BackgroundThe use of continuous glucose monitoring (CGM) in the hospital setting is growing, with more patients using these devices at home, especially during the COVID-19 pandemic. Frail and critically ill patients with COVID-19 and previously normal glucose tolerance are also associated with variability in their glucose levels during their intensive care unit (ICU) stay. However, very limited evidence supports the use of CGM in ICU settings, especially among frail patients with COVID-19. ObjectiveWe aimed to investigate the effectiveness of CGM on ICU-related outcomes among frail and critically ill patients with confirmed COVID-19. MethodsThis was an exploratory, prospective, open-label, parallel, single-center, randomized controlled trial. A total of 124 patients was finally analyzed. The primary outcome was 28-day, in-ICU mortality. The secondary outcome included the length of ICU stay as well as the occurrence of hypoglycemia and severe hypoglycemia events. ResultsThe mean age was 78.3 (SD 11.5) years. The mean fasting glucose level and hemoglobin A1c level at baseline were 8.12 (SD 1.54) mmol/L and 7.2% (SD 0.8%), respectively. The percentage of participants with diabetes was 30.6% (38/124). The corresponding hazard ratio of the primary outcome in the intermittently scanned CGM (isCGM) group when compared with the point-of-care testing (POCT) group was 0.18 (95% CI 0.04-0.79). The average length of ICU stay was 10.0 (SD 7.57) days in the isCGM group and 14.0 (SD 6.86) days in the POCT group (P=.02). At the end of study period, the mean value of fasting glucose in the isCGM group and the POCT group was 6.07 (SD 0.63) mmol/L and 7.76 (SD 0.62) mmol/L, respectively (P=.01). A total of 207 hypoglycemia events (<3.9 mmol/L) was detected, with 43 in the isCGM group and 164 in the POCT group (P<.001). A total of 81 severe hypoglycemia events (<2.8 mmol/L) was detected, with 16 in the isCGM group and 65 in the POCT group (P<.001). The major adverse event in this study was bleeding in the puncture site, with a total of 6 occurrences in the isCGM group. During the follow-up, none of the participants dropped out because of bleeding in the puncture site. ConclusionsWe found a significant clinical benefit from the use of CGM among frail and critically ill patients with COVID-19. These findings support the use of CGM in the ICU and might help with the extension of application in various in-hospital settings. Trial RegistrationChinese Clinical Trial Registry ChiCTR2200059733; https://www.chictr.org.cn/showproj.html?proj=169257

Introduction: Carbapenem-Resistant Enterobacteriaceae (CRE) has posed a significant threat to humans.The aim of this study was to investigate the molecular characteristics of blaKPC-producing Escherichia coli in a university-affiliated tertiary hospital. Methods: Polymerase chain reaction (PCR) and BLAST+ software were used to detect the prevalence of blaKPC in E. coli and Klebsiella pneumoniae. Whole-genome sequencing was performed for the blaKPC-harboring clinical E. coli isolates. Antimicrobial resistance genes, MLSTs, KPC-carrying plasmid typing and genetic environment of blaKPC were analyzed. A maximum likelihood core single nucleotide polymorphism (SNP)-based phylogeny tree was constructed to determine the evolutionary relationships within this ST131 collection. Conjugation experiments were performed to determine the mobilization of blaKPC. The minimal inhibitory concentrations of the common antimicrobial agents were determined using the broth microdilution method. Results: The prevalence of blaKPC in 424 clinical E. coli isolates and 1636 E. coli strains from GenBank database were 2.2% (45/2060) whereas the detection rate of blaKPC in K. pneumoniae from the GenBank database was 29.8% (415/1394). The blaKPC-harboring conjugants exhibited resistance to multiple beta-lactams, except for cefepime-zidebactam and ceftazidime-avibactam. All blaKPC-carring E. coli isolates were susceptible to tigecycline and polymyxin B. ST131 was the dominant sequence type of blaKPC-carring E. coli, accounting for 40.0% (18/45). Most of the blaKPC-producing ST131 E. coli (89.5%,17/19) belonged to clade C ST131 lineage. Genetic environment analysis revealed that 57.8% (26/45) of blaKPC gene was linked to Tn4401-associated structure ISKpn6-blaKPC-ISKpn7. IncN was the most common plasmid type in KPC-producing E. coli whereas IncFII was the dominant plasmid type in KPC-producing K. pneumoniae. Conclusion: The detection rate of blaKPC was lower in E. coli compared with K. pneumoniae. The dominant sequence and plasmid types of blaKPC-harboring isolates differed between E. coli and K. pneumoniae. Further studies about the role of the defense system in acquisition of KPC-plasmids in E. coli will be performed to provide new insights into the low prevalence of blaKPC.

