摘要
目的观察脱污染集束化护理方案对心脏手术院内感染的预防效果。方法收集2012年1月至2013年12月行心脏手术常规护理方案患者712例作为对照组。2014年5月至2016年4月执行心脏手术围手术期脱污染集束化护理方案患者791例作为脱污染组，该方案包括术前鼻咽腔细菌定植筛查，围手术期鼻咽腔和全身脱污染，针对耐甲氧西林金黄色葡萄球菌（MRSA）定植者采取隔离措施，并围手术期应用莫匹罗星和糖肽类抗生素预防感染。收集患者一般临床资料和转归，院内感染情况，进行统计学分析。结果对照组院内感染率为8.29%（59/712），其中MRSA感染4例。脱污染组院内感染率为5.56%（44/791），其中MRSA感染2例。2组院内感染率比较差异有统计学意义（χ^2=4.356，P〈0.05）。脱污染组鼻咽拭子发现MRSA定植6例（0.76%），都未发生MRSA感染。结论制定实施围手术期脱污染集束化护理方案，有助于进一步预防术后感染，尤其是MRSA感染。
Objective To observe the effect of the decontamination bundle of care for prevention of nosocomial infection after cardiac surgery.
Methods Patients who underwent routine perioperative care from January 2012 to December 2013 for cardiac surgery were enrolled as the control group, while patients with bundle of care from May 2014 to April 2016 as the decontamination group. The care bundle included preoperative nasopharyngeal screening for methicillin-resistant Staphylococcus aureus （MRSA）, perioperative systematic decontamination, isolation and antibiotic prophylaxis （mupirocin and glycopeptide） for MRSA carriers. The clinical data and nosocomial infection was collected and statistically analyzed. Results There were 712 cases in the control group and the incidence of nosocomial infection was 8.29% （59/712） including 4 MRSA cases. The decontamination group enrolled 791 cases with 5.56% （44/791） nosocomial infection including 2 MRSA cases. The bundles of care inhibited the nosocomial infection significantly （χ^2=4.356, P〈0.05）, and there was a trend of decrease on MRSA infection. A total of 6 cases （0.76%） in the decontamination group were detected as MRSA colonization, but none of them got infected.Conclusions The care bundle of perioperative decontamination is useful to prevent nosocomial infection in cardiac surgery, especially to MRSA infection.
作者
孙菊芳
普鹰
汤荣
虞敏
方芳
Sun Jufang Pu Yin Tang Rong Yu Min Fang Fang(Department of Nursing, Shanghai First People＇s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201620, China)
出处
《中国实用护理杂志》
2017年第27期2115-2118,共4页
Chinese Journal of Practical Nursing
基金
上海交通大学医学院科技基金（jyh1411）
关键词
心脏手术
集束化护理
氯己定
院内感染
预防性抗生素
Cardiac surgery
Bundles of care
Chlorhexidine
Nosocomial infection
Antibiotic prophylaxis
