Prevalence of nosocomial infections in selected hospitals

A point prevalence survey of NI in 10 hospitals has been carried out with the aim to obtain more valid results about their occurrence and to raise the interest of clinicians in this problem. Altogether data on 5,553 hospitalized patients have been evaluated. An epidemiologist along with a clinician jointly found a total 365 of NI in 344 patients a point prevalence 6.6%. The prevalence ranged between 3.6 and 10.5% for different hospitals. The highest NI prevalence was found in surgical wards (urology 19.6%, surgery 12.2%). Undesirably high prevalence of NI was observed in paediatrics (mainly diarrhoeal diseases) and neonatal (conjunctivitis) wards. Infections of the upper respiratory tract were most frequently followed by surgical wound infections and infections of the urinary tract. The occurrence of NI of surgical wounds, urinary tract infections and infections of skin was increasing, while the occurrence of infections of gastrointestinal tract and of the eye was decreasing with age. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria (2:1).     

Measures of prophylaxis of nosocomial infections in somatic hospitals

Data are presented on the complex of measures for the prophylaxis of infections at the obstetrical and surgical clinics; also information on the efficacy of new disinfectants made in the USSR for the disinfection of objects of external environment, hands of medical personnel and air in somatic hospitals is given.     

A system for the operative management of hospital infections in maternity hospitals]

A system for controlling the epidemic process of hospital infections in maternity hospitals and departments of infant pathology has been created. The specific feature of the proposed method is the prospective character of epidemiological surveillance: from the cause to the effect, and not vice versa. This is achieved by using the results of follow-up of the preconditions of the epidemic process activation (preterm delivery, gestosis, dry labor, birth injuries in mothers and infants) and the precursors of the beginning aggravation of the epidemic situation (the level of the contamination of infants with hospital microflora). Early information in this respect will help foresee the possible activation of the epidemic process of hospital infections and take necessary measures when infant infection rate is just elevated.     

Etiology, risks factors, therapy of nosocomial cerebrovascular infections

Nosocomial cerebrovacsular infections are substantial cause of mortality and morbidity in patients after neurosurgery. Risk factors, etiology, treatment strategies and outcome of nosocomial meningitis and brain abscess are briefly reviewed.     

Measures of performance in Scottish maternity hospitals.

OBJECTIVE--To develop measures of hospital performance over time with particular reference to maternal and neonatal care by controlling for case mix. DESIGN--Analysis of computerised records of births. SETTING--Scotland, 1980-7. SUBJECTS--Over half a million singleton live births and stillbirths. MAIN OUTCOME MEASURES--Numbers of perinatal deaths and caesarean sections. RESULTS--Scottish maternity hospitals perform more or less equally with regard to perinatal mortality. When caesarean sections are considered, there is evidence that hospitals differ in their treatment of different groups of women; in two examples one hospital had an increased rate among women of parity 2 or more and another had a reduced rate of repeat caesarean section. CONCLUSIONS--Developing measures of performance over time by controlling for case mix is a valid system for monitoring hospital outcomes and activity, and allows comparison either between hospitals or with data for all Scottish maternity hospitals. Hospital profiles permit identification of differences for particular patient groups after allowance is made for other case mix variables.     

恶性肿瘤患者院内细菌感染临床高危因素调查分析

目的探讨恶性肿瘤患者院内细菌感染的危险因素。方法收集2009年1月至2011年12月大连医科大学附属二院肿瘤内科恶性肿瘤院内细菌感染的98例患者的临床资料,对感染相关高危因素采用单因素及Logistic多因素回归分析。结果单因素分析显示性别、感染部位、留置导尿、WBC下降程度及PS评分与G＋/G-菌感染种类有关（P〈0.05）,但进一步进行多因素分析后显示只有性别和留置导尿对细菌感染种类有影响（OR值分别为0.257、7.726）;细菌种类、性别、深静脉置管及化疗疗程数是血液感染发生的危险因素（OR值分别为8.634、8.000、2.012、0.025）。结论女性较男性更易发生G＋菌感染,而留置导尿则以发生G-菌感染为主;G-菌感染、女性、深静脉置管及多疗程化疗者易发生血液感染。应针对各种危险因素采取有效的预防措施,减少恶性肿瘤患者院内细菌感染的发生。     

The characteristics of the epidemic process of hospital infections in maternity hospitals influenced by an operational management system]

As shown in this investigation, the introduction of the algorithmic system of the control of the epidemiological process of hospital infections (HI) in maternity hospitals makes it possible to reduce HI-induced morbidity and mortality rates more than by half, as well as to alter their nosological and age structures, without additional economic expenditures and under the existing material conditions of maternity hospitals. Such success is achieved by the observation of infection precursors indicating the activation of the mechanisms of the transmission of Staphylococcus, Escherichia and Klebsiella infections and the risk factors (preconditions) facilitating this activation with the immediate involvement of all relevant specialists into action at the stage when an increase in the contamination of newborns and puerperal women is noted and not as late as at the stage of morbidity and mortality.     

