胸外科病房医院感染监测分析及护理

Nosocomial infection in thoracic surgery ward:monitoring and nursing

目的了解胸外科病房医院感染分布及相关因素,采取控制措施。方法对2008年1-12月收治的患者进行重点监测,采取前瞻性和回顾性调查的方法,感染科专职人员参加科内查房,查看住院病历,发现问题,讨论解决方法,对疑有感染者及时送标本细菌培养与药敏试验,进一步采取有效的治疗预防措施。结果监测病例619例,感染病例46例,感染率7.43%,感染部位以下呼吸道为主,占76.09%,手术患者下呼吸道感染率为13.66%;病原菌以革兰阴性菌占首位66.67%,革兰阳性菌为14.10%,真菌为19.23%,其中铜绿假单胞菌最多。结论麻醉气管插管、基础疾病、老年体弱呼吸功能差、咳嗽乏力排痰不畅是引起肺部感染的主要原因,通过加强呼吸功能训练,促进咳嗽、排痰、加强消毒灭菌,合理使用抗菌药物,使感染率下降。

OBJECTIVE To understand the distribution and related factors of nosocomial infection in thoracic surgery ward and take control measures. METHODS From Jan to Dec of 2008, patients were investigated retrospectively. The full-time staff of infectious disease were participated in the section rounds and patient medical records were viewed. The problems were identified and the solution was discussed. For the suspected infected persons, the samples of bacterial culture were sended in time and the sensitivity test was performed, further effective treatment was taken for preventive measures. RESULTS Among the monitored 619 cases, 46 cases were with infection, the infection rate was 7. 43%, lower respiratory tract was the major infection site with 76.09%, lower respiratory tract infection rate of surgical patients was 13.66%. Among the pathogens the Gram-negative bacteria accounted for 66. 67%, ranking the first, Gram-positive bacteria was 14. 10%, fungi was 19. 23%, Pseudomonas aeruginosa was the most. CONCLUSION Anesthesia endotracheal intubation, basic disease, the frail elderly poor respiratory function, weak cough and expectoration weakness are the main reasons to cause lung infections. Through strengthening the respiratory function training to promote the cough and expectoration, the disinfection and sterilization should be strengthened, and antibacterial drugs are applied rationally to reduce the infection rate.