5.12汶川大地震伤员气性坏疽预防医院感染应急预案及应用研究

Schemes prepared for urgent condition and its application for preventing nosocomial infection of gas gangrene in 5.12 Wenchuan earthquake victims

目的早期发现地震伤特殊病原菌感染隐患，预防气性坏疽引起的医院感染。方法①建立预防气性坏疽感染预防预案及工作流程；②感控人员在收治地震伤伤员一线采用现场查看伤口、快速微生物涂片方法，对地震伤员进行气性坏疽感染的分诊和排查，排查重点是开放性伤口、四肢伤口、污染较重伤口、深部伤口；④指导建立特殊感染性疾病清创室、手术室、换药室、病房；④督促确诊伤员即刻送入特殊感染疾病区进行治疗；现场开展对医务人员预案和工作流程的培训和指导。结果2008年5月12～29日，排查开放性伤口237例，确诊为气性坏疽感染患者20侧，治愈19例，死亡1倒。无1例气性坏疽二代感染发生、结论保持对地震后特殊病原菌感染高度的警惕性，及时制订切实可行并启动预防气性坏疽感染的应急预案及工作流程，对早期发现气性坏疽患者。

Objective To early find out specific pathogenic bacteria infection dangers and prevent nosocomial infecfion caused by gas gangrene. Methods ①Establish the protocols of preventing gas gangrene infection and practical procedures. ②Assign medical staff to the scene of earthquake to determine and triage the wounded by inspecting wounds and swift microorgan- ism smear. Attention should especially be paid to open wounds, extremity wounds, severely polluted and deep wounds. ③Set up debriding, operating, dressing rooms and wards for specific infections. ④Supervise the referral of definitely-diagnosed victims into the specific infection area for treatment. Conduct training and guidance about the scheme and practice on the scene. Results During the period of May 12 -29, 2008, 237 open wounds were observed and 20 cases were diagnosed as gas gangrene. Among the 20 cases, 19 healed, 1 died, and no reinfection occurred in all the cases. Conclusion In order to early detect gas gangrene patients and prevent nosocomial infection, it is essential to keep a high vigilance on specific pathogenic bacteria infection after earthquake, work out schemes timely for preventing gas gangrene and put it into practiee.