Journal of Patient Safety & Infection Control最新文献

英文中文

Promotion of Successful Hand Hygiene practices in the Intensive Care Units of a Tertiary Care Hospital 在一家三级护理医院的加护病房推广成功的手部卫生习惯

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.11.004

Juhi Taneja , Bibhabati Mishra

Background

Control of nosocomial infections is a major health concern in a hospital setting and hand hygiene is considered as the most important tool in nosocomial infection control.

Methods

This prospective study about the practice of hand washing by 106 HCWs (Health Care Workers) working in Intensive Care Unit (ICU) before and after patient contact in a tertiary care hospital was conducted to find out the hand washing compliance rate in ICU of GB Pant Institute of Postgraduate Medical Education and Research and the factors associated with noncompliance and to find out the impact of a task-orientated hand hygiene education and intervention program.

Results

462 opportunities of hand hygiene were observed in the ICUs over 30 h. Adherence was found to be 52%. A positive intention to comply with hand hygiene was found among 94% of the respondents. Most respondents (78.2%) believed that they could improve compliance with hand hygiene on their own. Intervention included education on hand hygiene indications and technique, hand hygiene performance feedback, and discussion of the previous assessment of HCWs’ beliefs toward hand hygiene. After intensive promotion of hand hygiene, observation sessions were performed on 98 nursing staff, which provided 425 opportunities of hand hygiene, and hand hygiene adherence was increased to 63% as an impact of measures taken.

Conclusions

The study revealed that hand hygiene compliance can be effectively increased among HCWs by regular reminders and surveys. Training programs on hand hygiene should be systematically planned, regularly conducted, and evaluated for staff nurses so as to keep them motivated.

背景:医院感染的控制是医院环境中主要的健康问题，手卫生被认为是医院感染控制中最重要的工具。方法对某三级医院重症监护病房(ICU) 106名医护人员在接触病人前后的洗手情况进行前瞻性研究，了解英国潘特医学研究生教育研究所重症监护病房(ICU)洗手依从率及不依从性的相关因素，并探讨任务导向的手卫生教育干预方案的影响。结果icu 30 h内共观察手部卫生462次，依从率为52%。94%的受访者表示有积极的意愿遵守手部卫生。大多数受访者(78.2%)认为他们可以自行改善手部卫生依从性。干预措施包括手卫生指征和技术教育、手卫生表现反馈和讨论以往对医护人员手卫生信念的评估。强化手卫生宣传后，对98名护理人员进行了观察，提供了425次手卫生机会，采取措施后，手卫生依从性提高到63%。结论通过定期提醒和调查，可有效提高卫生工作者的手卫生依从性。应系统地规划、定期开展并评估护理人员的手部卫生培训计划，以保持他们的积极性。

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引用次数: 11

Ventilator-associated pneumonia in intensive care units of a tertiary care hospital in Punjab 旁遮普一家三级医院重症监护病房的呼吸机相关肺炎

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.11.001

Veenu Gupta , Deepinder Chhina , Rajoo Singh Chhina , Kanwal Deep Singh Lyall , Pooja Suri

Introduction

Health care associated infections from invasive medical devices in intensive care pose the highest risk prolonging the hospital stay and cost for the patients. Ventilator-associated pneumonia (VAP) is an important infection in mechanically ventilated patients. Due to increasing incidence of multidrug-resistant organisms in intensive care units (ICUs), early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment.

Objectives

The aim of this study was to assess the incidence, commonest pathogens, and resistance pattern of isolates of VAP in ICUs of a tertiary care hospital.

Material and methods

A prospective study was performed over a period of six months, enrolling patients undergoing mechanical ventilation for >48 h. Endotracheal aspirates and bronchoalveolar lavage samples were collected from patients suspected of VAP and semi-quantitative cultures were performed on all samples. VAP was diagnosed by m-CPIS score (≥6).

Results

A total of 2369 patients were admitted in ICUs, of which 979 patients were on ventilator assistance (4165 ventilator days). Out of these, 47 (4.8%) patients developed VAP and early onset VAP was seen in 66% cases. The VAP rate was 11.03/1000 ventilator days. The commonest pathogen was Acinetobacter spp. followed by Pseudomonas spp. and Klebsiella spp. Most of the Acinetobacter spp. were resistant to cephalosporins, ciprofloxacin, and showed maximum susceptibility to tigecycline and polymyxin B.

Conclusions

The early onset VAP was more and incidence was high in males. This study highlights the predominance of resistant Gram-negative pathogens in VAP cases.

