Objective:To explore the application effect of training methods based on cross-theoretical model in improving the master of knowledge, compliance and implementation rate of nursing students to standard prevention.Methods:A total of 92 nursing trainees participating clinical practice in Zhangjiagang Traditional Chinese Medicine Hospital and Zhangjiagang First People's Hospital in 2017 were selected as the control group, and 112 trainees were selected as the experimental group; the control group adopted conventional standard prevention training method; the training procedure of the experimental group were divided into five stages according to the behavior of trainees, and training was carried out corresponding to different stages and behavioral transformation processes. Standard prevention knowledge, compliance belief scale score, behavior change stage distribution and standard prevention implementation rate between these two groups were compared.Results:The standard prevention theory and skill assessment scores were 84.41±4.64 and 67.01±4.53 in the experimental group and the control group after intervention, respectively. The difference was statistically significant ( t value was 26.934, P<0.01). Nurse standard prevention compliance belief scale scores were 156.21±6.96 and 119.73±5.77 in the experimental group and the control group after intervention, respectively. The difference was statistically significant ( t value was 40.156, P<0.01). The distribution of behavioral changes was statistically significant ( Z value was 8.173, P<0.01). The standard prevention implementation rate of hand washing and hand disinfection, protective equipment uses, sharp and medical waste disposal, item and environmental treatment after intervention was 78.78%(438/556), 76.69%(385/502), 91.47%(193/211), 88.27%(173/196) in the experimental group, and 62.72%(254/405),62.26%(231/371), 76.22%(141/185), 69.23%(117/169) in the control group, the differences were statistically significant( x 2 values were 17.367-29.987, all P<0.01). Conclusions:The training strategy based on cross-theoretical model can improve the attention of nursing trainees to standard prevention work, change adherence beliefs, working attitudes and behaviors, and thus improve the implementation rate of standard prevention behaviors.

目的 观察区域隔离对ICU患者多重耐药菌(MDROs)感染发生率和检出率的影响.方法 收集ICU患者160例,根据隔离方法不同将其分为对照组79例和观察组81例,分别采用单间隔离、区域隔离方法.应用全自动细菌鉴定仪进行菌种鉴定,采用K-B法进行药敏试验;自制评价量表,评估医护人员的工作效率.结果 观察组MDROs检出率为48.15％,对照组MDROs检出率为44.30％,其中耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类铜绿假单胞菌检出率最高,两组差异无统计学意义;观察组医护人员的工作效率评分为(92.45±4.63)分,高于对照组的(85.34±4.58)分(P＜0.05).结论 区域隔离与单间隔离方法在降低ICU患者MDROs检出率方面无明显差异,但能提高医护人员的工作效率.

OBJECTIVE To explore the effect of intervention of environmental cleaning measures on the rate of HAIs in ICU , so as to provide references for the prevention and reduction of HAI rates of ICU.METHODS A total of 3439 cases in ICU from Jan.2012 to Jun.2016 were selected.Among them, 1821 cases from Jan.2012 to Jun.2014 were set as observation group, and 1618 cases from Jul.2014 to Jun.2016 were set as control group.The HAI rates before and after intervention were compared.RESULTS Before the intervention, the HAI rate was 10.05%, the incidence rate of ventilator-associated pneumonia (VAP) was 12.55‰, catheter-associated urinary tract infection (CAUTI) rate was 1.24‰, and catheter-related bloodstream infection(CRBSI) rate was 1.65‰.After the interventions were taken, the HAI rate was 7.05%, the incidence rate of VAP was 6.86‰, CAUTI rate was 1.17 ‰, and CRBSI rate was 1.18‰.There were significant differences in the HAI rate and the incidence rate of VAP of patients before and after the intervention (P<0.05), and there was no significant difference in CAUTI and CRBSI before and after the intervention.CONCLUSION It is effective to take intervention measures of environment cleaning to reduce the HAI rate, especially for the incidence rate of VAP.