Background Evaluating energy expenditure is important for establishing optimal goals for nutrition treatment. However, indirect calorimetry, the reference standard for measuring energy expenditure, is difficult to apply widely in clinical practice. Objective To test the consistency of bioelectrical impedance analysis (BIA) relative to indirect calorimetry for evaluating energy expenditure in critically ill patients. Methods A cross-sectional study of 140 critically ill adult patients was conducted. Within 24 hours of a patient being transferred to the intensive care unit, trained researchers assessed the patient’s energy expenditure by use of BIA and indirect calorimetry simultaneously. Consistency of the 2 measurements was detected by intraclass correlation coefficients with a 2-way random-effects model. Factors affecting consistency were analyzed. Results Median energy expenditure measured by indirect calorimetry was 1430.0 kcal/d (IQR, 1190.5–1650.8 kcal/d). Median energy expenditure measured by BIA was 1407.0 kcal/d (IQR, 1248.5–1563.5 kcal/d). The correlation coefficient between indirect calorimetry and BIA was 0.813 (95% CI, 0.748–0.862; P < .001). The consistency of the 2 measurements was lower in patients with comorbidities than in those without (P = .004). Conclusions Results of BIA were highly consistent with indirect calorimetry assessments of energy expenditure in critically ill patients. Few factors except comorbidity affect the accuracy of BIA when assessing energy expenditure. Therefore, as a low-cost, easy-to-use, and noninvasive method, BIA is a valuable clinical tool for assessing energy expenditure in critically ill patients.

Objective We aimed to investigate the effectiveness of CGM on intensive care unit (ICU) related outcomes among frail and critically ill patients with confirmed COVID-19. Research design and methods This was an exploratory, prospective, randomized, open-label, parallel, single-center clinical trial. A total of 124 patients was finally analyzed. The primary outcome was 28-day in-ICU mortality. The secondary outcome included the length of ICU stay, the occurrence of hypoglycemia and severe hypoglycemia events. Results The mean age was 78.3±11.5 years old. The mean fasting glucose level at baseline was 8.12±1.54 mmol/L. The mean HbA1c level was 7.2±0.8%. The percentage of participants with diabetes was 30.6%. The corresponding hazard ratio of the primary outcome in the isCGM group when compared with the POCT group was 0.18 (95%CI 0.04-0.79). The average length of ICU stay was 10.0±7.57 days in the isCGM group and 14.0±6.86 days in the POCT group (P < 0.05). Conclusions We found a significant clinical benefit from the use of CGM among frail and critically ill patients with COVID-19. These findings support the use of CGM in ICU and might help with the extension of application in various in-hospital settings. We aimed to investigate the effectiveness of CGM on intensive care unit (ICU) related outcomes among frail and critically ill patients with confirmed COVID-19. This was an exploratory, prospective, randomized, open-label, parallel, single-center clinical trial. A total of 124 patients was finally analyzed. The primary outcome was 28-day in-ICU mortality. The secondary outcome included the length of ICU stay, the occurrence of hypoglycemia and severe hypoglycemia events. The mean age was 78.3±11.5 years old. The mean fasting glucose level at baseline was 8.12±1.54 mmol/L. The mean HbA1c level was 7.2±0.8%. The percentage of participants with diabetes was 30.6%. The corresponding hazard ratio of the primary outcome in the isCGM group when compared with the POCT group was 0.18 (95%CI 0.04-0.79). The average length of ICU stay was 10.0±7.57 days in the isCGM group and 14.0±6.86 days in the POCT group (P < 0.05). We found a significant clinical benefit from the use of CGM among frail and critically ill patients with COVID-19. These findings support the use of CGM in ICU and might help with the extension of application in various in-hospital settings.

