革兰阳性菌在NICU的分布及其与医院感染的关系

目的 研究革兰阳性菌引发神经内科重症监护病房(NICU)医院感染的临床及其在病房环境中的分布特征.方法 选取2010年10月-2011年9月某三级医院NICU患者为监测对象,对其中发生医院感染患者进行病原学检查及药敏试验,同时监测NICU空气和病床单位环境的革兰阳性菌分布特征.结果 209例患者中有61例发生医院感染,感染率为29.19％;其中42例进行了病原学检测,革兰阳性菌占15.44％,均为革兰阳性球菌,以金黄色葡萄球菌为主;病房空气、枕头、被服上检出菌种的构成差异无统计学意义.结论 金黄色葡萄球菌、肺炎链球菌、溶血葡萄球菌等革兰阳性球菌是引发NICU患者下呼吸道和泌尿道医院感染的重要病原菌,病房空气和床单位环境是溶血葡萄球菌引发下呼吸道感染的重要传播途径,其对氨苄西林/舒巴坦、莫西沙星、亚胺培南、万古霉素等抗菌药物具有很高的敏感性.     

NICU使用中呼吸机连接管口病原菌调查

[目的]预防控制新生儿重症监护病房（NICU）医院感染,降低医院感染率,探讨呼吸机连接管口导致医院感染的途径和预防措施。[方法]分6次采集10个呼吸机连接管口使用前、后内壁样本（棉拭）进行细菌培养检测,并采集患儿呼吸道分泌物进行培养检测。[结果]经检测10个呼吸机连接管口内壁使用前均未检测到病原微生物,患儿使用后40%的呼吸机连接管口内壁检测到与患者呼吸道分泌物培养结果相同的致病菌。[结论]呼吸机连接管口内壁是导致医院感染的最危险因素,应对其进行彻底消毒,切断引起医院感染的传播途径。     

SARS患者某定点收治医院空气样本中SARS-CoV及其RNA的检测

目的 了解SARS某定点收治医院空气中的SARS病毒污染情况及SARS病毒在空气中的分布和传播特性。方法 采用FA-2型空气微生物采样器在病房区及病房阳台连续采样。将采集到的空气样本洗脱后分别采用细胞分离和逆转录-聚合酶链反应分析,并对细胞分离阳性者作进一步的系列分析鉴定。结果 SARS患者某定点收治医院病房区及阳台空气样本中均有部分PCR结果阳性,SARS阳性率病房区为29％,阳台为20％;其中一份样品中分离出活性病原体,并稳定传代;经免疫荧光染色鉴定阳性,RT-PCR扩增产物的测序结果显示该病原体与已知SARS-CoV的同源性在98％以上。结论 SARS急性期后期与恢复期早期的患者仍然从呼吸道排毒,病毒在距传染源周围1m之内的空气中具有感染活性,在此范围之内存在气溶胶传播的潜在威胁。     

一起由腺病毒7型引起的呼吸道传染病聚集性疫情的流行病学调查

目的对一起发生在早读制小学内呼吸道感染疫情的流行病学和病原学特点进行探讨研究,分析其流行因素和传播途径,为制定疫情防控措施提供依据。方法采用相应的流行病学个案调查表进行现场调查,描述流行特征;采集患者咽拭子,利用反转录聚合酶链式反应(RT-PCR)技术进行病毒核酸检测,确定致病原。结果累计发现病例27例,无重症病例和死亡病例的发生,疫情波及范围较小。RT-PCR病毒核酸检测确认为腺病毒感染,病毒分型鉴定为腺病毒7型,其临床特征主要表现为发热(38℃以上),伴有乏力、头痛、咳嗽、咽痛、恶心、呕吐等症状。结论该疫情是由腺病毒7型引起的学校内呼吸道传染病聚集性疫情,传播途径可能以密切接触和空气传播为主。     

神经内科多重感染患者病原学及其病房环境特征的分析

目的 通过对神经内科住院患者多重感染的病原学及其病房环境主要微生物学特征的分析,有针对性地进行预防与控制医院感染的发生.方法 选取2009年4月-2010年9月某三甲医院神经内科住院患者为监测对象,对发生感染患者进行病原学检查,并对其所住病房的空气和床单位等进行微生物学监测.结果 神经内科住院患者2481例中感染110例占4.43％,多重感染42例,占感染患者的38.18％；以下呼吸道感染为主占76.92％；检出病原菌主要为铜绿假单胞菌占24.73％、肺炎克雷伯菌占19.35％;病房空气和床单位中以藤黄微球菌、表皮葡萄球菌等革兰阳性球菌为主,并检测到大肠埃希菌、鲍氏不动杆菌等少量条件致病菌；其中3例多重感染患者,在病房的空气、枕头、棉被中同时检测出表皮葡萄球菌,1例多重感染患者同时检测到大肠埃希菌.结论 神经内科多重感染患者的病原菌和病房空气及床单位中微生物分布具有明显的一致性,病房空气及床单位环境中的微生物是医院感染的主要病原菌.     

