Résumé
Objective To investigate perioperative antimicrobial prophylaxis in arthroscopic surgery in a hospital before and after intervention,evaluate intervention efficacy,and provide evidence for the rational clinical antimicro-bial application.Methods From August 2012,measures were taken to intervene perioperative antimicrobial use, perioperative antimicrobial use and surgical site infection(SSI)in 312 patients undergoing arthroscopic surgery be-tween September 2011 and August 2013 were retrospectively surveyed.Results A total of 312 patients were investi-gated,pre-and post-intervention were 150 and 162 cases respectively,SSI rates were both 0 before and after inter-vention. Antimicrobial usage rate after intervention was lower than before intervention (26.54% vs 100.00% ,χ2=1.781,P<0.001). Irrational antimicrobial use dropped obviously;average expense of antimicrobial agents dropped from (1165.69±756.33)yuan (RMB)before intervention to (32.71 ±119.29)yuan (RMB)after intervention (t= 3.330,P<0.001).Conclusion Perioperative antimicrobial usage rate in arthroscopic surgery at this hospital decreased significantly after intervention,rational use of antimicrobial agents has improved,SSI rate still remains zero.
Résumé
Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 (except 2006)were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant (χ2 = 35.14,P < 0.001 );prevalence rates of community-associated infection(CAI)were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit (ICU)had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant(χ2 = 5.21,96.24,respectively,both P <0.001).In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant (χ2 = 22.78,10.03,26.49,respectively,all P < 0.001 ).Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined (P < 0.05 ).Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.
Résumé
Objective To evaluate the effect of evidence-based bundle intervention strategy on reducing the inci-dence of central line-associated bloodstream infection (CLABSI).Methods Prospective and multicenter study was adopted,patients admitted to 54 intensive care units (ICUs)of 41 hospitals and with central venous catheters (CVCs)between October 1 ,2013 and September 30,2014 were monitored .Baseline data between October 2013 and March 2014 were collected as pre-intervention data;from April to September 2014,the participated hospitals performed intervention strategy,post-intervention data were compared with pre-intervention data.Results The usage rate of CVCs before and after intervention was significantly different (44.18% vs 44.63%,χ2 =5.526,P =0.019).Incidence of CLABSI before and after intervention was not significantly different(RR ,0.82[95%CI ,0.59-1 .13],P =0.10).Constituent ratio of catheter insertion sites between pre-and post-intervention was significantly different (χ2 =76.264,P <0.001),femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased(17.25% VS 13.72%;2.27% VS 1 .44%,respectively);hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention (79.73% vs 76.14%,P <0.001 ;91 .47% vs 74.26%,P <0.001 ,respectively);constituent ratio of skin disinfectant applica-tion before and after intervention was significantly different(χ2 =3.861 ,P <0.001 ),proportion of chlorhexidine ethanol increased (29.62% VS 50.56%);except daily assessment and record,compliance to other prevention and control measures before and after intervention were all significantly different(all P <0.001);utilization rate of max-imal sterile barrier,qualified rate of dressing of operators,and port disinfection were all significantly enhanced. Conclusion Bundle intervention in intubation and maintenance are implemented effectively,but intervention effect on CLABSI needs further study.
Résumé
OBJECTIVE@#To evaluate illness severity and to assess the prognosis with acute physiology and chronic health evaluation II (APACHE II) for patients after cardiovascular surgery.@*METHODS@#APACHE II scores of 234 patients in the cardiac surgical intensive care unit (CSICU) were calculated, and the actual mortality and the predicted mortality were obtained based on the score.@*RESULTS@#The APACHE II score of the 234 patients was 14.22±6.77. The difference in the APACHE II score between the survivors, the patients with complications and the death group was significant; the difference in the APACHE II score between patients with different preoperative cardiac functions was significant; the detention time in the CSICU was positively related to APACHE II scores; and the ROC area under the curve of APACHE II was 0.991±0.006. With the predicted rate >30% as the standard for death, sensitivity of APACHE II score for mortality risk prediction was 80.00%, specificity was 99.12%, and the accuracy was 98.72%. According to the score, we divided the patients into 3 groups (20 points), forecast mortality in the >20 point group was in the 95% confidence interval of actual mortality.@*CONCLUSION@#APACHE II is a good index for illness severity and prognosis assessment for patients after cardiovascular surgery.