[目的]检索分析并总结重症监护室(ICU)病人皮肤清洁相关证据,为临床护理人员对ICU病人擦浴提供依据。[方法]应用循证护理的方法,针对成人ICU病人擦浴提出问题,并检索近10年内的相关研究,检索数据库依次为:Best Practice、Up to Data、...[目的]检索分析并总结重症监护室(ICU)病人皮肤清洁相关证据,为临床护理人员对ICU病人擦浴提供依据。[方法]应用循证护理的方法,针对成人ICU病人擦浴提出问题,并检索近10年内的相关研究,检索数据库依次为:Best Practice、Up to Data、美国指南网(NGC)、苏格兰学院间指南网(SIGN)、澳大利亚循证卫生保健中心(JBI)证据总结数据库、Cochrane Library,并补充了检索原始文献数据库PubMed、Web of Science、Science Direct数据库和中国生物医学文献数据库及中国知网数据库。采用英国2012年更新的《临床指南研究与评价系统》AGREE Ⅱ、JBI的文献质量评价工具对各类研究进行文献质量评价及证据级别评定。[结果]包括指南4篇、证据总结2篇、专家共识2篇、系统评价4篇、随机对照试验10篇、类实验研究6篇,前瞻性队列研究1篇。最终从适宜人群、不同部位的清洁、洗浴用品的选择、洗浴用品的浓度、洗浴的频率和总时长、卫生经济评价、安全性评价7个方面进行了证据总结,形成了17条最佳证据。[结论]建议临床使用证据时充分考虑可行性及适宜性,由于最佳证据会随着时间的推移不断更新,应用者还需持续对证据进行更新以应用最佳证据。展开更多
医源性感染(health care-associated infection)是威胁病人安全的主要问题,世界病人安全联盟会议制定2005～2006年度全球病人安全挑战的主题是“清洁卫生更安全(clean care is safer care)”,目的在于在全球推行使用成本低、操作简便和...医源性感染(health care-associated infection)是威胁病人安全的主要问题,世界病人安全联盟会议制定2005～2006年度全球病人安全挑战的主题是“清洁卫生更安全(clean care is safer care)”,目的在于在全球推行使用成本低、操作简便和卓有成效的方法控制医源性感染,其核心思想是在卫生保健中开展“手部清洁(hand hygiene)”运动。文章介绍此次全球病人安全挑战的主要工作目标和内容。展开更多
Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low...Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).展开更多
AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients wi...AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous e展开更多
<strong>Background:</strong> This paper aims to determine if the combination of polymerase chain reaction (PCR) and next-generation sequencing (NGS) could identify bacteria in culture-negative urine that w...<strong>Background:</strong> This paper aims to determine if the combination of polymerase chain reaction (PCR) and next-generation sequencing (NGS) could identify bacteria in culture-negative urine that would alter prophylaxis management. <strong>Methods:</strong> We sent approximately 5 - 10 mL of a preoperative urine sample to MicrogenDx for PCR/NGS analysis performed after surgery (blind to the surgeon). The physician prescribed standard of care antibiotic prophylaxis. Cases modeling the hospital course of 3 random patients were reviewed by eight urologists after surgery to determine if NGS results would change their prophylaxis regimen. An infectious disease pharmacist reviewed the cases and provided the “ideal” regimen. <strong>Results:</strong> Urine cultures identified bacteria in 11% (2/18) of cases. Culture speciation results were consistent with NGS results. NGS detected a dominant bacteria in 56% (10/18) of negative cultures and targetable bacteria in all samples. There was a 15% (3/20) infection rate. In both cases, NGS results suggest inadequate prophylaxis. In response to the case scenarios, 100%, 88%, and 88% of the urologists reported they would change prophylaxis with NGS results. During a case scenario, physicians would tend to overprescribe antibiotics given PCR/NGS data for prophylaxis selection. <strong>Conclusion:</strong> NGS identifies a targetable bacterium in up to 80% of negative urine cultures before urologic stone surgery. Responses to case scenarios indicate that physicians would change management based on NGS results. Inter-professional (urologic and pharmacy) antibiotic selection with PCR/16S DNA testing may be helpful to improve antibiotic stewardship.展开更多
文摘[目的]检索分析并总结重症监护室(ICU)病人皮肤清洁相关证据,为临床护理人员对ICU病人擦浴提供依据。[方法]应用循证护理的方法,针对成人ICU病人擦浴提出问题,并检索近10年内的相关研究,检索数据库依次为:Best Practice、Up to Data、美国指南网(NGC)、苏格兰学院间指南网(SIGN)、澳大利亚循证卫生保健中心(JBI)证据总结数据库、Cochrane Library,并补充了检索原始文献数据库PubMed、Web of Science、Science Direct数据库和中国生物医学文献数据库及中国知网数据库。采用英国2012年更新的《临床指南研究与评价系统》AGREE Ⅱ、JBI的文献质量评价工具对各类研究进行文献质量评价及证据级别评定。[结果]包括指南4篇、证据总结2篇、专家共识2篇、系统评价4篇、随机对照试验10篇、类实验研究6篇,前瞻性队列研究1篇。最终从适宜人群、不同部位的清洁、洗浴用品的选择、洗浴用品的浓度、洗浴的频率和总时长、卫生经济评价、安全性评价7个方面进行了证据总结,形成了17条最佳证据。[结论]建议临床使用证据时充分考虑可行性及适宜性,由于最佳证据会随着时间的推移不断更新,应用者还需持续对证据进行更新以应用最佳证据。
文摘医源性感染(health care-associated infection)是威胁病人安全的主要问题,世界病人安全联盟会议制定2005～2006年度全球病人安全挑战的主题是“清洁卫生更安全(clean care is safer care)”,目的在于在全球推行使用成本低、操作简便和卓有成效的方法控制医源性感染,其核心思想是在卫生保健中开展“手部清洁(hand hygiene)”运动。文章介绍此次全球病人安全挑战的主要工作目标和内容。
文摘Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).
基金Supported by A grant for her PhD from Sanofi Pasteur,France,to Khanafer N
文摘AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous e
文摘<strong>Background:</strong> This paper aims to determine if the combination of polymerase chain reaction (PCR) and next-generation sequencing (NGS) could identify bacteria in culture-negative urine that would alter prophylaxis management. <strong>Methods:</strong> We sent approximately 5 - 10 mL of a preoperative urine sample to MicrogenDx for PCR/NGS analysis performed after surgery (blind to the surgeon). The physician prescribed standard of care antibiotic prophylaxis. Cases modeling the hospital course of 3 random patients were reviewed by eight urologists after surgery to determine if NGS results would change their prophylaxis regimen. An infectious disease pharmacist reviewed the cases and provided the “ideal” regimen. <strong>Results:</strong> Urine cultures identified bacteria in 11% (2/18) of cases. Culture speciation results were consistent with NGS results. NGS detected a dominant bacteria in 56% (10/18) of negative cultures and targetable bacteria in all samples. There was a 15% (3/20) infection rate. In both cases, NGS results suggest inadequate prophylaxis. In response to the case scenarios, 100%, 88%, and 88% of the urologists reported they would change prophylaxis with NGS results. During a case scenario, physicians would tend to overprescribe antibiotics given PCR/NGS data for prophylaxis selection. <strong>Conclusion:</strong> NGS identifies a targetable bacterium in up to 80% of negative urine cultures before urologic stone surgery. Responses to case scenarios indicate that physicians would change management based on NGS results. Inter-professional (urologic and pharmacy) antibiotic selection with PCR/16S DNA testing may be helpful to improve antibiotic stewardship.
