重症医学科医院感染现状及其风险评估研究进展
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摘要
重症监护病房(ICU)医院感染发生率是普通病房的2～5倍,且绝大部分是由多重耐药革兰阴性杆菌引起,患者基础疾病严重、免疫力低下、侵入性操作多、抗菌药物使用频繁是引起感染的主要危险因素。利用风险评估模型预测ICU患者医院感染发生的风险并据此做出前瞻性防控,可有效降低医院感染发生率,并提高工作效率。但是目前缺乏关于ICU医院感染风险评估的系统化、科学化研究,本文就重症医学科医院感染现状及其风险评估研究进展作一综述。
The incidence of nosocomial infection in intensive care unit(ICU)is 2-5 times higher than that in general wards,and most of them are caused by multidrug-resistant gram-negative bacilli.Severe underlying diseases,low immunity,more invasive procedures and frequent use of antibiotics are the main risk factors for infection.Using the risk assessment model to predict the risk of nosocomial infection in ICU patients and make forward-looking prevention and control accordingly can effectively reduce the incidence of nosocomial infection and improve work efficiency.However,there is a lack of systematic and scientific research on risk assessment of ICU nosocomial infection.This paper reviews the current status of nosocomial infection in intensive care unit and research progress of its risk assessment.
The incidence of nosocomial infection in intensive care unit(ICU)is 2-5 times higher than that in general wards,and most of them are caused by multidrug-resistant gram-negative bacilli.Severe underlying diseases,low immunity,more invasive procedures and frequent use of antibiotics are the main risk factors for infection.Using the risk assessment model to predict the risk of nosocomial infection in ICU patients and make forward-looking prevention and control accordingly can effectively reduce the incidence of nosocomial infection and improve work efficiency.However,there is a lack of systematic and scientific research on risk assessment of ICU nosocomial infection.This paper reviews the current status of nosocomial infection in intensive care unit and research progress of its risk assessment.
引文
[1]李六亿,徐艳,贾建侠,等.医院感染管理的风险评估分析[J].中华医院感染学杂志,2016,26(11):2607-2610.
[2]徐艳,杨怀,张曼,等.外科系统医院感染管理的风险评估研究[J].中华医院感染学杂志,2017,27(8):1890-1892.
[3]李六亿,徐艳.医院感染管理的风险评估[J].中国感染控制杂志,2016,15(7):441-446.
[4]Rausand M.Risk assessment theory,methods,and applications[M].John Wiley&Sons,Inc,2011:1-10.
[5]周春莲,陈惠清,王世英,等.某三级医院医院感染风险评估[J].中华医院感染学杂志,2015,25(2):360-362.
[6]邓琼,何思云,余奇,等.综合性医院医院感染风险评估方法构建[J].中国消毒学杂志,2017,34(12):1164-1166.
[7]Chacko B,Thomas K,David T,et al.Attributable cost of a nosocomial infection in the intensive care unit:aprospective cohort study[J].World J Crit Care Med,2017,6(1):79-84.
[8]朱英,刘世英,刘珍秀.重症监护病房并发医院感染现状及危险因素分析[J].中国老年医学杂志,2017,37(16):4079-4080.
[9]史文昕,史文晶,李会峰,等.重症监护病房医院感染目标性监测分析[J].中国全科医学,2012,15(19):2231-2232.
[10]Viderman D,Khamzina Y,Kaligozhin Z,et al.An observational case study of hospital associated infections in a critical care unit in Astana,Kazakhstan[J].Antimicrob Resist Infect Control,2018,7:57.
[11]Yetkin F,Yakupogullari Y,Kuzucu C,et al.Pathogens of intensive care unit-acquired infections and their antimicrobial resistance:a 9-year analysis of data from a university hospital[J],Jundishapur J Microbiol,2018,11(10):e67716.
[12]Jean SS,Hsueh PR.High burden of antimicrobial resistance in Asia[J].Int J Antimicrob Agents,2011,37(4):291-295.
[13]徐晓芸,潘金波.重症监护病房鲍曼不动杆菌的感染现状及耐药分析[J].中国医药导报,2015,12(8):135-138,142.
[14]郭勇,薛杨勇,唐建国.重症监护病房鲍曼不动杆菌感染[J].中国感染与化疗杂志杂志,2014,14(2):172-175.
[15]Tsakiridou E,Mega AM,Zakynthinos E,et al.Pre-intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator-associated pneumonia[J].Clin Respir J,2018,12(10):2497-2504.
[16]Seki M,Machida H,Yamagishi Y,et al.Nosocomial outbreak of multidrug-resistant Pseudomonas aeruginosa caused by damaged transesophageal echocardiogram probe used in cardiovascular surgical operations[J].J Infect Chemother,2013,19(4):677-681.
[17]Das S,Rai G,Tigga RA,et al.Candida auris in critically ill patients:emerging threat in intensive care unit of hospitals[J].J Mycol Med,2018,28(3):514-518.
[18]Zurita J,Mejia L,Zapata S,et al.Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash[J].Int J Infect Dis,2014,29:96-99.
