Deniz Ahmet, Erhan Ömer Lütfi, Bayar Mustafa Kemal, Karatepe Ümit, Demirel İsmail
Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey.
Department of Anaesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2017 Dec;45(6):353-360. doi: 10.5152/TJAR.2017.68095. Epub 2017 Nov 29.
This retrospective study aimed to evaluate the effect of a restructured anaesthesia intensive care unit (ICU) on changes in infection rates and infections.
Organisational restructuring was done in the anaesthesia ICU of Firat University Hospital after it was relocated on 14 March 2012. This study was designed to investigate the effect of restructuring on infection rates through a comparison of periods encompassing one year before relocation and one year after relocation. Nosocomial infections were diagnosed according to modified Centers for Disease Control and Prevention (CDC) criteria. In total, 406 patients who were over 18 years old and admitted to the ICU were included; they were hospitalised for 48 h or longer and had non-infectious diseases according to physical examination, laboratory and culture results on admission. The data of 214 patients (Group A) and 192 patients (Group B) were examined.
Parameters such as age, gender, primary diagnosis and mean GCS score at admission and mean duration of hospitalisation showed no effect on the rates of infection, but rates of total infection (41.1% vs. 25%), urinary (18.7% vs. 10.4%) and VIP (32.7% vs. 14.6%) were detected in Groups A and B. Statistically significant differences were found for the causative pathogens Pseudomonas (15.4% vs. 6.8%), Acinetobacter (18.2% vs. 12%) and Escherichia (8.9% vs. 2.1%); the mean duration of mechanical ventilation (15.01±16.681 vs. 12.22±17.595) and discharge with improvement (31.8% vs. 44.3%).
We detected that restructuring (such as acclimatization, educated staff, hepa filter) caused a significant decline in infection rates. Because ICU staff may be a major cause of infection, we believe that providing education and conducting effective surveillance programs will be the most important factors for reducing infection rates.
本回顾性研究旨在评估重组后的麻醉重症监护病房(ICU)对感染率变化及感染情况的影响。
菲拉特大学医院麻醉ICU于2012年3月14日搬迁后进行了组织架构重组。本研究旨在通过比较搬迁前一年和搬迁后一年的时间段来调查重组对感染率的影响。医院感染根据美国疾病控制与预防中心(CDC)修改后的标准进行诊断。总共纳入了406例18岁以上入住ICU的患者;他们住院时间为48小时或更长时间,根据入院时的体格检查、实验室检查和培养结果患有非感染性疾病。对214例患者(A组)和192例患者(B组)的数据进行了检查。
年龄、性别、入院时的主要诊断、平均格拉斯哥昏迷评分(GCS)以及平均住院时间等参数对感染率无影响,但A组和B组的总感染率(41.1%对25%)、泌尿系统感染率(18.7%对10.4%)和血管内导管相关感染率(32.7%对14.6%)有所不同。在致病病原体方面发现了统计学上的显著差异,如铜绿假单胞菌(15.4%对6.8%)、不动杆菌(18.2%对12%)和大肠埃希菌(8.9%对2.1%);机械通气的平均持续时间(15.01±16.681对12.22±17.595)以及好转出院率(31.8%对4)。
我们发现重组(如环境适应、工作人员培训、高效空气过滤器)导致感染率显著下降。由于ICU工作人员可能是感染的主要原因,我们认为提供培训和开展有效的监测计划将是降低感染率的最重要因素。