Is every microorganism detected in the intensive care unit a nosocomial infection?Isn’t prevention more important than detection?

The present letter to the editor is related to the study entitled“Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors.”Not every microorganism grown in samples taken from critically ill patients can be considered as an infectious agent.Accurate and adequate information about nosocomial infections is essential in introducing effective prevention programs in hospitals.Therefore,the development and implementation of care bundles for frequently used medical devices and invasive treatment devices(e.g.,intravenous catheters and invasive ventilation),adequate staffing not only for physicians,nurses,and other medical staff but also for housekeeping staff,and infection surveillance and motivational feedback are key points of infection prevention in the intensive care unit.

Healthcare Associated Infection in the Neonatal Intensive Care Unit of King Abdl Aziz Specialist Hospital, Taif, KSA

Healthcare-associated infection is a common problem of newborn in neonatal intensive care units. It results in high mortality rate and serious complications. The Aim: to assess the incidence, etiology and the mortality of healthcareassociated infections of patients in neonatal intensive care unit at King Abdl Aziz Specialist Hospital (KAASH), Taif, Kingdom of Saudi Arabia. Material and Methods: This is a retrospective study including 8033 neonates admitted to neonatal intensive care unit during period between April, 2006 and December, 2012. The health-care associated infection rate, mortality rate, causative organism and risk factors were studied. Results: The prevalence of health-care associated infection was found to be 6.03%;the mortality rate was 27.1%. The highest prevalence was among children with the birth weight below 1000 g. The most frequent causative pathogen was klebseilla spp, followed by other gram negative bacilli. Conclusion: The rate of healthcare-associated infections in neonatal intensive care unit at KAASH was relatively high. In addition, the mortality rate was observed to be high (27.1%) owing to the high virulence of the causative organisms.

Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care

AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous exposure to fluoroquinolones(OR=9.29;95%CI:1.16-74.284,P=0.036)were independently associated with severe CDI.CONCLUSION:We report predictors of severe CDI not dependent on time of assessment.Such factors could help in the development of a quantitative score in ICU’s patients.

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Infection management strategy based on prevention and control of nosocomial infections in intensive care units

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection,which is clinical problem often faced by intensive care units (ICU) doctors.Without positive treatment,the incidence and mortality of sepsis are high.^[1]As hospital infection control plays an essential role in treating the nosocomial infections in the ICU,and according to the clinical presentation of critically ill patients,the biological characteristics of pathogenic microorganisms and the ICU environment,this article put forward a strategy for the nosocomial infections in the ICU.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Clinical characteristics and outcomes of nosocomial COVID-19 in Turkey:A retrospective multicenter study

Objective:To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey.Methods:COVID-19 patients followed in the pandemic services across Turkey between January 1,2021,and March 31,2022 were investigated retrospectively.Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19≥5 days after hospital admission.The primary outcome of this study was in-hospital mortality;demographic features and vaccination status was compared between survivors and non-survivors.Results:During the study period,15573 COVID-19 patients were followed in 18 centers and 543(3.5%)patients were nosocomial COVID-19.Most patients with nosocomial COVID-19(80.4%)were transferred from medical wards.162(29.8%)of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138(25.4%)of the patients died during hospital stay.Advanced age(≥65 years)and number of comorbid diseases(≥2)was found to be associated with mortality in nosocomial COVID-19(OR 1.74,95%CI 1.11-2.74 and OR 1.60,95%CI 1.02-2.56,respectively).Vaccination was associated with survival in nosocomial COVID-19(OR 0.25,95%CI 0.16-0.38).Conclusions:Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate.Vaccination can decrease the in-hospital mortality rate.

Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana

Background: Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital. Methods: A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050® machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via tuf gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2. Results: Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of the CoNS, S. haemolyticus and S. epidermidis were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. Conclusions: These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.

