SICU多重耐药菌定植感染监测及传播动力学研究

发布时间：2018-04-22 20:44

本文选题：医院感染 + ICU　；参考：《吉林大学》2009年博士论文

【摘要】： 随着人口寿命延长,各种慢性病、肿瘤患者逐渐增多,由于治疗的科技水平大幅度提高,各种创伤性和侵入性检查广泛应用,及免疫抑制剂、细胞毒性药物使用,均可使患者免疫功能严重受创并极易发生感染。再加上抗菌药物的广泛应用,滥用、乱用现象日益严重,导致细菌变成多重耐药菌,感染患者愈后极差,治疗十分棘手。目前,医院感染已经成为制约医疗效果的主要负面因素,影响波及全世界,患者病死率极高,与艾滋病、肿瘤并称世界三大医学难题。开展医院感染监测对于控制管理医院感染有着十分重要的意义,主要包括综合性监测和目标性监测,二者各有局限性。而多重耐药菌的动力学研究在目前国际国内研究中仍处于尝试阶段。因此,开展多重耐药菌定植感染目标性结合全面性监测,同期结合传播动力学研究,分析感染控制措施作用,全面研究多重耐药菌定植感染的关键因素,有助于降低医院感染的流行。本研究选择一所国内大型综合性医院的外科重症监护病房作为目标性监测对象,采用前瞻性设计,开展住院患者、医护人员和环境因素(空气及物品表面等)的综合性监测。以耐甲氧西林金黄色葡萄球菌和多重耐药鲍曼不动杆菌为目标菌群。监测同期开展多重耐药菌传播动力学研究,主要包括:医患接触率,患者与医务人员数量比,阳性患者转出频率及接触中传播机率等;感染控制措施(医护人员的手卫生和医务人员分组)效果研究。利用该病房搬迁事件,深入分析环境因素与多重耐药菌传播的关系。开展多重耐药菌定植感染监测,减少医务人员病房内接触,适当隔离并加快转出阳性携带患者,加强手卫生宣传监督,建议护士与患者1对1分组原则,加强环境消毒,才能有效地减少多重耐药菌医院内定植感染的发生,为医院感染多重病原体监测和传播动力学的进一步深入发展提供研究依据。
[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.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2009
【分类号】：R181.3

【引证文献】