重症监护室信息系统污染调查及预防对策

发布时间：2018-05-07 16:21

本文选题：计算机 + 电话　；参考：《重庆医科大学》2010年硕士论文

【摘要】： 目的: 探讨重症监护室信息系统(计算机键盘鼠标与内部固定电话的控制按键和电话听筒)表面以及工作人员双手表面病原菌的分布和耐药情况,为有效防治院内感染提供参考。方法: 2009年9月14日～2009年9月20日在重庆医科大学附属儿童医院重症监护室,对其使用的所有计算机键盘鼠标(9台)与内部固定电话的控制按键和电话听筒(3部)以及每天随机抽取的13名工作人员的双手表面连续取样7天。采用常规方法对各类标本进行分离培养,并就病原菌分布和耐药情况进行分析。结果: 1、175例标本中,有21例标本分离培养出病原菌,阳性率12.0%;其中10例(47.6%)来自工作人员双手,7例(33.3%)来自计算机键盘鼠标,4例(19.1%)来自内部固定电话的控制按键和电话听筒。 2、共分离培养出病原菌3种,均为革兰氏阳性菌。溶血性葡萄球菌19株(90.4%)、金黄色葡萄球菌1株(4.8%)、木糖葡萄球菌1株(4.8%)。溶血葡萄球菌占检出病原菌的首位,在计算机键盘鼠标,内部固定电话和工作人员双手上均有发现。金黄色葡萄球菌来自计算机键盘鼠标。木糖葡萄球菌来自工作人员双手。 3、19株溶血葡萄球菌中耐甲氧西林溶血葡萄球菌检出率为68.4%(13/19)。耐甲氧西林的溶血葡萄球菌对20种抗生素的耐药率明显高于甲氧西林敏感的溶血葡萄球菌。 4、药敏结果显示病原菌对万古霉素、利奈唑胺、替考拉宁、利福平、四环素、呋喃妥因、阿米卡星、奎奴普汀/达福普汀全部敏感。甲氧苄啶和哌拉西林的耐药率也较低,均为14.3%。20种抗生素耐药率最高的是氨苄青霉素,达71.4%。其他抗生素也有较高的耐药率。 5、本研究中ICU与所在医院的2009年全院常见革兰阳性球菌药敏结果比较显示:ICU溶血葡萄球菌耐药率和MRS的检出率均低于全院水平。结论: 1、重症监护室的信息系统的污染情况值得关注,它们可以作为引起院内交叉感染的跨载体。应定期对其清洁和消毒,从而把院内感染的危险因素降到最低。 2、科室工作人员应当认识到他们双手传播的细菌可以导致重症监护室内发生院内感染。每个工作人员在进行操作前后和使用信息系统之前都要进行洗手或是消毒或者使用手套隔离。
[Abstract]:Objective: To investigate the distribution and drug resistance of pathogens on the surface of the information system of intensive care unit (computer keyboard mouse and internal fixed telephone control keys and telephone handsets) as well as on the surface of staff hands in order to provide a reference for the effective prevention and treatment of nosocomial infection. Methods: From September 14, 2009 to September 20, 2009 in the intensive Care Unit of Children's Hospital affiliated to Chongqing Medical University. For all the computer keyboards and mice used, 9 units) and 3 control buttons and telephone handsets for internal fixed phones) and 13 staff members randomly sampled daily for 7 consecutive days on the surface of the hands. All kinds of specimens were isolated and cultured by routine method, and the distribution and drug resistance of pathogens were analyzed. Results: Of the 1175 specimens, 21 samples were isolated and cultured, with a positive rate of 12.0, among which 10 cases (47.6) came from the hands of the staff, 7 cases (33.3) from the computer keyboard, mouse and mouse (4 cases) and 19.1) from the control keys and telephone handsets of the internal fixed telephone. 2. Three kinds of pathogenic bacteria were isolated and cultured, all of them were Gram-positive bacteria. There were 19 strains of Staphylococcus haemolyticus, 1 strain of Staphylococcus aureus, 1 strain of Staphylococcus aureus, and 1 strain of Staphylococcus xylose. Staphylococcus haemolyticus was the most common pathogen found in computer keyboard mouse internal fixed telephone and staff hands. Staphylococcus aureus comes from a computer keyboard and mouse. Staphylococcus xylostaphylococcus comes from the hands of the staff. The detection rate of methicillin-resistant Staphylococcus haemolyticus in 19 strains of Staphylococcus haemolyticus was 68.4 / 19. The resistance rate of methicillin-resistant staphylococcus haemolyticus to 20 antibiotics was significantly higher than that of methicillin-sensitive Staphylococcus haemolyticus. 4. The results of drug sensitivity showed that the pathogens were all sensitive to vancomycin, linazolamine, tetracycline, quinapine / difampicin. The resistance rates of trimethoprim and piperacillin were also low, which were 14.3.20 antibiotics and the highest resistance rate was ampicillin, which reached 71.4. Other antibiotics also have high rates of drug resistance. 5. In this study, the results of drug sensitivity of common Gram-positive cocci in our hospital in 2009 showed that the rate of drug resistance and the detection rate of MRS in ICU were lower than those in the whole hospital. Conclusion: 1. The contamination of information system in ICU is worthy of attention. They can be used as cross-carriers to cause cross-infection in hospital. They should be cleaned and disinfected regularly to minimize the risk of nosocomial infection. 2. Staff should recognize that the bacteria transmitted by their hands can cause nosocomial infections in intensive care units. Before and after operation and before using the information system, each staff member should wash their hands or sterilize or use gloves to isolate them.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R187

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