ABSTRACT
Objective To investigate the detection and distribution of hospitalized specimens from a tertiary hospital over 5 years. Methods Specimens of sputum, urine, blood, secretions and puncture fluid were collected from patients admitted to the Harrison International Peace Hospital from November 2013 to November 2018. The origin of specimens, the distribution of departments and the distribution of pathogenic bacteria isolated were analyzed retrospectively. Results A total of 61 286 specimens were sent for examination during the 5 years. The top 5 specimens were sputum culture (n = 18 302, 29.9%), sputum smear (n = 11 253, 18.4%), blood culture (n = 9 713, 15.8%), urine culture (n = 6 448, 10.5%) and secretion culture (n = 6 133, 10.0%), accounting for 84.6% (51 849/61 286). Sputum specimens accounted for 48.2% (29 555/61 286) with the largest proportion. The number of specimens from medical wards was much higher than that from surgical wards (specimens: 25 468 vs. 10 521), respiratory medicine, department of critical care medicine and emergency intensive care unit (EICU) were important sources of pathogenic specimens in the hospital, accounting for 29.8% (18 243/61 286) in total. The average positive rate of all specimens was 23.5% (14 424/61 286). The positive rates of sputum culture and urine culture were 29.7% (5 428/18 302) and 35.4% (2 281/6 448), respectively, while the positive rate of blood culture was only 6.6% (643/9 713). Escherichia coli was the most common pathogen in all specimens except for sputum culture and fecal culture. Escherichia coli [40.6% (926/2 281)], Klebsiella pneumoniae [9.2% (210/2 281)], Pseudomonas aeruginosa [8.2% (188/2 281)], Enterococcus faecalis (group D) [6.6% (151/2 281)] and Candida albicans [3.2% (73/2 281)] were the most common pathogens in urine culture. Klebsiella pneumoniae [24.1% (1 309/5 428)], Acinetobacter baumannii [21.3% (1 154/5 428)], Pseudomonas aeruginosa [15.1% (818/5 428)], Escherichia coli [6.5% (351/5 428)] and Maltose oligotrophomonas maltose [5.8% (316/5 428)] were the most common pathogens in sputum culture. Escherichia coli [36.5% (235/643)], Klebsiella pneumoniae [10.9% (70/643)], Pseudomonas aeruginosa [4.8% (31/643)], Staphylococcus epidermidis [3.4% (22/643)] and Staphylococcus humanis [3.3% (21/643)] were the most common pathogens in blood culture. Conclusion Specimens sent for examination by inpatients are mainly from internal medicine wards, mainly from sputum, blood and urine, and the detected pathogens are mainly Gram-negative bacteria.
ABSTRACT
Objective To use evidence-based nursing on patients with artificial airway to the practice of stomach tube, and to evaluate the self made guidance for difficult gastric tube placement in patients with artificial airway.Methods Forty patients with artificial airway and were difficult to put the tube, and admitted to Department of Critical Care Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from April to December in 2016 were enrolled as observation group. Through the evidence-based nursing strategy, the related literatures at home and abroad were collected to search clinical evidence and formulate and implement the nursing program, the gastric tube was inserted into the stomach tube under the direct vision of the laryngoscope. Thirty-six patients of difficult gastric tube placement with artificial airway straightly under the direct vision of the laryngoscope from August 2015 to March 2016 were retrospectively analyzed as the control group. The success rate of first catheterization, indwelling time, throat edema and bleeding of pharyngeal mucosa were compared between the two groups.Results All patients were enrolled in the final analysis. In the control group, 28 patients were successfully placed once, while 8 failed. Only 1 patient in observation group failed to catheterize, and successful placed after symptomatic treatment, the one-time success rate of catheter was significantly higher than that of control group (97.5% vs. 77.8%), and catheter time was significantly shortened (minutes: 4.8±1.2 vs. 5.1±1.0), the difference was statistically significant (bothP < 0.05). There were 2 patients with laryngeal edema in the control group and 4 patients of pharyngeal mucosal hemorrhage. In the observation group, there was no laryngealedema and laryngeal edema occurred in the patients with laryngoscopy, and only 1 patient had a hemorrhage of pharyngeal mucosa.Conclusion Using self made guiding device can effectively insert the difficult gastric tube in patients with artificial airway, and increase the one-time success rate of intubation, shorten the catheter time, and have a trend in reduce complication as compared with traditional gastric tube placement.