目的:探讨基于多学科协作的镇静和镇痛集束化护理对ICU机械通气患者谵妄和转归的影响.方法:选取2020年3月至2022年2月上海市第六人民医院ICU收治且行机械通气的患者为研究对象.按照随机数字表法将患者随机分为对照组(n=46)与观察组(n=46).对照组实施镇静和镇痛常规护理,观察组实施基于多学科协作的镇静和镇痛集束化护理.比较2组谵妄发生情况及身体约束情况、镇痛药物使用剂量、干预前后睡眠质量及临床结局.结果:与对照组相比,观察组谵妄发生率及身体约束率降低,谵妄开始时间较晚,谵妄持续时间较短,差异均有统计学意义(均P＜0.05).观察组右美托咪定及瑞芬太尼使用剂量均少于对照组(均P＜0.05).干预后,与对照组相比,观察组睡眠总时间、快速眼动睡眠时间延长,睡眠效率增高,睡眠潜伏时间及觉醒时间缩短,差异均有统计学意义(均P＜0.05).2组非计划性拔管及病死率差异均无统计学意义(均P＞0.05);观察组机械通气时长及ICU住院时长均短于对照组(均P＜0.05).结论:对ICU机械通气患者实施基于多学科协作的镇静和镇痛集束化护理能降低谵妄发生率,减少镇静和镇痛药物使用剂量,缩短患者治疗时间,促进患者良好转归.

An earlier study found that heated humidification reduced the side effects of positive airway pressure (PAP) in patients with obstructive sleep apnoea (OSA). However, other studies disagreed with this finding. Therefore, we evaluated the relationship between heated humidification and the side effects of PAP in patients with OSA. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases were searched for relevant randomised controlled trials (RCTs) performed from January 1999 to June 2021. From 1012 retrieved articles, we identified 9 eligible RCTs. Compared to the control group, the heated humidification group reported improvements in dry nose (pooled standardised mean difference [SMD] = − 0.70, 95

目的 探讨重症监护病房(ICU)护士职业压力对报警疲劳的影响,并分析心理弹性在ICU护士职业压力和报警疲劳的中介作用.方法 通过整群抽样法,对上海市6所(上海市第六人民医院、上海华山医院、上海瑞金医院、上海肿瘤医院、上海市第八人民医院、上海金山区中心医院)综合医院2020年10月至11月的752名ICU护士分别采用护士工作压力源量表、ICU护士报警疲劳量表、心理弹性量表(CD-RISC)中文版进行调查分析.结果 不同医院等级、年龄、性别、学历、ICU工作年限、婚姻状况、子女情况、月收入、近3个月翻班数、血型的ICU护士职业压力得分比较,差异有统计学意义(P<0.05).近3个月不同工作/生活事件职业压力得分比较,差异有统计学意义(P<0.05).相关分析显示,ICU护士职业压力各维度得分与心理弹性各维度得分呈负相关(r<0,P<0.05),与报警疲劳得分呈正相关(r>0,P<0.05).线性回归结果显示,ICU工作年限、子女情况、翻班情况、离职想法、报警疲劳状况及心理弹性情况是ICU护理人员职业压力的影响因素(P<0.05).ICU护士职业压力、报警疲劳、心理弹性三者呈线性关系,中介效应验证,心理弹性的中介效应值为0.134,占整体效应的64.73％.结论 ICU护士职业压力通过心理弹性对报警疲劳起中介效应.

目的 探讨重症监护室(ICU)患者家属探视信念与态度的影响因素.方法 选取上海市第六人民医院2018年12月至2020年12月收治的108名ICU患者的家属(每例患者均选取1名家属).采用ICU探视信念与态度量表(BAVIQ)评估全部ICU患者家属探视信念与态度,并收集全部患者家属相关基线资料.比较不同资料特征患者家属BAVIQ评分,分析可能影响ICU患者家属探视信念与态度的相关因素.结果 不同受教育程度、对探视满意度、焦虑自评量表评分患者家属BAVIQ评分比较,差异有统计学意义(P<0.05).经多元线性回归分析,受教育程度为高中及以下、对探视不满意、焦虑情绪较重是ICU患者家属探视信念与态度一般的影响因素(P<0.05).得到回归方程:Y=71.085+6.935X1+8.065X2+9.915X3.结论 ICU患者家属探视信念与态度一般,受患者家属受教育程度低、对探视不满意、焦虑情绪较重等因素影响.

