住院患者多重耐药菌感染情况的分析及护理对策

Analysis and Nursing Strategy of Multi-durg Resistant Infections of Inpatients

目的调查住院患者多重耐药菌(multiple resistant bacteria,MRB)感染情况并提出护理防控措施。方法对2008-2009年住院患者中出现MRB感染的病例进行全程追踪调查,搜集2年以来MRB感染患者的一般资料、病原菌的种类、感染发生部位、科室来源及标本种类。结果 2008、2009年MRB感染患者分别为6例和18例。2008年的感染患者均来自内科,分离标本主要以痰标本为主,病原菌以产生超广谱β-内酰胺酶的铜绿假单胞菌及肺炎克雷伯菌多见,感染部位以下呼吸道为主。2009年的大部分感染患者来自内科,来自外科的患者仅有3例,分离标本以痰标本和尿标本为主,其病原菌以产生超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌多见,感染部位以下呼吸道和泌尿道为主。结论加强MRB感染患者的监测,切实落实消毒隔离措施,认真执行标准预防和手卫生规范,加强抗菌药物的合理应用,对患者的康复及交叉感染的控制起着举足轻重的作用。

Objective To investigate the infections of multiple resistant bacteria（MRB）of inpatients so as to propose health care prevention and control measures.Methods Investigation of the entire process of MRB infections was conducted in inpatients from 2008 to 2009 to collect the demographic data,the type of pathogen,the infection site,the department sources and types of specimens of MRB infections.Results MRB infections were found in 6 cases in 2008 and 18 cases in 2009.The patients in 2008 were all from the department of internal medicine with the segregation sample of sputum.Pseudomonas aeruginosa and Klebsiella pneumoniae which produced ultra-wide common β-lactamases（ESBLs）were the most common pathogens mainly in respiratory tract.The patients in 2009 were mainly from the department of internal medicine except 3 surgical patients.Escherichia coli and Klebsiella pneumoniae which produced ESBLs were the most common pathogenic bacteria mainly in lower respiratory tract and urinary tract.Conclusion The keys to control cross infection and promote the patient＇s rehabilitation lie in strengthening the monitoring of multi-drug resistant infections,effectively accomplishing disinfection and isolation measures,implementing standard precautions and careful hand hygiene practices and strengthening rational use of antibiotics.