基于风险管理方案预防NICU患儿院内感染的应用与分析

目的:探讨基于风险管理方案在预防新生儿重症监护室(NICU)患儿院内感染中的应用价值。方法:选取2022年6月-2023年6月本院NICU收治的134例患儿为对象。以2022年6月-12月入组的67例患儿为对照组,以2023年1月-6月入组的67例患儿为观察组。对照组采用常规管理,观察组采用风险管理方案。比较两组院内感染发生率、卫生合格率及满意度。结果:对照组NICU院内感染发生率为10.45%(7/67),高于观察组的1.49%(1/67)(P <0.05)。观察组空气质量、病区卫生、医护人员手部卫生合格率高于对照组(P <0.05)。观察组配奶间设施、洗浴间设施、诊疗设备、监测仪器消毒合格率均高于对照组(P <0.05)。观察组住院及抗生素应用时间短于对照组(P <0.05)。观察组家属对管理的满意度为97.01%,高于对照组的82.09%(P <0.05)。结论:风险管理方案用于NICU,可降低院内感染发生率,提高卫生设施、医用物品消毒合格率及患儿家属的满意度,缩短患儿住院时间。

NICU院内感染病原菌流行分布情况及其耐药性变迁

目的研究NICU近年院内感染病原菌的流行分布情况及耐药性的变迁,为临床合理用药提供理论依据。方法回顾性分析2006年1月至2008年6月NICU住院的2596例患儿,对1474例疑合并有院内感染患儿分别采集下呼吸道分泌物、血液、尿和粪便等进行培养。结果414例患儿4060份标本共分离出病原菌622株,阳性率为15.32%(622/4060),平均院内感染率为15.95%(414/2596),其中2006年为10.18%(91/894)、2007年为18.64%(205/1100)和2008年上半年为19.60%(118/602)。2006年前3位的病原菌为葡萄球菌、铜绿假单胞菌、克雷伯杆菌和链球菌(并列第三);2007年为真菌、葡萄球菌和肠球菌;2008年上半年为真菌、克雷伯杆菌和葡萄球菌。下呼吸道院内感染病原菌前3位,2006年为铜绿假单胞菌、葡萄球菌和嗜麦芽黄单胞菌;2007年为真菌、铜绿假单胞菌和链球菌;2008年上半年为克雷伯杆菌、嗜麦芽黄单胞菌和铜绿假单胞菌。细菌耐药情况:阳性菌对克林霉素、头孢唑啉和青霉素G的耐药性较高,而对万古霉素、替考拉宁和利奈唑胺敏感性高;革兰阴性杆菌对头胞第二、三代抗生素耐药性高,但对碳青霉烯类和氨基糖苷类抗生素敏感。结论院内感染的发生率逐年增加,病原菌谱不断改变,特别是真菌目前占居首位,但病原菌的耐药性变迁不大。

NICU导管相关感染现状调查分析

目的调查分析新生儿重症监护病房医疗装置导管相关感染的发生率、危险因素及病原菌的分布特点。方法收集2002年1月-2007年12月248例入住中山大学附属第一医院NICU,并接受气管插管及经外周置入中心静脉导管患儿的临床资料,分析导管装置相关感染发生的百分率和导管相关感染的感染率、病原菌种类和特点。结果248例患儿中,侵入性操作相关感染141例次(56.9%);发生呼吸机相关肺炎感染率为66.9%或64.9/1000通气日,导管相关血源感染为7.7%或5.8/1000置管日。置管时间和多种侵入性操作是导管相关感染的独立危险因素。导管相关感染的病原菌以耐甲氧西林凝固酶阴性葡萄球菌为主(占29.4%),其次分别为肺炎克雷伯杆菌(14.7%,ESBL为主)、铜绿假单胞菌(8.6%)、金黄色葡萄球菌(8.0%)、阴沟肠杆菌(8.0%)。结论NICU导管相关感染尤其是呼吸机相关肺炎的感染率高,病原菌多为耐药菌,需采取有效的干预措施进一步降低院内感染的发生率。