在重症监护中，侵入性医疗器械引起的卫生保健相关感染是延长患者住院时间和增加患者费用的最大风险。呼吸机相关性肺炎(VAP)是机械通气患者的一种重要感染。由于重症监护病房(icu)多药耐药菌的发病率不断上升，VAP的早期正确诊断是最佳抗生素治疗的紧迫挑战。目的评价某三级医院icu中VAP的发病率、最常见病原菌及分离株的耐药模式。材料和方法前瞻性研究为期6个月，纳入机械通气48小时的患者。收集疑似VAP患者的气管内吸入物和支气管肺泡灌洗液样本，并对所有样本进行半定量培养。以m-CPIS评分(≥6)诊断VAP。结果icu共收治患者2369例，其中使用呼吸机辅助的患者979例(4165个呼吸机日)。其中，47例(4.8%)患者发生VAP，早发性VAP占66%。VAP率为11.03/1000呼吸机d。最常见的病原菌是不动杆菌，其次是假单胞菌和克雷伯菌，大多数不动杆菌对头孢菌素和环丙沙星耐药，对替加环素和多粘菌素b最敏感。这项研究强调了在VAP病例中耐药革兰氏阴性病原体的优势。

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引用次数: 0

Knowledge and attitude of dentists in India towards patient safety – A cross-sectional study 印度牙医对病人安全的知识和态度-一项横断面研究

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.11.002

Ajay Mahajan , Raman Bedi

Aim

To record the knowledge and attitude of dentists in India towards patient safety in dentistry.

Materials and method

An online questionnaire of 13 questions was prepared to determine dentist's knowledge and attitudes towards patient safety in dentistry. Members of an online closed discussion group of dentists (n = approximately 5000) working in India were contacted on three separate occasions during October 2013–January 2014.

Results

1025 responses were obtained. 19% of respondents stated that they actively took steps to improve safety standards but only 8% of the total sample believed that their employing organisation or professional body would support them to improve patient safety. In addition, only 8% believed that senior staff members encouraged open discussion on surgical errors or how to prevent them. 67% of dentists stated that they had inadequate knowledge on patient safety issues and 97% recommended that patient safety in dentistry be given a higher priority in the undergraduate dental curriculum.

Conclusion

There is a need to improve knowledge about patient safety in dentistry among dentists in India and to create a more open culture in reporting adverse incidents.

目的记录印度牙医对牙科患者安全的知识和态度。材料与方法编制了一份包含13个问题的在线问卷，以确定牙医对牙科患者安全的知识和态度。2013年10月至2014年1月期间，在印度工作的牙医(n =约5000)的在线封闭讨论组成员在三个不同的场合进行了联系。结果共获得1025份问卷。19%的受访者表示他们积极采取措施提高安全标准，但只有8%的受访者认为他们的雇主机构或专业团体会支持他们改善患者安全。此外，只有8%的人认为高级工作人员鼓励公开讨论手术错误或如何预防手术错误。67%的牙医表示他们对病人安全问题的认识不足，97%的牙医建议在牙科本科课程中给予病人安全更高的优先级。结论需要提高印度牙医对牙科患者安全的认识，并在报告不良事件方面建立更加开放的文化。

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引用次数: 1

A prospective study on various factors influencing post-operative wound infection in emergency surgeries 急诊手术中影响术后伤口感染的各种因素的前瞻性研究

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.11.003

Jeffrey Daniel Mathew , R. Kalaivani , C.P. Ganesh Babu

Background

The risk of surgical site infection (SSI) is approximately 1–3% for elective surgery and more for emergency surgeries. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the various measures to prevent SSI, only some are based on strong evidence, and there is insufficient evidence to show whether one method is superior to any other. Therefore, this study was carried out to find out the various factors causing post-operative wound infection, the commonly associated microorganisms, and antibiotic sensitivity and resistance pattern.

Methods

The study was conducted in tertiary care hospital, Pondicherry between September 2012 and September 2014. All the patients who underwent emergency surgeries in the Department of General Surgery were included in the study. An elaborative clinical study of post-operative wound infection was conducted. The suture site was inspected for any sign of infection starting from the second post-operative day till discharge from hospital. Wound swabs were collected and sent for aerobic culture and sensitivity.

Results

In this study, open appendectomy was the most common surgery that was performed on an emergency basis. Anemia followed by hypoalbuminemia were the two important comorbid conditions. The rate of infection for clean-contaminated, contaminated, and dirty wound were 16.88%, 38%, and 20% respectively.

Conclusion

SSI occupies a significant proportion among various hospital-acquired infections. SSI not only prolongs the hospitalization but also markedly increases the expenditure and morbidity.

择期手术的手术部位感染(SSI)风险约为1-3%，急诊手术的风险更高。除患者内源性因素外，外部危险因素在SSI发病中的作用已得到充分认识。然而，在各种预防SSI的措施中，只有一些是基于强有力的证据，并且没有足够的证据表明一种方法是否优于其他方法。因此，本研究旨在了解引起术后伤口感染的各种因素，常见的相关微生物，以及抗生素的敏感性和耐药模式。方法研究于2012年9月至2014年9月在本地治里三级医院进行。所有在普通外科接受急诊手术的患者均被纳入研究。对手术后伤口感染进行了详细的临床研究。从术后第二天起至出院，检查缝合处是否有感染迹象。收集伤口拭子进行有氧培养和敏感性检测。结果在本研究中，开放性阑尾切除术是最常见的急诊手术。贫血和低白蛋白血症是两个重要的合并症。清洁伤口感染率为16.88%，污染伤口感染率为38%，脏伤口感染率为20%。结论ssi在各种医院获得性感染中占有重要的比例。SSI不仅延长了住院时间，而且显著增加了费用和发病率。

