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重症监护病房中耐甲氧西林金黄色葡萄球菌的获得情况。

MRSA acquisition in an intensive care unit.

作者信息

Dancer Stephanie J, Coyne Michael, Speekenbrink A, Samavedam Sam, Kennedy Julie, Wallace Peter G M

机构信息

Health Protection Scotland, Clifton House, Western Infirmary, Glasgow, Scotland.

出版信息

Am J Infect Control. 2006 Feb;34(1):10-7. doi: 10.1016/j.ajic.2005.08.009.

Abstract

BACKGROUND

This paper describes a retrospective investigation of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in an 8-bed intensive care unit (ICU) over a 5-month period.

METHODS

Clinical and microbiologic data were collected from the ICU, including MRSA detection dates, patient dependency scores, standardized environmental screening data, weekly bed occupancies, number of admissions, and nurse staffing levels. MRSA acquisition weeks were defined as weeks during which initial delivery of MRSA occurred before sampling and laboratory confirmation. Weekly workloads were plotted against staffing levels and modelled against MRSA acquisition weeks and hygiene failures.

RESULTS

Of 174 patients admitted into the ICU, 28 (16%) were found to have MRSA; 12 of these (7%) acquired MRSA on the ICU within 7 of the 23 weeks studied. Six of these 7 weeks were associated with a deficit of trained nurses during the day and 5 with hygiene failures (data unavailable for 2). Pulsed-field gel electrophoresis (PFGE) profiles demonstrated relationships between staphylococci from staff hands, hand-touch sites, and patients' blood.

CONCLUSION

MRSA acquisition in the ICU was temporally associated with reduced numbers of trained nurses and hygiene failures predominantly involving hand-touch sites. Epidemiologic analysis suggested that patient acquisitions were 7 times more likely to occur during periods of nurse understaffing.

摘要

背景

本文描述了对一家拥有8张床位的重症监护病房(ICU)在5个月期间耐甲氧西林金黄色葡萄球菌(MRSA)感染情况的回顾性调查。

方法

从ICU收集临床和微生物学数据,包括MRSA检测日期、患者依赖评分、标准化环境筛查数据、每周床位占用情况、入院人数和护士人员配备水平。MRSA感染周定义为在采样和实验室确认之前首次检测到MRSA的周数。将每周工作量与人员配备水平进行对比,并针对MRSA感染周和卫生失误情况进行建模。

结果

在入住ICU的174名患者中,有28名(16%)被发现感染了MRSA;其中12名(7%)在研究的23周中的7周内在ICU感染了MRSA。这7周中的6周与白天训练有素的护士短缺有关,5周与卫生失误有关(2周数据缺失)。脉冲场凝胶电泳(PFGE)图谱显示了来自工作人员手部、手部接触部位和患者血液中的葡萄球菌之间的关系。

结论

ICU中MRSA的感染在时间上与训练有素的护士数量减少以及主要涉及手部接触部位的卫生失误有关。流行病学分析表明,在护士人员不足期间,患者感染MRSA的可能性要高7倍。

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