甲型H1N1流感危重症患儿医院感染控制对策

Prevention and Control Measures of Nosocomial Infection on Emergency and Critical Care Children with Influenza A H1N1

目的了解甲型H1N1流感危重症患儿发生医院感染的危险因素,提高临床医护人员对医院感染控制的认识。方法采用描述性流行病学方法,对医院2009年10月收治确诊的14例甲型H1N1流感危重症患儿资料进行回顾性分析。结果 14例甲型H1N1流感危重症患儿发生医院感染6例,为深部真菌感染;从发病到住院间隔时间最短1 d,最长15 d,平均4.1 d;主要临床表现为发热11例、呼吸困难14例,咳嗽12例;合并症的发生率为100.0%,主要为肺炎10例,Ⅰ型呼吸衰竭10例,多脏器功能不全8例;患儿抵抗力差、复合感染多、合并症多、大量使用抗菌药物、环境因素、使用有创呼吸机、静脉置管等侵入性操作均是发生医院感染的危险因素。结论甲型H1N1流感危重症患儿易感因素多,很容易造成医院感染的发生,应引起医护人员的高度重视。

OBJECTIVE To understand the risk factors of nosocomial infection and clinical characteristics of influenza A H1N1 on children′s patients and improve the strategies for prevention of nosocomial infection for medical staff.METHODS The epidemiological information and clinical characteristics of 14 patients with influenza A H1N1 hospitalized in our hospital from Oct to Dec in 2009 were analyzed retrospectively by descriptive epidemiology.RESULTS There were 8 boys and 6 girls in this group.The range of age was from 27 days to 11 years.Six children were infected by fungus.The most frequently reported symptoms were fever in 11 cases,cough in 12 cases,and dyspnea in 14 cases.The incidence rate of complications was 100% and the main complication were pneumonia in 10 cases,type 1 respiratory failure in 10 cases,and multiple organ dysfunction syndrome in 8 cases.The risk factors were weak immunity,complicated infections,long-time use of broad spectrum antibiotics,hormones,invasive operations,and so on.Physical signs included throat congestion,swelling of tonsil,etc.The number of leukocytes in the peripheral blood was normal or low.CD3 T lymphocyte count was lower than normal in some cases.Abnormal appearance of chest X-ray and computerized tomography（CT） included increased bronchovascular shadows,pneumonia,pleural thickening and pleurisy.The prognosis was good and the most patients recovered.CONCLUSION We should pay attention to nosocomial infections and take effective and early intervention measures to prevent them.