目的 分析重症监护室(ICU)护士职业获益感与睡眠质量的关系.方法 采用便利抽样法,选取2017年10月至2020年10月在上海市两所三甲医院ICU工作的160名护士作为研究对象,均为女性.调查时,采用护士职业获益感问卷评估护士职业获益感、采用匹兹堡睡眠质量指数(PSQI)评估护士睡眠质量;统计ICU护士基线资料,比较不同资料特征ICU护士PSQI评分,分析ICU护士职业获益感与睡眠质量的关系,并分析ICU护士职业获益感对睡眠质量的影响.结果 纳入的160名ICU护士职业获益感评分为(89.45±4.17)分,PSQI评分为(10.28±0.88)分.职业获益感低分组PSQI评分高于职业获益感高分组,差异有统计学意义(P<0.05);不同年龄、工作年限、技术职称、受教育程度、编制、婚姻状况及有无儿童照护的ICU护士PSQI评分比较,差异无统计学意义(P>0.05).经双变量Pearson相关性检验,ICU护士职业获益感与PSQI评分呈负相关(r=-0.718,P<0.05).经多元线性回归分析显示,ICU护士职业获益感评分降低是睡眠质量变差的危险因子(P<0.05),线性方程为Y=-1.882+0.239X(调整后R2=0.777).结论 ICU护士睡眠质量处于中等水平,职业获益感与ICU护士PSQI评分呈负相关,职业获益感评分降低对ICU护士睡眠质量变差有一定影响.

Background. Various noninvasive methods of intracranial pressure (ICP) measurement have been proposed. Each has unique advantages and limitations. This study was aimed at investigating the relationships between lateral ventricular asymmetry on admission computed tomography, optic nerve sheath diameter (ONSD), and ICP in traumatic brain injury (TBI) patients. Methods. A prospective observational study was conducted in the patients admitted to our department between October 2018 and October 2020. 20 patients with moderate-severe TBI with a Glasgow Coma Scale of 3–12 were enrolled. Lateral ventricle volume (LVV) value measurements were conducted using ITK-SNAP software. The lateral ventricular volume ratio (LVR) was quantified by dividing the larger LVV by the smaller. Results. ONSD and LVR had a good correlation with ICP. Admission LVR of >1.735 was shown to have a sensitivity of 90.9% and a specificity of 88.9% for prediction of ICP increase (AUC=0.879; standard error=0.091; 95% CI=0.701 to 1.0; significance level p<0.004). Admission ONSD of >5.55 mm was shown to have a sensitivity of 81.8% and a specificity of 88.9% for prediction of ICP increase (AUC=0.919; standard error=0.062; 95% CI=0.798 to 1.0; significance level p<0.002). Combining the ONSD and LVR, the sensitivity could be improved to 90.9% in parallel test, and the specificity could be improved to 100% in serial test. Conclusion. ONSD and LVR measurements can diagnose elevated ICP in traumatic brain injury patients. ONSD combining with LVR may further improve the diagnostic evaluation.

目的 对护士报警疲劳量表(NAFS)进行汉化及信效度分析.方法 通过便利取样的抽样方法 ,对上海市1056名三甲医院重症监护室(ICU)护士进行问卷调查,并运用SPSS21.0和AMOS22.0统计软件对所得数据进行分析、处理.结果 中文版护士报警疲劳量表(NAFS-C)条目相关性分析结果 显示,所有条目-总分均呈显著性相关;I-CVI为0.830～1.000,S-CVI/UA为0.860、S-CVI/Ave为0.970;探索性因子分析得到三因子结构方程模型,累积方差贡献率为77.645％,对模型进行结构性因子分析得到CMIN/DF<3,GFI、TLI、CFI均>0.90,RMSEA<0.08,PGFI>0.50;Cronbach a系数为0.883,3个维度的Cronbach a系数分别为0.876、0.882、0.755,分半信度系数为0.769,重测组内相关系数为0.795.结论 NAFS-C信效度良好,可用于评价我国ICU护士报警疲劳的状态,从而为ICU护士报警疲劳的管理提供一种更加简便的新型工具.