Objective To explore and analyze the clinical efficacy of bronchoalveolar lavage combined with invasive noninvasive mechanical ventilation sequential therapy in the treatment of chronic obstructive pulmonary disease ( COPD) patients with respiratory failure. Method 100 cases of COPD complicated with respiratory failure patients from January 2011 to Decwmber 2013 in our hospital were selected according to the random number table, which were divided into observation group and control group, each group with 50 cases. The patients in control group were treated with invasive mechanical ventilation, while the observation group patients with the bronchoalveolar lavage therapy combined with sequential invasive-noninvasive mechanical ventilation therapy. Curative effect was observed and compared between the two groups after treatment. Result The infection correcting time, the total duration of me-chanical ventilation, duration of hospitalization of patients with respiratory failure were significantly shorter than those of the control group;each index with blood gas analysis in the two groups after switching windows significantly changed,pH, and PaO2 of the observation group patients after switching time window were significantly higher than those of the control group, and the PaCO2 was significantly lower than that of the control group, and the two groups had significant difference(P<0. 05); the overall complication rate of the patients in observation group after treat-ment was 10%, significantly lower than that of the control group (40%),with statistical significance(P<0. 05). Conclusion Bronchoalveolar lavage combined with sequential mechanical ventilation has significant curative effect in the treatment of COPD with respiratory failure, not only can effectively improve the symptoms of the COPD patients, control the infection, shorten the time of hospitalization, but also reduce the incidence of ventilator-associated pneu-monia and other complications rate; therefore it is an effective means of treatment, which is worthy of putting into clinical application.

目的 分析ICU院内肺部感染的病原菌的种类、分布及对常用抗生素的耐药情况.方法 回顾性分析ICU病区387例院内肺部感染患者的病原学资料.结果 共检出病原菌1073株:革兰阴性菌878株(81.8％),革兰阳性菌118株(11.0％),真菌77株(7.2％).革兰阳性菌以金黄色葡萄球菌比例最高(71株,6.6％),对万古霉素和利奈唑胺敏感率分别为98.6％和97.2％,耐甲氧西林金黄色葡萄球菌(MRSA) 48株(4.5％);革兰阴性菌前3位分别是鲍曼不动杆菌(361株,33.6％)、铜绿假单胞菌(184株,17.1％)和肺炎克雷伯菌(120株,11.2％),药敏试验呈多重耐药,泛耐药及全耐药鲍曼不动杆菌呈逐年递增趋势;真菌以白色念珠菌为主(57株,5.3％).结论 受检医院ICU病区院内肺部感染病原菌以革兰阴性菌为主,细菌耐药性明显增强.

OBJECTIVE To analyze the results of the targeted monitoring of nosocomial infections in the ICU before and after the cleaning so as to reduce the incidence of nosocomial infections in the ICU and prevent the nosocomial infections.METHODS The patients who were enrolled the ICU from May 2011 to Oct 2011 group were selected as the control group,and the patients who were treated from Nov 2011 to Apr 2012 were set as the observation group.During the treatment period,the ICU was cleaned with the routine method in the control group,while the ICU of the observation group was cleaned with the intensified cleaning mode.The environmental health in the ICU and the incidence of nosocomial infections were monitored during the treatment period.RESULTS After taking the intensified cleaning mode,the environment of ICU was significantly better in the observation group than in the control group.During the treatment period,there were 41(9.6%) cases with infections in the control group and 28(7.7%) cases with infections in the observation group,the difference was statistically significant.CONCLUSION ICU is the risk department for nosocomial infections and is also the key target for hospital infection prevention and control.The intensified cleaning mode can improve the environmental health of the ICU and significantly reduce the incidence of nosocomial infections.

目的观察盐酸右美托咪定联合咪达唑仑对ICU机械通气患者的镇静效果,探讨其临床应用的价值。方法选取我院2011年1～12月进行机械通气的ICU患者48例,随机平均分为观察组24例和对照组24例,对照组患者应用咪达唑仑注射进行镇静,观察组患者应用盐酸右美托咪定联合咪达唑仑进行镇静。比较2组患者Ramsay评分、咪达唑仑使用量、恢复时间。结果观察组中患者Ramsay评分与对照组中患者Ramsay评分无显著差异,不具有统计学意义(P>0.05)。观察组患者咪达唑仑使用量明显少于对照组、恢复时间明显短于对照组,2组差异均具有显著性,有统计学意义(P<0.05)。结论对于ICU机械通气患者,给予盐酸右美托咪定联合咪达唑仑能够显著提高临床效果,达到满意的镇静作用。

通过对引发ICU综合征相关因素的分析,以预防和减少ICU颈椎骨折患者急性精神障碍的发生。