地震伤员开放性伤口感染相关因素及目标监测

Target monitoring and relative factors of open wound infection of earthquake casualty

目的了解5.12汶川大地震伤员四肢开放性伤口感染情况,分析感染相关因素,为预防和控制感染提供依据。方法感控办专业人员每天进入收治地震伤员科室,通过对伤员伤口查看、症状体征观察、参加医生护士查房、查阅微生物检验报告及病历资料,对地震伤员开放性四肢伤口感染相关因素进行调查及目标监测。结果共监测165例伤员,发现伤口感染66例40.0%(66/165)。从年龄、损伤情况、伤口个数分析:>60岁伤员感染率高于<60岁伤员;有骨折伤员感染率高于无骨折伤员;有>2个创口感染率高于一个创口感染率,P<0.05。感染病原菌:芽胞杆菌感染20例;多重耐药菌感染28例;其它病原菌感染18例。其中多重(>2种)病原菌感染占47.0%;引起伤口感染的细菌以鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌主等阴性杆菌为主。结论及时对地震伤员四肢开放性伤口进行感染目标监测,能早期识别特殊病原菌、及时发现耐药菌感染,对降低继发性损害具有重要意义。

Objective To investigate the condition of open wound infection of 5.12 Wenchuan earthquake casualty and analysis the relative factors of infection, in order to provide evidence for preventing and controlling infection. Methods Professionals of department of Hospital Infection Management went to the department which the earthquake casualty stayed in to monitor and investigate the relative factors of open wound infection by observing the wounds,symptoms and signs of the wounded, taking part in ward round of doctors and nurses and consulting the reports of microorganism checking and medical record. Results 165 wounded person wore monitored. In those, there were 66 cases（40.0% ） undergoing wounld infection. Analysis from the aspects of age, injuring condition and wound numbers,the infective rates of the wounds upon 60 yeras old,with fractures and more than two wounds were respectively higher than those under 60 years old; without fractures and only one wound （P 〈 0.05 ）. Infective pathogen： bacillus 20 cases, multi-drug resistant bacteria 28 cases,other pathogen 18 cases. There were 47% cases were multi-pathogen infection. The main bacterium of wound infection were banman acinetobacter, enterobacter cloacae, eacherichia coll. Conclusion It has the importsnt significance to reduce secondary injury by identifying special pathogen early and fingding out drug resistant bacteria in time that taking target monitoring to open wound infection of earthquake casualty.