目的 探讨重症监护病房(ICU)护士创伤后应激障碍对报警疲劳的影响,并在此基础上,分析心理资本在创伤后应激障碍和报警疲劳中的中介作用.方法 2019年9-11月,通过便利取样的方法,对上海市14所三级甲等综合医院1 056名ICU护士分别采用创伤后应激障碍量表平民版(PCL-C)、ICU护士报警疲劳量表、护士心理资本问卷中文版(PCQ-R)进行调查分析,并构建结构方程模型.结果 不同年龄、婚姻状况、子女情况、ICU工作年限、职称的ICU护士创伤后应激障碍、报警疲劳、心理资本得分差异均有统计学意义(均P＜0.05);不同学历的ICU护士创伤后应激障碍、报警疲劳得分差异均有统计学意义(均P＜0.05);不同月收入的ICU护士报警疲劳得分差异有统计学意义(P＜0.05).创伤后应激障碍得分与报警疲劳得分呈正相关(P＜0.05),与心理资本得分呈负相关(P＜0.05);心理资本得分与报警疲劳得分呈负相关(P＜0.05).Bootstrap法检验结果显示,创伤后应激障碍到报警疲劳的直接效应、间接效应的95％CI均未包含0,心理资本的中介模型成立,所产生的部分中介效应值为0.128,占总效应的66.34％.结论 ICU护士创伤后应激障碍通过心理资本对报警疲劳起中介效应.

目的 观察分指握力球运用于重症监护病房(ICU)机械通气患者的效果.方法 前瞻性纳入2018年7月至2019年1月上海第六人民医院收治的100例ICU机械通气患者,按照随机数字表法分为常规组与试验组,各50例.常规组采用常规干预,试验组采用常规干预+分指握力球.记录两组脱机时间,评估两组患者约束舒适度[采用数字疼痛分级法(NRS)进行评估],统计两组不良事件[手腕约束处红肿、手腕约束处皮肤损伤、静脉血栓栓塞症(VTE)]发生情况.结果 试验组脱机时间短于常规组,差异有统计学意义(P＜0.05).试验组约束总舒适度高于常规组,差异有统计学意义(P＜0.05).试验组手腕约束处红肿、手腕约束处皮肤损伤发生率低于常规组,差异有统计学意义(P＜0.05).两组VTE发生率比较,差异无统计学意义(P＞0.05).结论 ICU机械通气患者采用分指握力球干预的约束舒适度高,可缩短脱机时间,减少手腕约束处红肿、损伤发生.

目的:研究重症监护室(ICU)呼吸机相关性肺炎(VAP)患者炎性因子水平与病原学特征及危险因素.方法:将从2017年1月～2019年12月,于我院ICU接受治疗的120例患者纳入研究.将其按照是否发生VAP分成VAP组48例与无VAP组72例.比较两组炎性因子水平,分析VAP患者的病原菌分布情况,分析ICU患者发生VAP的危险因素.结果:VAP组肿瘤坏死因子-0(TNF-α)、降钙素原(PCT)及C反应蛋白(CRP)水平均高于无VAP组(均P＜0.05).48例VAP患者共分离得到病原菌76株,按照占比从高到低的顺序依次为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、凝血酶阴性葡萄球菌、真菌,占比分别为22.37％、18.42％、17.11％、14.47％、13.16％、7.89％、6.58％.经单因素分析发现:ICU患者发生VAP与机械通气时间、抗菌药物联用以及留置胃管有关(均P＜0.05),与年龄、性别无关(均P＞0.05).经多因素Logistic回归分析发现:机械通气时间＞7d、抗菌药物联用、留置胃管均是ICU患者发生VAP的危险因素(P＜0.05).结论:VAP患者的炎性因子水平存在显著升高的情况,且其病原菌以铜绿假单胞菌、鲍氏不动杆菌以及金黄色葡萄球菌等为主.此外,机械通气时间、抗菌药物联用以及留置胃管均与VAP的发生关系密切,值得临床重点关注.

目的 探讨手指操应用于"全厚皮"法根治腋臭术后早期并发症的效果观察.方法 选取2017年1月—2018年7月择期行"全厚皮"法根治腋臭的住院患者100例为研究对象,按照组间基本特征具有可比性的原则分为对照组和观察组,各50例.对照组采用常规护理,观察组在对照组基础上采用手指操进行护理管理,比较两组术后24 h内出血情况,术后术侧肢体肿胀与疼痛程度,睡眠质量和住院护理满意率.结果 两组术后24 h出血情况比较差异无统计学意义(P>0.05),观察组术后6 h和24 h的术侧肢体肿胀程度低于对照组(P<0.05);观察组患者睡眠质量及住院护理满意度优于对照组(P<0.05).结论 "全厚皮"法根治腋臭术后患者予手指操锻炼,能减轻患者术侧肢体的肿胀程度和疼痛感,提升患者的睡眠质量,提高患者的住院护理满意度.

