地震伤员开放性伤口感染相关因素及目标监测
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摘要
目的了解5.12汶川大地震伤员四肢开放性伤口感染情况,分析感染相关因素,为预防和控制感染提供依据。方法感控办专业人员每天进入收治地震伤员科室,通过对伤员伤口查看、症状体征观察、参加医生护士查房、查阅微生物检验报告及病历资料,对地震伤员开放性四肢伤口感染相关因素进行调查及目标监测。结果共监测165例伤员,发现伤口感染66例40.0%(66/165)。从年龄、损伤情况、伤口个数分析:>60岁伤员感染率高于<60岁伤员;有骨折伤员感染率高于无骨折伤员;有>2个创口感染率高于一个创口感染率,P<0.05。感染病原菌:芽胞杆菌感染20例;多重耐药菌感染28例;其它病原菌感染18例。其中多重(>2种)病原菌感染占47.0%;引起伤口感染的细菌以鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌主等阴性杆菌为主。结论及时对地震伤员四肢开放性伤口进行感染目标监测,能早期识别特殊病原菌、及时发现耐药菌感染,对降低继发性损害具有重要意义。
Objective To investigate the condition of open wound infection of 5.12 Wenchuan earthquake casualty and analysis the relative factors of infection,in order to provide evidence for preventing and controlling infection.Methods Professionals of department of Hospital Infection Management went to the department which the earthquake casualty stayed in to monitor and investigate the relative factors of open wound infection by observing the wounds,symptoms and signs of the wounded,taking part in ward round of doctors and nurses and consulting the reports of microorganism checking and medical record.Results 165 wounded person were monitored.In those,there were 66 cases(40.0%)undergoing wounld infection.Analysis from the aspects of age,injuring condition and wound numbers,the infective rates of the wounds upon 60 yeras old,with fractures and more than two wounds were respectively higher than those under 60 years old;without fractures and only one wound(P<0.05).Infective pathogen:bacillus 20 cases,multi-drug resistant bacteria 28 cases,other pathogen 18 cases.There were 47% cases were multi-pathogen infection.The main bacterium of wound infection were bauman acinetobacter,enterobacter cloacae,escherichia coli.Conclusion It has the important significance to reduce secondary injury by identifying special pathogen early and fingding out drug resistant bacteria in time that taking target monitoring to open wound infection of earthquake casualty.
Objective To investigate the condition of open wound infection of 5.12 Wenchuan earthquake casualty and analysis the relative factors of infection,in order to provide evidence for preventing and controlling infection.Methods Professionals of department of Hospital Infection Management went to the department which the earthquake casualty stayed in to monitor and investigate the relative factors of open wound infection by observing the wounds,symptoms and signs of the wounded,taking part in ward round of doctors and nurses and consulting the reports of microorganism checking and medical record.Results 165 wounded person were monitored.In those,there were 66 cases(40.0%)undergoing wounld infection.Analysis from the aspects of age,injuring condition and wound numbers,the infective rates of the wounds upon 60 yeras old,with fractures and more than two wounds were respectively higher than those under 60 years old;without fractures and only one wound(P<0.05).Infective pathogen:bacillus 20 cases,multi-drug resistant bacteria 28 cases,other pathogen 18 cases.There were 47% cases were multi-pathogen infection.The main bacterium of wound infection were bauman acinetobacter,enterobacter cloacae,escherichia coli.Conclusion It has the important significance to reduce secondary injury by identifying special pathogen early and fingding out drug resistant bacteria in time that taking target monitoring to open wound infection of earthquake casualty.
引文
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[8]Fedorov VD,Borisova OK,Kuleshov SE,et al.Characteristics of woundin-fectioninlong-termcrush syndrom[J].Khiurgiia:(Mosk),1990,6:33～38
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[2]胡必杰,陶黎黎.地震灾害伤员的常见感染类型和预治对策[J].中华医院感染学杂志,2008,18(6):1～3
[3]Lai SW,Liu CS,Li C,et al.Post-earthquake illness and disease after the chi-chi earthquake[J].Eur J Intern Med,2000,11(6):353～354
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314～320
[5]医院感染监控信息.创伤后气性坏疽[J].中南大学湘雅医院.卫生部医院感染培训基地,2008,22(68～69):114～115
[6]医院感染监控信息.气性坏疽[J].中南大学湘雅医院.卫生部医院感染培训基地,2008,22(68～69):66～67
[7]Uckay I,Sax H,Harbarth S,et al.Multi-resistant infections in repatriated patients after natural disasters:lessons learned fromthe2004tsunami for hospital infection control[J].J Hosp Infect,2008,68(1):1～8
[8]Fedorov VD,Borisova OK,Kuleshov SE,et al.Characteristics of woundin-fectioninlong-termcrush syndrom[J].Khiurgiia:(Mosk),1990,6:33～38
[9]黄娟,谢志春.不动杆菌属细菌医院感染研究现状[J].中华医院感染学杂志,2007,17(6):757～760
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