本文選題：醫(yī)院感染 + ICU��； 參考：《吉林大學》2009年博士論文

【摘要】： 隨著人口壽命延長,各種慢性病、腫瘤患者逐漸增多,由于治療的科技水平大幅度提高,各種創(chuàng)傷性和侵入性檢查廣泛應用,及免疫抑制劑、細胞毒性藥物使用,均可使患者免疫功能嚴重受創(chuàng)并極易發(fā)生感染。再加上抗菌藥物的廣泛應用,濫用、亂用現(xiàn)象日益嚴重,導致細菌變成多重耐藥菌,感染患者愈后極差,治療十分棘手。目前,醫(yī)院感染已經成為制約醫(yī)療效果的主要負面因素,影響波及全世界,患者病死率極高,與艾滋病、腫瘤并稱世界三大醫(yī)學難題。 開展醫(yī)院感染監(jiān)測對于控制管理醫(yī)院感染有著十分重要的意義,主要包括綜合性監(jiān)測和目標性監(jiān)測,二者各有局限性。而多重耐藥菌的動力學研究在目前國際國內研究中仍處于嘗試階段。因此,開展多重耐藥菌定植感染目標性結合全面性監(jiān)測,同期結合傳播動力學研究,分析感染控制措施作用,全面研究多重耐藥菌定植感染的關鍵因素,有助于降低醫(yī)院感染的流行。 本研究選擇一所國內大型綜合性醫(yī)院的外科重癥監(jiān)護病房作為目標性監(jiān)測對象,采用前瞻性設計,開展住院患者、醫(yī)護人員和環(huán)境因素(空氣及物品表面等)的綜合性監(jiān)測。以耐甲氧西林金黃色葡萄球菌和多重耐藥鮑曼不動桿菌為目標菌群。監(jiān)測同期開展多重耐藥菌傳播動力學研究,主要包括:醫(yī)患接觸率,患者與醫(yī)務人員數量比,陽性患者轉出頻率及接觸中傳播機率等;感染控制措施(醫(yī)護人員的手衛(wèi)生和醫(yī)務人員分組)效果研究。利用該病房搬遷事件,深入分析環(huán)境因素與多重耐藥菌傳播的關系。開展多重耐藥菌定植感染監(jiān)測,減少醫(yī)務人員病房內接觸,適當隔離并加快轉出陽性攜帶患者,加強手衛(wèi)生宣傳監(jiān)督,建議護士與患者1對1分組原則,加強環(huán)境消毒,才能有效地減少多重耐藥菌醫(yī)院內定植感染的發(fā)生,為醫(yī)院感染多重病原體監(jiān)測和傳播動力學的進一步深入發(fā)展提供研究依據。
[Abstract]:With the prolonged life span of the population, various chronic diseases, cancer patients gradually increased, due to the significant improvement in treatment technology, various traumatic and invasive tests are widely used, and immunosuppressants and cytotoxic drugs are used. It can make the patient's immune function seriously damaged and highly susceptible to infection. In addition, the widespread use of antimicrobial agents, abuse, misuse of the phenomenon of increasingly serious, leading to bacteria into multi-drug resistant bacteria, infection patients after recovery is extremely poor, treatment is very difficult. At present, nosocomial infection has become the main negative factor that restricts the effect of medical treatment, which affects the whole world. The mortality rate of patients is very high, and AIDS and tumor are the three major medical problems in the world. Nosocomial infection surveillance is of great significance for the control and management of nosocomial infection, including comprehensive surveillance and targeted surveillance, each of which has its own limitations. The kinetic study of multidrug resistance bacteria is still in the stage of trial at home and abroad. Therefore, comprehensive surveillance of multidrug resistant bacteria infection was carried out, combined with the study of transmission dynamics, the effect of infection control measures was analyzed, and the key factors of multidrug resistant bacteria infection were comprehensively studied. It helps to reduce the prevalence of nosocomial infections. In this study, the surgical intensive care unit (ICU) of a large general hospital in China was selected as the target monitoring object, and comprehensive monitoring of inpatients, medical staff and environmental factors (air and object surfaces) was carried out by prospective design. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii were used as target bacteria. To monitor the transmission kinetics of multidrug resistant bacteria in the same period, including: the contact rate between doctors and patients, the ratio of patients to medical personnel, the frequency of positive patients' transfer and the probability of transmission in contact. Effectiveness of infection control measures (hand hygiene and medical staff groups). The relationship between environmental factors and multidrug resistant bacteria transmission was analyzed. To carry out surveillance of multidrug resistant bacteria infection, reduce the contact in medical staff ward, isolate and speed up the transfer of positive patients, strengthen the supervision of hand hygiene, recommend the principle of 1 to 1 grouping of nurses and patients, and strengthen environmental disinfection. Only in order to effectively reduce the incidence of multidrug resistant bacteria in hospital colonization infection, and provide the basis for the further development of surveillance and transmission dynamics of multiple pathogens in hospital infection.
【學位授予單位】：吉林大學
【學位級別】：博士
【學位授予年份】：2009
【分類號】：R181.3

【引證文獻】

相關期刊論文 前2條

1 劉坤;袁曉寧;武迎宏;薛文英;;重癥監(jiān)護病房多重耐藥菌監(jiān)測與控制現(xiàn)狀分析[J];中國醫(yī)院管理;2012年03期

2 盛燕軍;王志峰;何瑜佳;;ICU多重耐藥菌的分布特征及危險因素[J];中國衛(wèi)生檢驗雜志;2013年09期

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本文編號：1788878