目的 通过评估骨科创伤患者深静脉血栓(deep venous thrombosis,DVT)的发生与Caprini静脉血栓风险评分的相关性,分析Caprini评估量表在创伤患者静脉血栓风险中的预测价值.方法 采用回顾性研究方法,选取2017年6月-2018年6月上海市第六人民医院收治的创伤患者2401例,收集患者一般资料,统计下肢深静脉超声及血栓发生事件数、Caprini风险评估量表得分情况,并分析其相关性.结果 本研究纳入的2401例创伤患者中,发生下肢深静脉血栓为483例(20.11％);DVT和非DVT两组患者一般资料调查结果均无显著差异;Caprini风险评估量表的受试者工作特征曲线的曲线下面积为(0.760±0.107);与低危组患者相比,极高危组患者DVT风险显著增高,表明Caprini评分与静脉血栓形成具有较好相关性.结论 Caprini静脉血栓风险评估可以较好的预测创伤患者下肢深静脉血栓的发生.

[目的]探讨体位变化对高血压脑出血术后病人颅内压和脑灌注压的影响。[方法]2012年8月—2016年12月选择在我院诊治的高血压脑出血病人66例,根据随机数字表法分为观察组与对照组,所有病人都行开颅去大骨瓣减压手术,对照组给予传统手术体位干预,观察组给予抬高体位干预,记录颅内压和脑灌注压的变化情况。[结果]观察组开骨瓣时与清除血肿后的颅内压和脑灌注压均低于对照组（P＜0.05）,术后第14天观察组总有效率为97.0%,高于对照组（81.8%,P＜0.05）,且观察组卒中量表（NIHSS）评分为2.22分±0.84分,对照组NIHSS评分为4.11分±0.52分,均低于术前的7.30分±1.11分和7.33分±1.19分。[结论]术中抬高手术床头30°,有利于降低高血压脑出血术后病人颅内压和脑灌注压,从而提高预后疗效,促进神经功能恢复。

目的 观察应用苯扎氯铵溶液在尿道端端吻合术后患者导管护理预防感染中的临床疗效.方法 选取2013年2月至2014年1月行尿道端端吻合术的80例患者作为研究对象,按照随机数字表法分为两组,每组各40例.试验组采用苯扎氯铵溶液棉球实施导管护理,对照组采用生理盐水棉球实施导管护理,两组于术后第3、5、7天及拔管前行尿常规及中段尿培养检查,并在住院期间进行舒适度及满意度调查.结果 试验组患者应用苯扎氯铵溶液行导管护理后无明显不适,各时间点行中段尿培养及尿常规检查结果均明显低于对照组,差异有统计学意义(P<0.05);试验组舒适度评分低于对照组,总体满意度高于对照组,差异均有统计学意义(P<0.05).结论 尿道端端吻合术后应用苯扎氯铵溶液行导管护理无明显不良反应,并且可明显降低泌尿系感染的发生率,值得临床推广应用.

目的 了解重症监护病房(ICU)医务人员耐甲氧西林金黄色葡萄球菌(MRSA)的定植情况.方法 2014年5-8月,于每周一对某院ICU医务人员进行MRSA的主动筛查,监测MRSA的定植情况,对MRSA检出阳性医务人员使用莫匹罗星进行治疗并继续采样;并调查同期ICU住院患者临床标本MRSA阳性情况.结果 共调查160名医务人员,共采样317份,其中MRSA检出阳性人员7名,定植率为4.38%.主要检出于ICU护士(4名)、外科医生(2名)及ICU医生(1名);经莫匹罗星治疗后仅有1名ICU护士仍为阳性.而同期ICU住院患者临床标本MRSA检出阳性率为4.54%(2/44).结论 应加强对ICU医务人员MRSA定植情况的主动筛查,主动筛查是减少MRSA医源性传播的有效措施.