目的 监测员工发生感染性职业暴露后预防措施落实情况,提高员工对暴露后防控措施的认知水平,减少职业感染的发生.方法 从医院异常事件上报管理系统中收集2014年1月—2015年12月感染性职业暴露上报数据进行统计分析.结果 2014和2015年每100张床位发生职业暴露人次为5.2和4.9,发生职业暴露的例数降低.乙型肝炎病毒为主要暴露源;暴露中以女性、护士、工作年限小于5年为主,分别占81.8%、52.4%、60.1%;发生地点主要集中于病区、手术间.暴露后立即局部处理、上报以及分别在基线检查、1个月、3个月、6个月及1年进行相关血源性疾病检验及随访的比例明显提高.失访人数明显减少,且集中在实习及进修的医护人员.结论 发生职业暴露后选择恰当检查与预防措施是减少职业感染的保障.

目的 了解医务人员发生职业暴露现状及暴露后的心理变化,及时采取干预治疗措施,保障医务人员身心健康与安全.方法 对医院2012年1月-2014年12月上报的156例血源性职业暴露者,在1个月内进行现状调查;同时,采用美国创伤后应激障碍研究中心行为科学分部制定的PTSD症状调查表(PCL-C),对其暴露者暴露后的心理影响程度进行评估.结果 156例发生职业暴露医务人员中,女性居多,发生率为74.4％;不同医务人员中护士发生率占59.0％,所占比例最高;乙型肝炎是各科室医务人员的首位暴露源;对不同人口社会特征的医务人员暴露源差异性进行比较,不同职业间暴露源的构成存在差异(P=0.048);16.7％的医务人员PCL-C评分在38分以上,存在心理临床症状倾向,需进行干预引导.结论 为预防职业暴露的发生,除全面预防、加强培训,有效预防职业暴露的发生外,还应关注发生暴露后医务人员的心理疏导,及时干预,保障医疗安全.

Objective To know the surgical sites infection and pathogens distribution.Methods By retrospective survey and etiology detection,the surgical incision infections and the distribution of pathogens for patients who underwent surgery were investigated.Results 198 infected among the 62 723 surgical cases during the year 2008 ～ 2010,the hospital infection rate was 0.32%.A total of 215 strains of pathogens were isolated from infection specimens,including Gram-negative bacilli(76.3%),Gram-positive cocci(23.7%) and part of fungus.Conclusion The surgical incision infection rate was in general control range,pathogens form infection specimens were mostly Gram-negative bacilli in the hospital.

Objective Nosocomial infection control weaknesses will help take the appropriate containment measures.Methods A prospective method of investigation,in our hospital from January to December in 2009 for all inpatients survey of 64,285 cases.Results 775 cases of nosocomial infection,hospital infection rate was 1.21%.Hospital infection rates in order were neurosurgery(11.5%),cardiac surgery(6.3%),trauma surgery(2.8%),etc;Respiratory tract infection in hospital infection as the first,constitutes more than 67%.490 isolated pathogens,mainly gram-negative bacteria,accounting for 69.6%.The most common pathogens were Pseudomonas aeruginosa(15.3%),followed by Escherichia coli(15.1%),Klebsiella pneumoniae(14.3%),Acinetobacter baumannii(8.6%),Enterobacter cloacae(6.0 %),MRSA(5.5%),fungi(8.0%);and so on.Conclusion Epidemiological features of nosocomial infection,strengthening the monitoring of key departments goals,take effective interventions to reduce hospital infection rates.

OBJECTIVE To investigate and evaluate the perioperative prophylactic use of antibiotics among patients who underwent coronary artery bypass grafting.METHODS A total of 132 medical records of the discharged patients undergoing coronary artery bypass grafting were randomly collected in 2010,and the situations of antibiotic application during the perioperation period were retrospectively investigated and analyzed.RESULTS Of 132 patients investigated,the rate of prophylactic use of antibiotics was 100.0%,the duration of taking antibiotics was 5-13 days,with an average of 7 days;the timing of medication:the utilization rates were 97.7% 30min before the surgery and 96.7% for the additional use of antibiotics during the operation.CONCLUSION The unreasonable applications of antibiotics during perioperative period include prolonged medication duration,high level of prophylactic antibiotics,and improper choice and timing for application,which need to be further strengthened.