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引用次数: 1

Microbial epidemiology and antimicrobial susceptibility profile of wound infections in out-patients at a level 1 trauma centre 一级创伤中心门诊患者伤口感染的微生物流行病学和抗菌药物敏感性分析

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.06.001

Amit Kumar Gupta , Priyam Batra , Purva Mathur , Alphina Karoung , B.T. Thanbuana , Shiny Thomas , M. Balamurugan , Jacinta Gunjiyal , Mahesh C. Misra

Background

Wound is a disruption of normal anatomic structure and function of the skin, and any infection in this constitutes wound infection. Wound infection delays wound healing, and it causes wound breakdown, leading to increased hospital stay, morbidity and mortality. Most of the published data available focus on surgical site infections. In the developing countries, however, wound infection is an important cause of hospital mortality and morbidity. No data are available on the microbial profile of the wounds presenting at our hospital.

Objective

This study was thus designed to describe the microbial epidemiology and the antimicrobial resistance profile of the wounds of the patients presenting to the OPD.

Methodology and results

Retrospective review of records of all wound samples sent over 3 years from OPD was done. OPD sent 827 wound samples of 571 patients. Most common organism isolated was Staphylococcus aureus [132 (35%)], followed by Escherichia coli [54 (14%)] and Pseudomonas aeruginosa [49 (13%)]. Of the 145 S. aureus strains, 43 (30%) strains were Methicillin Resistant Staphylococcus aureus, and none were resistant to vancomycin/linezolid/teicoplanin. Gram-negative organisms were resistant to most antibiotics tested.

Conclusion

Wound healing is halted in the presence of prolonged inflammation such as due to infection. Presence of bacteria delays wound healing, but the presence of low number of microbes is required for wound healing. Absence of appropriate signs to guide treatment becomes a reason for prolonged indiscriminate use of antibiotics which leads to rapid emergence of resistant organisms. Data generated by our study would help in the formulation of antibiotic policy for OPDs and also help in checking inadvertent antibiotic usage.

背景:伤口是皮肤正常解剖结构和功能的破坏，任何感染都构成伤口感染。伤口感染会延迟伤口愈合，并导致伤口破裂，导致住院时间、发病率和死亡率增加。大多数已发表的数据集中在手术部位感染。然而，在发展中国家，伤口感染是医院死亡率和发病率的一个重要原因。没有关于在我们医院就诊的伤口微生物特征的数据。目的了解门诊患者伤口微生物流行病学及耐药情况。方法和结果回顾性回顾了3年内从OPD寄来的所有伤口样本记录。门诊送来了571名患者的827份伤口样本。最常见的分离菌为金黄色葡萄球菌[132例(35%)]，其次为大肠杆菌[54例(14%)]和铜绿假单胞菌[49例(13%)]。145株金黄色葡萄球菌中43株(30%)为耐甲氧西林金黄色葡萄球菌，对万古霉素/利奈唑胺/替柯planin均无耐药。革兰氏阴性菌对测试的大多数抗生素具有耐药性。结论由于感染等原因引起的长期炎症使创面愈合停止。细菌的存在会延迟伤口的愈合，但少量的微生物的存在是伤口愈合所必需的。缺乏适当的体征来指导治疗成为长期滥用抗生素的一个原因，从而导致耐药生物的迅速出现。我们的研究产生的数据将有助于门诊医生制定抗生素政策，也有助于检查无意使用抗生素。

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引用次数: 4

Kyasanur forest disease – Potential for transition into epidemic Kyasanur森林疾病-转变为流行病的可能性

Journal of Patient Safety & Infection Control

Pub Date : 2015-09-01 DOI: 10.1016/j.jpsic.2015.10.202

Abin Chandrakumar

引用次数: 0

Games in the education of medical students 医学生教育中的游戏

Journal of Patient Safety & Infection Control

Pub Date : 2015-05-01 DOI: 10.1016/j.jpsic.2015.10.071

Walter Popp , Birgit Ross , Stefanie Merse

引用次数: 0

Hand hygiene – Where the mind rules 手部卫生——心灵主宰

Journal of Patient Safety & Infection Control

Pub Date : 2015-05-01 DOI: 10.1016/j.jpsic.2015.10.069

L. Mendiratta , R. Sardana , E. Soni , J.M. Dua , Arpita , V. Sharma

引用次数: 0

Surveillance and intervention 监督和干预

Journal of Patient Safety & Infection Control

Pub Date : 2015-05-01 DOI: 10.1016/j.jpsic.2015.10.218

Mary Lou Manning

引用次数: 0

Assessing the impact of an educational intervention on central-line associated blood stream infections in a pediatric critical care unit: Are we right by comparing incidence rates? 评估教育干预对儿科重症监护室中心线相关血流感染的影响：比较发病率是正确的吗？

Journal of Patient Safety & Infection Control

Pub Date : 2015-05-01 DOI: 10.1016/j.jpsic.2015.10.078

A. Gupta

引用次数: 0

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