人腺病毒热点问答（3）

1．4 腺病毒患者的传染性怎样？腺病毒角膜结膜炎有很高的传染性，腺病毒肺炎也可造成医院内感染。1．5腺病毒的传播途径有哪些？传播途径主要为呼吸道飞沫和直接接触，也可通过粪口传播。1．6什么样的人容易感染腺病毒？各个年龄组均可感染，但以婴幼儿和老年人以及免疫功能缺陷者和接受器官移植者容易感染。健康成年人大多不易感。     

医院内下呼吸道感染原因分析及预防对策

目的:探讨医院内下呼吸道感染的发生原因及预防对策,降低其发病率.方法:对我院2000年医院内下呼吸道感染病例进行原因分析,制订并实施2001年医院内下呼吸道感染的预防措施.结果:2001年我院医院内下呼吸道感染的发病率为0.62%,比2000年(0.73%),下降0.11个百分点.结论:隔离感染源;保护易感人群;切断传播途径;及时做好空气、环境及有关器具的卫生学监测;加强病房管理和基础护理等措施,可降低医院内下呼吸道感染的发病率.     

NICU患者医院感染的病原学类型与病房环境的关系

目的 研究神经内科重症监护病房(NICU)发生医院感染的病原学与病房环境因素的关系,为有效切断致病菌的传播途径提供依据.方法 选取2010年9月-2011年9月唐山市某三甲医院NICU住院患者为监测对象,监测其医院感染的发生情况,同时监测发生感染患者室内空气及床单位(枕头、被服)等环境.结果 224例住院患者中有65例发生医院感染,感染率为29.02％,感染部位以下呼吸道为主,占90.24％;感染病原菌中革兰阴性杆菌占77.01％,主要为铜绿假单胞菌和肺炎克雷伯菌,革兰阳性球菌占16.67％,主要为金黄色葡萄球菌,真菌占6.32％;感染患者病房环境主要以革兰阳性球菌为主.结论 铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌等是引发NICU医院感染的主要病原菌,病房空气或床单位等环境因素是这些致病菌的重要传播途径之一,因此应加强病房环境和病床单位的消毒,以防止医院感染的传播.     

1起腺病毒7型暴发的调查

目的 报告并分析1起腺病毒7型感染引起的暴发疫情的流行病学特征及原因,为预防控制类似医院感染疫情提供参考。方法 对某医院1起腺病毒7型暴发进行流行病学调查,描述疫情流行特征;鼻咽拭子标本中提取核酸,PCR法检测甲型、乙型流感病毒、呼吸道合胞病毒、腺病毒等特异性基因片段。结果 本次疫情是1起腺病毒7型引起的暴发疫情,共报告14例病例,首发病例死亡,其余13例续发病例预后良好,且均与首发病例有密切接触史,除首发病例及其1名家庭成员是在院前感染外,剩余12例均在医院内感染发病,院内罹患率为14.00%。鼻咽拭子标本经PCR检测,腺病毒核酸检测阳性14份。结论 该医院未按规定启用发热门诊、发热患者未按要求进行预检分诊以及医护人员防护不规范是造成本次疫情暴发的主要原因,应加强院内感染的管控。     

一起腺病毒感染暴发的分子流行病学调查

目的调查某军校一起腺病毒疫情暴发情况。方法采用现场流行病学调查、临床检查和实验室检测等方法确定疫情性质和病原学。结果在 8d内发生 12 6例以发热、呼吸道症状为主的病人。血清腺病毒特异性IgM测定 6 8例病人阳性率为 76 .5 % ,10 0名无症状者阳性率为37.0 % ,两者间差异非常显著 (P <0 .0 1) ;7名病人咽拭子脱落上皮细胞免疫荧光试验检测腺病毒抗原 ,有 3例阳性 ;以 1例病人咽拭子标本腺病毒PCR产物测序 ,发现此株病毒是腺病毒 5型。病人经对症处理后痊愈 ,疫情得到迅速控制。结论基本可以判断这是一起由腺病毒 5型感染引起的暴发 ,传播途径可能是气溶胶导致的呼吸道传播     

医院SARS重症监护病区空气传播途径的研究

目的对SARS重症监护(ICU)病区患者及周围空气等进行研究,为SARS的传播途径提供帮助和证据支持.方法用日本产安德森空气采样器对SARSICU病区重复2次,对5个病房的空气和病区空调的过滤网、冷凝水取样,分别用RT-PCR和病毒分离培养方法检测.结果SARSICU病房空气样本中查出SARS病毒,并发现病毒既存在大的生物颗粒上,也存在较小的生物颗粒和病房外空调机过滤网上,表明在ICU病区SARS病毒可能存在近距离飞沫,也存在小的气溶胶的生物颗粒上,随空气在一定范围、一定的时间内传播.结论在SARSICU病房、病区空气中可能存在SARS病毒,所以加强病区的空气通风与ICU医务人员的呼吸道、黏膜等个人防护是防止SARS传播的关键.     