[19]刘先玲,程桂娥,胡祖圣,等.重症医学科医院感染目标性监测分析[J].中华医院感染学杂志,2016,26(22):5232-5234.
[20]何祖光,危群华,邓峥.ICU患者革兰阴性杆菌感染现状及耐药性[J].实验与检验医学,2014,32(1):96-97.
[21]黎亚琼,王晓东,何本珍,等.消毒供应中心质量管理与医院感染的相关研究[J].现代生物医学进展,2014,14(20):3928-3930.
[22]Finco G,Musu M,Landoni G,et al.Healthcare-associated respiratory infections in intensive care unit can be reduced by a hand giene program:a multicenter study[J].Australian Critical Care,2017,31(6):340-346.
[23]Kiser C,Nawab U,McKenna K,et al.Role of guidelines on length of therapy in chorioamnionitis and neonatal sepsis[J].Pediatrics,2014,133(6):992-998.
[24]梁海峰,刘晨霞,王书会,等.ICU住院患者耐药菌感染现状分析[J].齐鲁护理杂志,2017,23(19):43-45.
[25]Neuville M,El-Helali N,Magalhaes E,et al.Systematic overdosing of oxa and cloxacillin in severe infections treated in ICU:risk factors and side effects[OL].Ann Intensive Care,2017,7(1):34.
[26]欧阳育琪,向阳.风险评估在医院感染控制中的应用现状与展望[J].实用预防医学,2017,24(10):1277-1280.
[27]李洋,杜蕾,张立超,等.FMEA法在医疗风险管理中的应用现状与展望[J].中国医院管理,2014,34(9):36-37.
[28]Joint Commission International.Joint commission international accreditation standards for hospital[M].5th Edition.Department of Publication of Joint Commission Resources.IL.USA,2014:267-268.
[29]Duwe B,Fuchs BD,Hansen-Flaschen J.Failure mode andeffects analysis application to critical care medicine[J].Crit Care Clin,2005,21(1):21-30.
[30]关心,任慧,潘宇,等.基于logistic回归分析的医院感染风险评估模型应用研究[J].中国医院管理,2018,38(10):54-56.
[31]Song JY,Jeong IS.Development of a risk prediction model of carbapenem-resistant Enterobacteriaceae colonization among patients in intensive care units[J].Am J Infect Control,2018,46(11):1240-1244.
[32]Becker CD,Bowers C,Chandy D,et al.Low risk monitoring in neurocritical care[OL].Front Neurol,2018,9:938.
[33]徐妍,张扬,黄永彬.TISS评分与护理分层管理在ICU护理管理中的协同效应[J].护理研究,2018,32(19):3134-3136.
[34]沈忠明,张敏莉,朱莎,等.APACHEⅡ评分在专科ICU危重产科患者病情评估中的应用价值[J].云南医药,2018,39(5):399-403.
[35]吴梅霞,宋巧云,翟培峰,等.基于失效模式与效应分析降低导管室医院感染风险[J].解放军医院管理杂志,2018(9):828-830.
[36]黄菊,杨坚娥,肖瑜,等.基于FMEA法的医院感染预防与控制风险评估[J].中国医药导报,2016,13(4):156-159.
[37]陈萍,王燕,段晓菲,等.风险评估在传染病医院外科医院感染控制中的应用[J].华西医学,2017,32(3):339-343.
[38]赵霞,王力红,张京利,等.ICU医院感染风险评估[J].中华医院感染学杂志,2013,23(20):5016-5017,5053.
[2]徐艳,杨怀,张曼,等.外科系统医院感染管理的风险评估研究[J].中华医院感染学杂志,2017,27(8):1890-1892.
[3]李六亿,徐艳.医院感染管理的风险评估[J].中国感染控制杂志,2016,15(7):441-446.
[4]Rausand M.Risk assessment theory,methods,and applications[M].John Wiley&Sons,Inc,2011:1-10.
[5]周春莲,陈惠清,王世英,等.某三级医院医院感染风险评估[J].中华医院感染学杂志,2015,25(2):360-362.
[6]邓琼,何思云,余奇,等.综合性医院医院感染风险评估方法构建[J].中国消毒学杂志,2017,34(12):1164-1166.
[7]Chacko B,Thomas K,David T,et al.Attributable cost of a nosocomial infection in the intensive care unit:aprospective cohort study[J].World J Crit Care Med,2017,6(1):79-84.
[8]朱英,刘世英,刘珍秀.重症监护病房并发医院感染现状及危险因素分析[J].中国老年医学杂志,2017,37(16):4079-4080.
[9]史文昕,史文晶,李会峰,等.重症监护病房医院感染目标性监测分析[J].中国全科医学,2012,15(19):2231-2232.
[10]Viderman D,Khamzina Y,Kaligozhin Z,et al.An observational case study of hospital associated infections in a critical care unit in Astana,Kazakhstan[J].Antimicrob Resist Infect Control,2018,7:57.