NICU环境卫生监测及医院感染的多中心现况调查

目的 了解NICU环境卫生监测及医院感染的现况,为NICU医院感染管理和控制提供依据。方法 选取7所综合性儿童医院NICU进行为期6个月的医院环境监测、医务人员手卫生依从性调查及医院感染病例监测。结果 各医院NICU常规环境卫生监测合格率为98.87%,医院呼吸机相关性肺炎和中心静脉导管相关性血流感染的平均发生率分别为3.78‰和1.63‰,医院感染发生率与常规环境卫生监测合格率没有相关性。医务人员手卫生依从性为51.56%~67.19%。结论 NICU医院感染应更注重目标监测,医护人员的手卫生依从性有待加强,多中心调查可为全国范围内NICU医院感染管理和控制提供依据。

具体标识法在改善NICU医疗废物混放中的效果

目的探讨具体标识法在改善新生儿重症监护病房(NICU)医疗废物混放中的效果。方法收集2014年7—12月某院NICU病房内34个垃圾桶医疗废物分类情况,7—9月为具体标识法实施前期,10—12月为实施后期,比较实施前后医疗废物混放分类情况。结果共调查NICU病房内504例医疗废物分类情况,具体标识法实施前后各252例,共发现混放现象74例。具体标识法实施前废物混放率(25.40%,64/252)高于实施后(3.97%,10/252),差异有统计学意义(χ2=46.187,P<0.001);具体标识法实施前感染性废物放入非感染性废物、非感染性废物放入感染性废物者共57例,实施后仅为8例。医疗废物混放人员分布主要以进修与实习生为主,实施前后分别占39.06%、50.00%。结论具体标识法规范化管理医疗废物,能改善NICU医疗废物分类情况,同时提高各类医务人员规范处理医疗废物的依从性。

NICU医院感染及其防治

医院感染是新生儿科临床诊治和疾病管理中的难题,新生儿重症监护室(NICU)是医院感染的高危场所,不同年代、不同国家和地区NICU医院感染临床特点不尽相同。建议通过加强手卫生,合理使用抗生素,控制高危因素,有效控制NICU医院感染,提高危重新生儿救治水平。

知情权与新生儿重症监护病房(NICU)患儿父母的信息交流技巧

在新生儿重症监护病房 (neonatalintensivecareunit ,NICU)中接受治疗的危重新生儿约 90 %结果良好 ,而这些患儿的父母 10 0 %都在此过程中遭受不同程度的心理创伤。患儿父母及其家人应被充分告知患儿的病情、治疗方案及可能的预后 ,这是他们拥有的知情权。在临床工作中 ,怎样运用良好的信息交流技巧让患儿父母充分理解病情、配合治疗又不过分紧张这对患儿的康复比对患儿实施具体的诊疗方案更重要。从患儿父母、医护人员、人文关怀的角度探讨NICU医护人员与患儿父母之间信息交流的技巧。

353例NICU患儿自动听性脑干反应结果分析

目的探讨新生儿重症监护病房(neonatal intensive care unit,NICU)听力筛查模式及容易导致听力损失的高危因素。方法运用自动听性脑干反应(automatic auditory brainstemresponse,AABR)对353例(706耳)重症监护病房的新生儿进行初步听力筛查,随机抽样109例(218耳)正常新生儿为对照组,对比分析不同高危因素对筛查结果的影响。结果筛查NICU患儿353例(706耳),初筛未通过184例(281耳),初筛阳性率39.8%(281/706);筛查正常新生儿组109例(218耳),初筛未通过23例(27耳),初筛阳性率为12.4%(27/218),两组初筛阳性率差异有显著统计学意义(P=0.000),NICU的新生儿听力筛查初筛阳性率远高于正常新生儿。NICU新生儿不同疾病的初筛阳性率分别为:新生儿窒息46.4%,新生儿肺炎45.9%,高胆红素血症38.8%,早产儿38.1%,足月小样儿35.0%,其他34.0%。结论应用AABR技术进行听力筛查是可行的。在NICU中普及听力筛查,并对这些患儿随访、复筛,及时发现其听力损失,是提高新生儿听力损失早期诊断率的重要手段。

