Woeltje K F, Fraser V J
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
New Horiz. 1998 Feb;6(1):84-90.
Patients in an ICU are at increased risk for a nosocomial infection. Infection control practices to reduce these risks have often been based on scant information. A recent trend to base infection control practices on actual patient outcome data has often provided surprising results. Basic measures such as good handwashing and appropriate patient isolation must be followed. Routine venous catheter placement does not increase the risk of bacteremia, and increases procedure morbidity. The role of different catheter dressings and antibiotic-impregnated catheters in reducing bacteremia is unclear. Nosocomial pneumonias and ventilator-associated pneumonia are common in the ICU. Outcome studies suggest that infrequent changes of ventilatory circuits do not increase the risk of ventilator-associated pneumonia, while allowing substantial cost savings. Manipulation of the pH or flora of the gastrointestinal tract seems to have little influence on patient outcomes, even if there may be a slight reduction in nosocomial pneumonias. Although large randomized trials may be outside the scope of hospital infection control programs and ICUs, any hospital should be able to implement outcomes-based studies of changes in infection control policies and procedures.
重症监护病房（ICU）的患者发生医院感染的风险更高。降低这些风险的感染控制措施往往基于极少的信息。最近基于实际患者结局数据制定感染控制措施的趋势常常带来令人惊讶的结果。必须遵循如勤洗手和适当隔离患者等基本措施。常规静脉置管不会增加菌血症风险，反而会增加操作相关的发病率。不同的导管敷料和含抗生素导管在降低菌血症方面的作用尚不清楚。医院获得性肺炎和呼吸机相关性肺炎在ICU很常见。结局研究表明，不频繁更换通气回路不会增加呼吸机相关性肺炎的风险，同时还能大幅节省成本。即使可能会使医院获得性肺炎略有减少，但对胃肠道pH值或菌群的调控似乎对患者结局影响不大。尽管大型随机试验可能超出医院感染控制项目和ICU的范畴，但任何医院都应该能够开展基于结局的感染控制政策和程序变化研究。