全科医学科住院患者医院感染病原菌分布与危险因素

目的 分析2014年7月－2017年6月我院全科医学科住院患者医院感染的病原菌分布及危险因素,为临床合理应用抗生素提供依据。方法 采用Vitek 2 Compact全自动细菌鉴定及药敏分析系统进行病原菌的鉴定,采用纸片扩散法（K-B法）和MIC法测定其对抗菌药物的敏感性,根据美国临床实验室标准化协会（CLSI）2014年标准对药敏试验结果进行分析判断。结果 1532例全科医学科住院患者发生医院感染190例、245例次,医院感染率和例次感染率分别为12.40%和15.99%。感染部位以呼吸系统、泌尿系统和消化系统为主,分别占50.61%、21.63%和12.65%。共分离出病原菌125株,其中革兰阴性菌79株（63.20%）,革兰阳性菌38株（30.40%）。药敏结果显示：大肠埃希菌对氨苄西林的耐药率最高,为94.74%,对美罗培南和亚胺培南的耐药率均为0.00%;肺炎克雷伯菌对氨苄西林的耐药率最高,为95.45%,对美罗培南、亚胺培南的耐药率均为0.00%;鲍曼不动杆菌对头孢替坦的耐药率最高,为100.00%,对阿米卡星的耐药率最低,为20.00%;金黄色葡萄球菌对青霉素G的耐药率最高,为100.00%,对万古霉素、替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;表皮葡萄球菌对青霉素G的耐药率最高,为100.00%,对万古霉素、替考拉宁、替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;屎肠球菌对克林霉素的耐药率最高,为100.00%,对替加环素、利奈唑胺和奎奴普丁/达福普汀的耐药率均为0.00%;住院时间>30 d、糖尿病、鼻饲管置管、泌尿道插管、深静脉置管和应用抗菌药物是全科医学科住院患者医院感染的独立危险因素（P<0.05）。结论 应针对全科医学科住院患者医院感染的病原菌特点及危险因素,加强防控以降低医院感染率。     

Risk factors for acute respiratory tract infections in children

Acute respiratory tract infections (ARTI) are the most common cause of childhood morbidity and an important public health problem. The aim of this study was to identify the significant risk factors for ARTI in children. The study took place in Ivankovo which is a rural area of Eastern Slavonia and with small socio-economic differences. The study population were 159 children who were 3-5 years old at the time of the study, and who were registrated at doctor's office Ivankovo. The study was conducted retrospectively through a questionnaire from January 2008 to December 2008. The risk factors studied were the gender, breastfeeding history, any atopic manifestation in the form of atopic eczema, rhinoconjuctivitis and/or asthma, the size of the family, parents smoking habits and main form of childcare. The number of ARTI requiring the consultation of a doctor throughout 2007 were measured; and whether ARTI had been treated with antibiotic or there were recommendation for symptomatic treatment only. Results of this research show that the risk factor for consulting a doctor because ofARTI in children was passive exposure to cigarette-smoke. For receiving antibiotics because of ARTI in children, the risk factors were passive exposure to cigarette-smoke and atopic manifestation. By giving the available evidence, parents must be told that ceasing smoking offers a significant opportunity to reduce the risk of ARTI in their children.     

Methodological aspects of the evaluation of epidemiological safety in maternity hospitals

The distribution of morbidity and mortality in newborns, as well as morbidity of parturient women, in maternity hospitals of Moscow official have been analyzed according to statistical data for 1996-1999. The methods of cluster analysis (k-medium and tree classification by the method of the next door neighbours) were used. The evaluation of the stability of the distribution of morbidity and mortality in maternity hospitals was made with the use of chi 2 criterion. The specific features of the distribution of morbidity and mortality of newborns, as well as morbidity of parturient women, in the hospitals under study were detected. The methodological approach to the evaluation of epidemiological safety in maternity hospitals was proposed.     

耐利奈唑胺粪肠球菌感染的危险因素分析

分析深圳市南山区人民医院粪肠球菌感染患者的临床资料,探讨引起感染的危险因素,为防治耐利奈唑胺粪肠球菌感染提供临床参考。选取2010年1月-2015年9月在深圳市南山区人民医院住院的165例粪肠球菌感染患者,根据药敏结果分为利奈唑胺敏感组(103例)和利奈唑胺中介/耐药组(62例)。165例粪肠球菌主要来源于中段尿培养,占53.94%,其次为伤口分泌物培养(21.82%)、血培养(6.06%);科室分布以泌尿外科和肝胆外科为主,分别占35.76%和9.70%。单因素分析显示,碳青霉烯类抗生素暴露、留置尿管与感染相关。Logistic回归分析进一步明确碳青霉烯类抗生素暴露、留置尿管为耐利奈唑胺粪肠球菌感染的危险因素,提示应严格掌握碳青霉烯类抗生素的适应证,加强医院内感染的控制管理。     