[11]Yetkin F,Yakupogullari Y,Kuzucu C,et al.Pathogens of intensive care unit-acquired infections and their antimicrobial resistance:a 9-year analysis of data from a university hospital[J],Jundishapur J Microbiol,2018,11(10):e67716.
[12]Jean SS,Hsueh PR.High burden of antimicrobial resistance in Asia[J].Int J Antimicrob Agents,2011,37(4):291-295.
[13]徐晓芸,潘金波.重症监护病房鲍曼不动杆菌的感染现状及耐药分析[J].中国医药导报,2015,12(8):135-138,142.
[14]郭勇,薛杨勇,唐建国.重症监护病房鲍曼不动杆菌感染[J].中国感染与化疗杂志杂志,2014,14(2):172-175.
[15]Tsakiridou E,Mega AM,Zakynthinos E,et al.Pre-intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator-associated pneumonia[J].Clin Respir J,2018,12(10):2497-2504.
[16]Seki M,Machida H,Yamagishi Y,et al.Nosocomial outbreak of multidrug-resistant Pseudomonas aeruginosa caused by damaged transesophageal echocardiogram probe used in cardiovascular surgical operations[J].J Infect Chemother,2013,19(4):677-681.
[17]Das S,Rai G,Tigga RA,et al.Candida auris in critically ill patients:emerging threat in intensive care unit of hospitals[J].J Mycol Med,2018,28(3):514-518.
[18]Zurita J,Mejia L,Zapata S,et al.Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash[J].Int J Infect Dis,2014,29:96-99.
[19]刘先玲,程桂娥,胡祖圣,等.重症医学科医院感染目标性监测分析[J].中华医院感染学杂志,2016,26(22):5232-5234.
[20]何祖光,危群华,邓峥.ICU患者革兰阴性杆菌感染现状及耐药性[J].实验与检验医学,2014,32(1):96-97.
[21]黎亚琼,王晓东,何本珍,等.消毒供应中心质量管理与医院感染的相关研究[J].现代生物医学进展,2014,14(20):3928-3930.
[22]Finco G,Musu M,Landoni G,et al.Healthcare-associated respiratory infections in intensive care unit can be reduced by a hand giene program:a multicenter study[J].Australian Critical Care,2017,31(6):340-346.
[23]Kiser C,Nawab U,McKenna K,et al.Role of guidelines on length of therapy in chorioamnionitis and neonatal sepsis[J].Pediatrics,2014,133(6):992-998.
[24]梁海峰,刘晨霞,王书会,等.ICU住院患者耐药菌感染现状分析[J].齐鲁护理杂志,2017,23(19):43-45.
[25]Neuville M,El-Helali N,Magalhaes E,et al.Systematic overdosing of oxa and cloxacillin in severe infections treated in ICU:risk factors and side effects[OL].Ann Intensive Care,2017,7(1):34.
[26]欧阳育琪,向阳.风险评估在医院感染控制中的应用现状与展望[J].实用预防医学,2017,24(10):1277-1280.
[27]李洋,杜蕾,张立超,等.FMEA法在医疗风险管理中的应用现状与展望[J].中国医院管理,2014,34(9):36-37.
[28]Joint Commission International.Joint commission international accreditation standards for hospital[M].5th Edition.Department of Publication of Joint Commission Resources.IL.USA,2014:267-268.
[29]Duwe B,Fuchs BD,Hansen-Flaschen J.Failure mode andeffects analysis application to critical care medicine[J].Crit Care Clin,2005,21(1):21-30.
[30]关心,任慧,潘宇,等.基于logistic回归分析的医院感染风险评估模型应用研究[J].中国医院管理,2018,38(10):54-56.
[31]Song JY,Jeong IS.Development of a risk prediction model of carbapenem-resistant Enterobacteriaceae colonization among patients in intensive care units[J].Am J Infect Control,2018,46(11):1240-1244.
[32]Becker CD,Bowers C,Chandy D,et al.Low risk monitoring in neurocritical care[OL].Front Neurol,2018,9:938.
[33]徐妍,张扬,黄永彬.TISS评分与护理分层管理在ICU护理管理中的协同效应[J].护理研究,2018,32(19):3134-3136.
[34]沈忠明,张敏莉,朱莎,等.APACHEⅡ评分在专科ICU危重产科患者病情评估中的应用价值[J].云南医药,2018,39(5):399-403.
[35]吴梅霞,宋巧云,翟培峰,等.基于失效模式与效应分析降低导管室医院感染风险[J].解放军医院管理杂志,2018(9):828-830.
[36]黄菊,杨坚娥,肖瑜,等.基于FMEA法的医院感染预防与控制风险评估[J].中国医药导报,2016,13(4):156-159.
[37]陈萍,王燕,段晓菲,等.风险评估在传染病医院外科医院感染控制中的应用[J].华西医学,2017,32(3):339-343.
[38]赵霞,王力红,张京利,等.ICU医院感染风险评估[J].中华医院感染学杂志,2013,23(20):5016-5017,5053.
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