calculated for adult ICU surveillance component. For surgical patient surveillance component we used the surgical site infection (SSI) risk index based on wound class, duration of operation and American Society of Anesthesiology score. The NNIS System method allowed us to understand the most relevant problems in heart surgery patients: in comparison with NNIS data, we found high rates of SSIs both in procedures on valves and in coronary artery bypass grafts. The central line-associated bloodstream infection rate was higher than the American median rate. Therefore, we decided to focus on surgical risk factors linked to SSIs and to revise recommendations for intravascular-device use. In conclusion, in our experience the NNIS System method proved to be a very useful and versatile tool for nosocomial infections active surveillance.     

医院感染控制小组的建设与管理

目的 充分发挥医院感染控制小组成员在临床感染预防与控制中的作用.方法 通过人员重组、明确职责与工作质量考评标准,制定年度与季度工作计划及工作总结,建立内网“医院感染管理专栏”,加强基础培训与专题培训及培训后的考核,督导检查,确立管理流程、奖惩和例会制度等方法,进行感染控制小组的建设与管理.结果 各科室医院感染管理制度逐步完善并得到贯彻落实,建立了“临床医院感染及耐药菌监测网”,医院感染聚集性病例明显减少,感染患者微生物送检率明显增加,围术期预防用药较前规范,各级医务人员医院感染知识培训逐步规范化,感染控制工作得到了科室更好地配合.结论 加强感染控制小组的建设与管理,有助于全面地推进医院感染控制工作.