Chronic infections and genetic factors in the development of ischemic stroke

The aim of this study was to examine whether chronic infections and genetic factors of the host play roles in the pathophysiology of acute noncardioembolic ischemic stroke. Blood samples from 59 subjects with ischemic stroke and 52 control patients were investigated by nested PCR for the presence of C. pneumoniae DNA, HCMV DNA and enterovirus RNA, by ELISA for the levels of antibodies to C. pneumoniae, HCMV, HSV, HHV-6, EBV and the inflammatory chemokine IL-8, and by PCR for promoter polymorphism of the IL-8 and CD14 host genes. Associations of stroke with the HCMV IgG and HSV-1 IgA antibody levels were observed. No association of stroke was detected with the presence of C. pneumoniae, HCMV or enterovirus nucleic acids in the peripheral blood, C. pneumoniae IgM, IgG and IgA, the HSV IgG, the EBV IgG, or HHV-6 IgG antibody levels, the pathogen burden, the IL-8 or CD14 promoter polymorphisms, or with the serum levels of IL-8 in the overall study population. These results are consistent with the hypothesis that certain pathogens are involved in the development of ischemic stroke.     

恶性血液病患者医院侵袭性真菌感染的危险因素分析

目的了解恶性血液病患者袭性真菌感染的发生率及危险因素,为重症患者的真菌感染防治提供依据。方法回顾性调查2013年1月至12月期间的495例恶性血液病住院患者资料,用卡方检验及多因素Logistic回归分析等统计方法分析侵袭性真菌感染的危险因素。结果 16.4%(81/495)的患者发生侵袭性真菌感染,其中急性白血病、慢性白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤患者的真菌感染发生率分别为31.1%(66/212)、0.0%(0/19)、31.2%(5/16)、4.8%(10/207)和0.0%(0/41)。外周血白细胞计数低值≤1.0E+9/L、粒细胞缺少时间≥8天、使用糖皮质激素及抗生素使用种类≥3种是恶性血液病患者侵袭性真菌感染的独立危险因素,预防性使用抗真菌药物是独立保护因素(OR值分别为15.830、41.667、3.745、8.264及39.085,P值分别为0.000、0.011、0.035、0.007及0.000)。结论合理使用抗生素和糖皮质激素、在粒细胞缺少时间较长病例中及时使用集落刺激因子、抗真菌药或重建微生态是防治恶性血液病患者真菌感染的必要措施。     

深静脉置管患者感染危险因素分析及护理对策

目的探讨深静脉置管患者感染危险因素及护理对策。方法采用回顾性分析法探讨深静脉置管患者感染的危险因素,并制定相应的护理对策,比较实施前后患者深静脉置管感染率的差异。结果患者年龄、留置时间、插管部位、置管次数、换药频率、伴随症和使用激素均是导致深静脉置管患者感染的危险因素;采取相应的干预措施后,深静脉置管患者感染率由对照组的9.7%降低至试验组的4.4%,各项目差异具有统计学意义(P0.05)。结论深静脉置管患者存在诸多感染危险因素,通过对护理人员及患者进行积极的感染预防知识教育和护理技能培训,并对不同层次的患者采取有针对性的护理措施,改善了患者的静脉置管感染率,促进了患者的康复。     

ICU院内感染流行菌株及耐药情况

目的了解ICU院内感染的流行菌株及菌株耐药,为临床防治提供依据.方法对温州医学院附属第一医院ICU2002年7月～2003年6月所有分离的细菌菌株、真菌菌株及菌株耐药性进行回顾性调查.结果共检出菌株170例,其中G-菌95例(占55.9%),以铜绿假单胞菌、洋葱假单胞菌、鲍曼不动杆菌为主,主要见于呼吸道感染;G 菌36例(占21.2%),以肠球菌和葡萄球菌为主,前者主要见于泌尿道和消化道感染,后者均见于呼吸道;真菌38例(占22.4%),以白色念球菌为主,主要见于泌尿道感染.其细菌对常用抗菌药耐药严重,呈多重耐药,真菌耐药率尚低.结论加强室内外环境和空气监控,防止交叉感染,侵入性操作要严格无菌操作,在积极治疗原发病的基础上加强支持疗法,增强机体免疫能力,严格掌握抗生素使用原则,根据药敏选用抗生素,避免长期大量联合用药,减少抗生素使用率,从而有效减少院内感染的发生.     

EICU中心静脉导管相关性感染的危险因素分析及护理对策

目的 探讨急诊重症监护病房(EICU)患者深静脉置管后,中心静脉导管相关性感染的危险因素及护理对策.方法 采用表单式记录方法,记录置管前手消毒、置管时机、置管部位、置管顿次、置管时间、穿刺点护理、输液接头、敷料选择等内容.结果 通过对64例置管患者的—预,其导管相关性感染的发生率为7.8％,其危险因素主要与置管技术、无菌原则、插管部位、使用时间、导管维护等有关.结论 中心静脉导管在临床使用中由于多种因素的影响感染的发生难以避免,针对其危险因素,采用表单式的护理方法,可以提醒操作者及维护者在置管前的准备、置管中的配合及置管后的护理方法,从而降低感染的发生率.