新生儿病房医院感染分析及预防对策

目的：分析新生儿病房医院感染的发生情况及相关因素,探讨降低新生儿病房医院感染的预防及对策。方法：回顾分析2004~2008年新生儿病房医院感染监测资料。结果：新生儿病房医院感染率1.39%,其中2004年3.56%,2005年3.26%,2006年1.05%,2007年0.06%,2008年0.04%,以呼吸道感染为首位。结论：加强医院感染管理,制定各项规章制度,重视医护人员的手卫生;严格执行无菌技术操作加强空气消毒及呼吸道管理,使得新生儿病房医院感染发生率逐年下降。     

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.     

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.     

Value of environmental sampling and molecular typing of aspergilli to assess nosocomial sources of aspergillosis

In order to investigate the risk of hospital-acquired infections due to environmental Aspergillus, air sampling outside and inside the bone marrow transplantation (BMT) clinic of the University Hospital, Essen, Germany, was performed prospectively for one year. The spore concentration in the air was matched with meteorological data. Two BMT-patients, who were hospitalized during the sampling period, suffered from aspergillosis after discharge. The patients' isolates obtained at re-admission were compared with environmental isolates obtained during the first hospitalization. Analysis by randomly amplified polymorphic DNA showed that the two BMT-patients were infected with Aspergillus strains that were different from the environmental strains. It is concluded that it is not possible to predict the environmental Aspergillus spore concentration by analysis of meteorological data. Since the concentration of specific strains may fluctuate rapidly, a hospital-acquired Aspergillus infection cannot be excluded even if the infecting strain is not found in the hospital environment.     

经排风系统传播SARS可能性的示踪气体实验研究

目的 测定和分析某医院住院部病房楼空气流向及其与排风管道分布的关系并探讨和验证严重急性呼吸综合征(SARS)在医院感染可能的传播途径和影响因素。方法 在某医院住院部SARS输入病例所在病房卫生间燃放植物油熏香(示踪气体);为控制病房卫生间排风扇的开启、顶层抽风机的状态和病房新风系统等主要影响因素,共设计了6种实验状态。由4组实验员分别盲法到各楼层的4、5号病房采集、测量空气样本,并分别按10等分记分法评估其气味浓度。结果 在医院住院部8～13层的各病房均检测到示踪气体,在不同实验状态下,气体弥散的方向和浓度不尽相同。结论 医院目前的建筑结构和通风系统具备了病原体气溶胶自下而上经排风管道垂直传播的通道和空气动力学条件,示踪气体的分布与发病分布有一定的关联性。提示SARS存在气溶胶或其他载体形式长距离传播的可能性和证据,而在现有设施条件下,针对性的预防管理措施可在一定程度上阻断病原体经排风系统的传播。     

人工鼻对ICU负压病房空气菌落计数的影响作用研究

目的：研究人工鼻对ICU负压病房空气菌落计数的影响,以及人工鼻对下呼吸道院内感染播散的拦截效果。方法：使用人工鼻前后,计数ICU负压病房空气中菌落株数并比较ICU医院感染发生率,进而研究人工鼻对ICU医院感染细菌扩散的拦截作用。结果：使用人工鼻前后计数ICU负压病房空气中菌落株数及ICU医院感染发生率比较,差异均有统计学意义（P〈0．05）。结论：人工鼻对1CU负压病房空气菌落计数的影响作用以及对下呼吸道院内感染播散的拦截效果显著,对于预防院内感染的暴发流行有重要意义。     

Prevalence survey of nosocomial infections in a paediatric hospital.

A prevalence survey of nosocomial and community infections in a children's hospital was carried out in the wards of the Bambino Gesù Hospital, Rome, Italy. The overall prevalence of hospital-acquired infection (HAI) was 5.1%, with higher rates in surgical units and among children aged 1 to 5 years. The proportion of community-acquired infections was 9.2%, with higher rates in the infectious disease and internal medicine units and among children aged 6 to 11 years. The most frequent type of HAI was respiratory tract infection, with only a small number of urinary tract infections.     

National prevalence survey of hospital-acquired infections in Italy, 1983

In 1983 a national prevalence survey was conducted in Italy to discover the general distribution of infection among patients in public hospitals. Thirty-four thousand, five hundred and seventy-seven acute patients were surveyed in 130 hospitals spread throughout the country: 6668 patients (19.3%) had an active infection at the time of the survey; the infection was hospital-acquired in 2361 (6.8%) and community-acquired in 4307 (12.5%). The urinary tract was the site most frequently involved in hospital infection (30.2% of patients with hospital-acquired infection). The respiratory tract was the site most often involved in community infections (35.7% for the lower tract and 9.1% for the upper). Hospital-acquired infections were more frequent in intensive care units (12.4%) and in geriatric (11.6%), orthopaedic (8.2%) and surgical wards (7.6%). The prevalence of urinary tract infection was 10.4% among the 9.4% of patients who were catheterized compared with a prevalence of 2.6% in the uncatheterized. Thirty-five point five per cent of patients were receiving an antimicrobial on the day of the survey.     

Nosocomial bacteremia in children: a 15-year experience at a general hospital in Mexico.

OBJECTIVE: To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital. DESIGN: Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared. SETTING: A public general hospital in San Luis Potosi, Mexico. PATIENTS: Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection. INTERVENTIONS: Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel. RESULTS: There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions. Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.