收治地震灾区患者病区的医院感染预防与控制
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摘要
目的根据收治地震灾区患者的特点,做好医院感染预防与控制工作,提高救治的成功率。方法前接医疗队在列车上对患者进行分类和伤情评估,将有创面感染的患者与无伤口的患者分区和分病房安置,制定接收患者入住病房后的清洗和检疫流程,在观察伤情的第一时间,对开放伤口创面进行细菌、真菌和厌氧菌培养;严格病房、陪护及探视人员管理,督导消毒隔离、手卫生措施执行及医疗废弃物的正确处置。结果76例地震受伤患者多为四肢创伤,14例开放性创伤患者的创面中10例有细菌或真菌生长,大部分为≥2种的细菌或真菌混合感染,感染率为71.43%;所有创面分泌物中均未培养出破伤风梭菌和产气荚膜梭菌,地震创伤后合并泌尿系感染3例,肺部感染1例,褥疮感染1例;在有效的外科清创和换药处置基础上,根据病原菌和药敏情况,及时调整抗菌药物的使用,全身及创面感染状况很快得到控制;另有35例闭合性骨折损伤患者,限期施行切开内固定复位手术零感染。结论地震受伤患者开放性创面感染率较高,为多种细菌和真菌感染,呈多药耐药性,且合并有尿路及肺部感染存在,在收治过程中应加强医院感染的预防与控制管理,防治交叉感染。
OBJECTIVE To enhance the healing rate of the wounded victims in earthquake and to do a good job on the nosocomial infection prevention and control according to the feature of the victims. METHODS The advance medical team on the train evaluated thd traumatic condition of the victims and sorted them according to their condition,then the victims with raw surface infection and that with no wound were arranged to the different sections and wards.The cleaning and medical inspection procedure for the victims were formulated.The secretions of their open wound surface with bacterial,fungal and anaerobic culturing at the very beginning were taken when their traumatic condition were examined.The management of wards,attendants and visitors were strengthened,the hand hygiene compliance and the right way to disposal clinical waste the disinfection and sterilization were supervised and directed. RESULTS Most of the 76 victims were with limbs injury,of which 14 victims with open injury,10 got bacterial or fungal infection.The infection rate was 71.43%.Most of them had got combined infection.No Clostridium tetani and C.perfringens were isolated from the secretion of the raw surface.Three victims were complicated with urinary system infection,1 with pulmonary infection and 1 with bed-sore infection after wounded in earthquake.Basing on effective debridement and change dressings,the antibacterial agents were applied according to pathogenic bacteria and the antimicrobial susceptibility test,so the wound surface and general infection were controled effectivelly.Another 35 victims with closed fracture who were operated with internal fixation and reposition after discection in the limited time were not infected. CONCLUSIONS The infection rate of raw surface of victims with open injury is high.Most of the wound surface are infected with some multidrug resistant bacterial and fungi and combined with urinary system infection or pulmonary infection.The nosocomial infections precaution and control should be strengthened to prevent cross infection when treating the victims wounded in earthquake.
OBJECTIVE To enhance the healing rate of the wounded victims in earthquake and to do a good job on the nosocomial infection prevention and control according to the feature of the victims. METHODS The advance medical team on the train evaluated thd traumatic condition of the victims and sorted them according to their condition,then the victims with raw surface infection and that with no wound were arranged to the different sections and wards.The cleaning and medical inspection procedure for the victims were formulated.The secretions of their open wound surface with bacterial,fungal and anaerobic culturing at the very beginning were taken when their traumatic condition were examined.The management of wards,attendants and visitors were strengthened,the hand hygiene compliance and the right way to disposal clinical waste the disinfection and sterilization were supervised and directed. RESULTS Most of the 76 victims were with limbs injury,of which 14 victims with open injury,10 got bacterial or fungal infection.The infection rate was 71.43%.Most of them had got combined infection.No Clostridium tetani and C.perfringens were isolated from the secretion of the raw surface.Three victims were complicated with urinary system infection,1 with pulmonary infection and 1 with bed-sore infection after wounded in earthquake.Basing on effective debridement and change dressings,the antibacterial agents were applied according to pathogenic bacteria and the antimicrobial susceptibility test,so the wound surface and general infection were controled effectivelly.Another 35 victims with closed fracture who were operated with internal fixation and reposition after discection in the limited time were not infected. CONCLUSIONS The infection rate of raw surface of victims with open injury is high.Most of the wound surface are infected with some multidrug resistant bacterial and fungi and combined with urinary system infection or pulmonary infection.The nosocomial infections precaution and control should be strengthened to prevent cross infection when treating the victims wounded in earthquake.
引文
[1]黄寿清,张楚南,李向阳,等.开放性骨折创面处理与创面感染的关系[J].中国感染控制杂志,2003,2(3):170-171.
[2]邱方城,王崇玉.医护人员洗手后葡萄球菌带菌的调查[J].中华医院感染学杂志,2005,15(3):300-301.
[3]陈静,裴红生,凌汉栋,等.医疗废物管理的调查及分析[J].中华医院感染学杂志,2004,14(9):1025-1026.
[4]刘明华,张庆玲,刘玉馥,等.创伤患者金黄色葡萄球菌感染的分子流行病学研究[J].中华医院感染学杂志,2004,14(1):100-103.
[2]邱方城,王崇玉.医护人员洗手后葡萄球菌带菌的调查[J].中华医院感染学杂志,2005,15(3):300-301.
[3]陈静,裴红生,凌汉栋,等.医疗废物管理的调查及分析[J].中华医院感染学杂志,2004,14(9):1025-1026.
[4]刘明华,张庆玲,刘玉馥,等.创伤患者金黄色葡萄球菌感染的分子流行病学研究[J].中华医院感染学杂志,2004,14(1):100-103.
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