AABR和DPOAE联合筛查在NICU新生儿听力筛查中的应用

目的运用自动听性脑干反应（AABR）和畸变产物耳声发射（DPOAE）技术在NICU新生儿中开展听力筛查，获得NICU新生儿听力筛查阳性率，并探索NICU新生儿听力筛查阳性率的影响因素。方法筛查对象为2010年7月～2015年5月首都医科大学附属北京儿童医院NICU收治的2353例新生儿，全部采用AABR和DPOAE进行新生儿听力筛查并计算阳性率。同时采集新生儿及其母亲孕期相关因素，分析资料完整的2095例NICU新生儿听力筛查阳性率及其潜在影响因素。结果AABR左耳和右耳筛查阳性率分别为28．59％和26．73％，DPOAE左耳和右耳筛查阳性率分别为26．01％和22．63％，分析显示左右耳（x^2=0．706，P=0．401）和两种不同筛查技术（x^2=1．540，P=0．215）间阳性率均无显著差异。不同性别的新生儿筛查阳性率无显著性差异（x^2=2．89，P=0．089）。x^2检验显示伴有感染、高胆红素血症、窒息、低体重、早产、发育迟缓和多胞胎因素的NICU新生儿听力筛查阳性率显著高于不伴有上述因素的新生儿。结论感染、窒息、高胆素血症可能为NICU新生儿听力筛查呈阳性的危险因素。

发育支持护理对NICU极低出生体重儿降低院内感染的效果评价研究

目的发育支持护理降低住新生儿重症监护室(NICU)极低出生体重儿(VLBW)院内感染的效果。方法选取2015年3月-2016年3月我院NICU收治的VLBW患儿94例,随机分为对照组与研究组,各47例。对照组予以常规护理,观察组加用发育支持护理,对比两组院内感染发生率。结果研究组的达到足量喂养时间、恢复出生体重时间及静脉营养时间均较对照组短(P<0.05);研究组的喂养不耐受率及院内感染发生率分别为10.64%、2.13%,均低于对照组的27.66%、10.64%(P<0.05)。结论对NICU收治VLBW行发育支持护理能够降低院内感染发生率,提高生存质量。

NICU早产儿侵袭性真菌感染情况调查与防控对策

目的探讨早产儿侵袭性真菌感染的状况和相关因素,以控制其感染。方法对新生儿重症监护室的1 146例早产儿采用回顾性调查。结果66例早产儿发生了侵袭性真菌感染,感染率5.76%。早产儿侵袭性真菌感染的基本情况:胎龄、出生体重、母亲有合并症、窒息、机械通气、胃肠外营养、应用广谱抗生素、住院时间长等相关因素明显增加了早产儿侵袭性真菌感染的机会,差异有显著意义。结论早产儿侵袭性真菌感染的相关因素多,应采取及时有效的干预措施,以降低其发生率。

健康宣教及护理配合在NICU新生儿听力筛查中的应用观察

目的观察健康宣教及护理配合对提高新生儿重症监护室(NICU)新生儿听力筛查通过率和复筛率的效果。方法我院2013年加强了NICU新生儿听力筛查的护理力度和健康宣教,采用历史对照研究,比较2013年和2012年NICU新生儿听力筛查初筛未通过率、初筛未通过患儿复筛率、最终听力检测率。结果 2013年NICU新生儿初筛未通过率为13.17%,低于2012年,未通过患儿复筛率为84.06%,高于2012年,最终听力检测率为89.47%,高于2012年(P<0.05);2013年最终检出听力损失11例,检出率占64.71%,明显高于2012年(P<0.05)。2013年NICU新生儿窒息、高胆红素血症听力筛查通过率较2012年有明显提高(P<0.05)。结论 NICU新生儿听力损伤发生率较高,是听力筛查的重点。加强健康宣教,把握筛查时机及护理配合可提高通过率和未通过患儿复筛率,使听力障碍患儿得到及时治疗。