Objective To know the incidence of nosocomial infection in ICU,and to strengthen the hospital infection control measurement.Methods Target monitoring method was used to monitor the incidence of nosocomial infections in ICU from January to March in 2009.Results There were 1 501 patients admitted in 3 months in ICU,63 of patients and 70 cases got nosocomial infection.The nosocomial infections rate was 3.95%,and times/case infection rate was 4.95%.While living in ICU number was 7 236 d.The thousand days infection rate was 8.71‰.The major infection site was lower respiratory tract infection,accounting for 85.71%,the next was urinary tract infection,accounting for 10.0%.Ventilator using,urethral catheterization and vascular catheterization indwelling were the main risk factors for nosocomial infection.Conclusion The respiratory tract infection is the main nosocomial infection in ICU,the variety of intubation is the main risk factor for nosocomial infection.

OBJECTIVE To explore the nosocomial infection status of Ⅰ,Ⅱ Class surgical incision site in the hospital to provide bases for further intervention.METHODS Prospective study and retrospective investigation were taken to research Ⅰ,Ⅱ Class surgical incision site of 15 departments of clinical surgery in hospital in 2009.RESULTS Totally 44 cases occurred nosocomial infection in 8599 cases.The nosocomial infection rate was 0.51%.4 cases occurred to nosocomial infection in 4717 cases of Ⅰ type incision.The infection rate was 0.08%.40 cases occurred nosocomial infectional in 3882 cases of Ⅱ type incision.The infection rate was 1.03%.According to different levels of surgical risk index statistics,there were 2984 cases of 1 score risk index without surgical site infection occurred.22 cases occurred to nosocomial infection in 4053 cases of 2 score risk index.The infection rate was 1.35%.2 cases occurred nosocomial infectional in 77 cases of 3 score risk index.The infection rate was 2.6%.CONCLUSION With the increasing of incision pollution levels and risk index score(including operative time,incision type,and condition assessment of patients ASA),the incidence of nosocomial infection increases.

OBJECTIVE To investigate the occurrence characters of nosocomial infection in intensive care unit(ICU)in order to supply pertinent strategies for the control and prevention.METHODS By using the targeted surveillance,five patients who suffered from nosocomial infection were studied in one hospital from Jan to Dec in 2009.The incidence of nosocomial infection was adjusted by average severity of illness score(ASIS).Meanwhile,the infections associated with three kinds of invasive operation were analyzed and practical methods for prevention and control of nosocomial infection were made.RESULTS The incidence of ventilator associated infection was highest in general ICU(7.5%),urethral catheter associated infection was highest in emergency ICU(4.8%),and blood catheter associated infection was highest in neurosurgery ICU(3.5%).CONCLUSIONS According to the occurrence characters of nosocomial infection,the intervention with pertinence should be performed to decrease the incidence of nosocomial infection.

目的:评价沙丁胺醇氧气雾化吸入(简称氧雾吸入)院前急救支气管哮喘的疗效。方法:在51例支气管哮喘急性发作期患者的院前急救时,常规给予吸氧,建立静脉通道,脱离变应原,继之给予沙丁胺醇氧雾吸入,观察雾化前和雾化后5 m in的症状变化及经皮监测血氧饱和度。结果:本组总有效率90.24%。结论:沙丁胺醇氧雾吸入可作为支气管哮喘,尤其是中度至危重度哮喘患者的首选院前急救措施。

院内下呼吸道感染是常见的医院内感染,其发生率和病死率很高.尤其对于老年人,由于免疫功能低下,又多伴有慢性肺部疾病及其他多脏器病变,且反复使用抗生素,耐药病原菌不断增加,给呼吸道感染的诊治带来更大困难.

胸腔积液患者经X线胸透,CT及穿刺抽液等检查多能确诊,但少数不典型患者经常规内科检查仍不能确诊.为探讨胸腔镜检查诊断原因不明胸腔积液的价值及术前、术中、术后的护理,进行了临床观察,现报告如下.