目的 探讨急性Stanford A型主动脉夹层(AAAD)术后患者发生呼吸机相关肺炎(VAP)的危险因素,分析感染病原菌分布.方法 选取南京医科大学第一附属医院2015年4月-2020年10月行A型夹层标准术且术后使用机械通气的139例患者,根据是否出现VAP分为感染组(n=35)和非感染组(n=104),对年龄、性别、住院天数、呼吸机支持天数、使用呼吸机次数、是否行急诊手术等多项临床病例资料进行病例对照分析,探索危险因素,分析病原菌分布特点.结果 单因素分析显示高龄、长时间机械通气、频繁气管插管可能会增加术后VAP感染概率;多因素分析显示机械通气时间延长(OR=1.197,95％CI:1.102～1.299)是A型夹层标准术后发生VAP的独立危险因素.机械通气时间越长,感染风险越高,尤其是>10 d的患者,VAP发生率>70％.术后发生VAP的病原菌主要为鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌,耐药菌主要为泛耐药鲍氏不动杆菌(MDR-AB)、耐碳青霉烯铜绿假单胞菌(CR-PA)和肺炎克雷伯菌(CR-KP).结论 临床需积极采取预防措施,降低VAP感染风险,防治多药耐药菌感染,尤其尽可能缩短机械通气时间,改善预后.

目的 比较4种消毒方式对医疗机构物体表面消毒效果.方法 随机选取医疗机构常见物体表面40份,每份分4个区域,以4种消毒方式进行现场试验,比较消毒效果.方式1:一次性纸巾蘸取次氯酸消毒液直接擦拭物表;方式2:一次性纸巾蘸取清水擦拭物表达到去污效果后,再使用次氯酸消毒液喷洒消毒物表;方式3:一次性纸巾蘸取84泡腾片溶液擦拭物表;方式4:使用复合双链季铵盐化合物消毒湿巾擦拭物表.结果 消毒方式1～4回收菌量对数值由消毒前1.67(1.31～2.26)、1.87(1.26～2.47)、1.49(1.23～2.05)、1.77(1.25～1.97)降至消毒后的 0.15(0～0.84)、0(0～0.53)、0(0～0.78)、0(0～0.78),差异均有统计学意义(P值均＜0.05).消毒前、后各组回收菌量对数值分布差异均无统计学意义(P值均＞0.05).消毒方式2和方式3平均杀灭对数值＞1,为消毒合格,方式1和方式4均＜1,为不合格.结论 采用去污后再使用次氯酸喷洒消毒与84泡腾片消毒液擦拭消毒均合格,优于直接使用次氯酸消毒液擦拭消毒及使用复合双链接铵盐化合物消毒湿巾擦拭消毒.

Objective:To explore the effect of "four step" training mode for all staff in hospital infection control on monitoring indicators of nosocomial infection.Methods:From June 25 to September 30, 2019, the whole staff of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) were trained on the knowledge and skills of infection prevention and control by the "four step" training mode. The training contents include basic knowledge of nosocomial infection, hand hygiene, occupational exposure prevention and disposal, disinfection and sterilization, medical waste management, standardized inspection, multi drug resistant bacteria prevention and control, infectious disease management, etc. Monitoring indicators included hospital infection rate, hospital infection case rate, surgical incision infection rate, three tube infection rate of ICU patients, microbial sample submission rate before the use of therapeutic antibiotics, hand hygiene compliance and accuracy rate.Results:After the implementation of the "four step" sensing and control full staff training, the incidence of nosocomial infection in the whole hospital, internal medicine, surgery, geriatrics and ICU ward decreased (P<0.05), the infection rate of surgical site in the whole hospital decreased from 0.66% to 0.42%, and the infection rate of class I and class II surgical incision was also lower than that before the implementation of the training (P<0.05). There was no significant difference in the infection rate of class III surgical incision before and after the implementation of the training, The infection rate of three tubes in intensive care unit (ICU) patients did not change after the implementation of "four step" full staff training. The submission rates of all kinds of antibiotics, restricted antibiotics and special antibiotics in the whole hospital were improved (P<0.05), and the hand hygiene compliance and accuracy of nurses were improved (P<0.05), Although the compliance of hand hygiene was improved after the implementation of the training, there was no statistical difference in the correct rate (P>0.05).Conclusion:The "four step" training and assessment mode for all staff of infection control and prevention has a positive feedback effect on the monitoring indicators of nosocomial infection, and the level of nosocomial infection prevention and control has been significantly improved.

目的 调查某院心脏大血管外科重症监护病房(下简称心外ICU)聚集性碳青霉烯类耐药肠杆菌科细菌(CRE)感染事件,为医院感染防控提供依据.方法 对南京医科大学第一附属医院心外ICU 2019年6月-7月检出CRE的患者进行流行病学调查,给予控制措施,评价防控效果.结果 该病区在2019年6-7月出现5例患者检出CRE共9株,其中4例患者为医院感染,1例患者为CRE定植,CRE医院感染例次率高于4-5月,差异有统计学意义(P＜0.05).9株CRE中8株病原菌为肺炎克雷伯菌(药敏谱一致),1株为大肠埃细菌.CRE来源分析77.78％(7/9)来自于心外ICU本身.共采集标本60份,包括水池区域24份、A床床单元16份、B床床单元8份、C床床单元4份、护理移动掌上电脑(PAD)和标本传输物流系统各4份.共10个位点的标本检测出CRE,其中CRE显色平板培养出9株CRE,麦康凯平板培养出2株CRE.采取综合控制措施结合针对性加强清洁消毒,复查未检测出CRE.控制后的5个月CRE检出及感染数量下降,效果显著.结论 CRE显色平板结合麦康凯平板在CRE流行病学调查中可更有效且全面的培养出CRE,通过环境采样明确具体定植位点,并进行针对性干预,可高效去除CRE在环境中的定植.