Objective To explore the role and significance of full-time infection control nurses in the prevention and control of nosocomial infection in Intensive Care Unit (ICU). Methods Before Februry 2013, there was no full-time infection control nurses in ICU in West China Hospital of Sichuan University (before implementation); since March 2013, with a comprehensive evaluation of bed numbers and infection control nurses workload, the job of full-time infection control nurses were initiated (after implementation). The management of infection control was achieved through clarifying the responsibility of full-time infection control nurses, the implementation of infection monitoring and other related measures. Results Comparing to the condition before implementation, the hand hygiene compliance among nurses, doctors, workers and cleaners in ICU elevated from 49.8% to 74.9%, the infected rate decreased from 15.3% to 9.3%, the positive rate of multiple resistant bacteria decreased from 18.3% to 13.5%, the incidence of ventilator-associated pneumonia decreased from 13.02‰ to 6.63‰, and central venous catheter-related bloodstream infection rate decreased from 6.559‰ to 2.422‰; the differences were all significant (P<0.05). The incidence of urinary tract infection decreased from 1.21‰ to 1.07‰, and the difference was significant (P>0.05). Conclusions Full-time infection control nurses can introduce continuous and effective training to medical staffs, supervise the execution of hospital infection prevention and control measures, and examine all steps involved and relevant feedbacks. Therefore, the full-time infection control nurses play an important role in the prevention and control of nosocomial infection in ICU.
ObjectiveTo investigate the incidence and trendency of healthcare-associated infections (HAIs) in a pediatric intensive care unit (ICU) of a hospital, identify the main objectives of infection control, and formulate corresponding preventive and control measures.MethodsA prospective targeted monitoring method was adopted to investigate HAIs in the pediatric ICU of a hospital from January 2013 to December 2018.ResultsFrom January 2013 to December 2018, the number of target ICU patients was 11 898, the number of patient-days was 55 159; 226 HAIs occurred, the HAI case rate was 1.90%, the incidence of HAI per 1 000 patient-days was 4.10‰, and the adjusted incidence of HAI per 1 000 patient-days was 1.21‰. The main infection site was respiratory tract [83 cases (36.7%)], with ventilator-associated pneumonia in 73 cases (32.3%); secondly, 69 patients (30.5%) had bloodstream infection, among which 48 (21.2%) had non-catheter-related bloodstream infection.ConclusionHospital targeted monitoring is helpful to grasp the situation and trend of HAIs, define the main target of infection control, and formulate corresponding preventive and control measures, which can effectively reduce the incidence of HAIs.
ObjectiveTo explore medical waste management method in a large hospital and strengthen the standardized management of medical waste. MethodsBetween July 2012 and December 2014, according to the PDCA cycle working procedures, existing problems were found in medical waste management through survey, the cause of which was analyzed to formulate and implement a new system of medical waste management, to help carry out employee training and cross examination, and give feedback to clinical departments to make improvements. Then, we analyzed the awareness rate of medical waste-related knowledge among medical staff, accuracy rate of medical waste disposal, average daily medical waste amount before and after the application of PDCA cycle to evaluate the effect of the measures taken. ResultsAwareness rate of medical waste-related knowledge among medical staff (2012:55.59%, 2013:62.89%, 2014:94.43%) increased with statistical significance (χ2=410.871, P<0.001). Accuracy rate of medical waste disposal (2012:69.83%, 2013:87.29%, 2014:94.91%) increased with statistical significance (χ2=197.449, P<0.001). Rank correlation analysis showed that average daily medical waste amount declined as average daily inpatients number increased (rs=?0.590, P<0.001). ConclusionUsing PDCA cycle can improve the awareness rate of medical waste-related knowledge and accuracy among medical staff to achieve continuous quality improvement of medical waste management.
ObjectiveTo carry out targeted surveillance on ventilator-associated pneumonia (VAP) newly defined by the Centers for Disease Control and Prevention of the United States in 2013, and to understand its applicability and influence on the prognosis, and infection rate and risk factors of the disease. MethodsTargeted surveillance was carried out on all patients receiving mechanical ventilation in the general ICU of our hospital between January and December 2014. VAP infection rate was studied, and patients were divided into groups based on the development of the disease. SPSS 18.0 was used for statistical analysis of the prognostic indicators. ResultsA total of 885 patients received mechanical ventilation and were monitored, 31 of whom had VAP. The VAP case infection rate was 3.5% and its daily infection rate was 3.9‰. The results of multiple factors regression analysis showed that age (OR=1.025, P=0.025) and combining other types of hospital infection (OR=4.874, P<0.001) were independent risk factors for the development of VAP. VAP was the independent risk factor for both length of stay in the ICU and length of mechanical ventilation (P<0.001), but it was not the independent risk factor for mortality in the ICU (P=0.515). ConclusionThe applicability of the newly defined ventilator-associated pneumonia may be under restrictions in developing countries. It may influence the outcomes of patients by prolonging the length of stay in ICU and the length of mechanical ventilation.
Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.
【摘要】 目的 了解和分析玉树地震伤员急性应激期睡眠问题。 方法 2010年4月，对90例玉树地震伤员的急性应激反应采用创伤后应激障碍症状清单平民版(PCL-C)17项量表进行筛查评估，并应用SPSS 17.0软件进行统计学分析。 结果 在PCL-C 17个条目中，提示睡眠障碍的条目2和条目13发生率分别为61.10%、63.30%，分别排列第5位、第3位，其得分分别与PCL-C总得分、闪回症状得分、回避症状得分及高警觉性症状得分均呈正相关(P值均lt;0.01)。 结论 睡眠障碍是地震伤员急性应激反应中的常见问题，需高度重视，并进行积极有效的处理。【Abstract】 Objective To learn and analyze the sleep disorders in acute stress of the wounded persons in Yushu earthquake. Methods The acute stress reaction of 90 wounded persons in Yushu earthquake were screened with post-traumatic stress disorder (PTSD) Checklist-Civilian (PCL-C) version-17 in April 2010. Sleep disorders were statistically analyzed with SPSS 17.0. Results In the 17 items of PCL-C, the incidences of the second and the thirteenth item which were related to sleep disorders were respectively 61.10% ranking at the fifth and 63.30% ranking at the third. Both scores of these two items had significant positive correlation with the total score of PCL-C and the scores of the flashback symptom, the avoidance symptom and the heightened alertness symptom (Plt;0.01). Conclusion Sleep disorder is a common problem in acute stress reaction of wounded persons in earthquakes, which needs high attention to be treated positively.
ObjectiveTo analyze and discuss the importance of non-catheter-related hospital infection in intensive care unit (ICU). MethodA prospective target monitoring of all the patients in the general ICU was carried out from January 2011 to December 2013. The hospital infection cases grouped by infection types were analyzed with SPSS 17.0. ResultsA total of 5 364 patients were monitored, 455 of whom had hospital infections totaled 616 times. The hospital infection rate was 11.5%. The amount and constituent ratio of the catheter-related infections showed a declining trend year by year, while the non-catheter-related infections revealed an escalating trend year by year. In these 455 patients, the mixed infection group had the longest hospital stay, followed by the catheter-related infection group and the non-catheter-related infection group (P<0.05). The catheter-related infection group had higher crude mortality rate than both of the mixed infection group and the non-catheter-related infection group (P<0.017). ConclusionsNon-catheter-related infections which get higher and higher proportion in ICU hospital infections should be paid more attention to, while catheter-related infections which could prolong hospitalization and increase the risk of death in ICU patients, remain the focus of the target monitoring of hospital infection in ICU.
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.