| Part 1 Research on nosocomial infection in neonatal intensive care unitObjective:To analyze the occurrence of nosocomial infection(NI)in neonatal intensive care unit(NICU),understand the infection route,main pathogens and drug susceptibility,and further explore the risk of NI Factors to provide data support and scientific basis for clinical development of effective NI control measures.Method:The clinical data of all neonates with a history of more than 48 hours in the NICU of our hospital from January 01,2016 to December 31,2019 were collected for retrospective research.By analyzing the incidence of NI,the type of infection,the distribution of pathogenic bacteria,and the drug sensitivity of common pathogenic bacteria in NICU in our hospital in the past 4 years,and using case-control research methods,the general situation of children between hospitalized and non-academic univariate analysis was performed on the status,personal history,mother and pregnancy history,and diagnosis and treatment,and then variables with significant differences were analyzed by multivariate logistic regression to determine the independent correlation between the variables and the incidence of NI.Result:1.In this study,a total of 3515 hospitalized newborns with NICU meeting the inclusion criteria were collected,including 181 neonates with NI and the incidence rate of NI was 5.15%;NI occurred 209 cases,the incidence rate of cases was 5.95%.2.Type distribution of NI:68 cases of pneumonia(32.54%),46 cases of sepsis(22.01%),23 cases of oral infections(11.00%),23 cases of thrush(11.00%),12 cases of urinary tract infection(5.74%)6 cases of central infection(2.87%),1 case of skin infection(0.48%),other 22 cases(10.53%).3.Distribution of common pathogenic bacteria in NI:149 pathogenic bacteria were detected.Among them,103 strains of Gram-negative bacteria(69.13%),the top three are 55 strains of Klebsiella pneumoniae(36.91%),12 strains of Acinetobacter baumannii(8.05%),Pseudomonas aeruginosa 11 strains(7.38%);29 strains of Gram-positive bacteria(19.46%),the top three were 16 strains of Staphylococcus(10.74%),10 strains of Enterococcus faecium(6.71%),and 1 strain of Enterococcus faecalis(0.67%);15 strains of fungi(10.07%),including 7 strains of Candida albicans(4.70%),7 strains of Candida parapsilosis(4.70%),and 1 strain of Saccharomyces cerevisiae(0.67%).4.Drug sensitivity of common pathogens:carbapenems have good sensitivity to ESBL-producing Klebsiella pneumoniae,but their sensitivity to ESBL-negative Klebsiella pneumoniae decreases,especially meropenem and imipenem(Sensitivity:64.29%,32.14%);In addition,Pseudomonas aeruginosa has different degrees of resistance to carbapenems,penicillins,and cephalosporins;but Bowman does not Although Acinetobacter is more sensitive to carbapenems and most of the third and fourth generation cephalosporins,it is less sensitive to ampicillin and ceftriaxone.At the same time,common Gram-positive bacteria are also highly resistant to penicillins,aminoglycosides,and quinolones;common fungi are highly sensitive to voriconazole,fluconazole,and amphotericin B,but they are nearly smooth The bacteria have developed different degrees of resistance to 5-fluorocytosine and itraconazole.5.Analysis of risk factors for NI in NICU:Univariate analysis showed that:neonates in hospital sense group and non-hospital sense group had gestational age,birth weight,mode of delivery,1-minute Apgar score,history of mechanical ventilation,history of indwelling gastric tube,indwelling center The history of venous catheters,the use of pulmonary surfactant(PS),glucocorticoids,blood transfusions,fatty milk,special-use antibacterial drugs,combined antibacterial drugs,and phototherapy have statistically significant differences(P<0.05);Further unconditional logistic regression analysis showed that the child's mode of delivery,history of indwelling central venous catheter,history of indwelling gastric tube,history of using PS,and history of blood transfusion were independent risk factors for NI.Conclusion:1.The incidence of NI in our hospital's NICU is lower than most domestic and foreign research reports.The main infection types are pneumonia and sepsis.The top three pathogens are Klebsiella pneumoniae,staphylococcus and Acinetobacter baumannii.The sensitivity to some clinical commonly used antimicrobial drugs showed a downward trend to varying degrees.2.The independent risk factors for NI in our hospital's NICU are:delivery method,history of indwelling central venous catheter,history of indwelling gastric tube,history of using PS,and history of blood transfusion.Part 2 Research on the influence of hand hygiene intensive management system on NI incidence in NICUObjective:To explore the application effect of hand hygiene intensive management system in the prevention and control of NI in NICU.Methods:Prospective research method was used to record the hand hygiene compliance rate,pass rate,and correlation of 233 clinical front-line staff in our NICU before and after the implementation of intensive hand hygiene management from October 01,2018 to September 30,2019 Indicators such as the rate of theoretical knowledge mastery and the amount of hand hygiene products used per bed.Comparing the awareness and compliance of the hand hygiene of the staff in the NICU before and after the implementation of strengthened management to evaluate the effect of the system on the incidence of NI in the NICU.Results:After the implementation of the hand hygiene strengthening management system,the overall hand hygiene compliance rate,pass rate,and related theoretical knowledge grasp rate of the staff in the NICU of our hospital were significantly improved compared with those before the strengthening management,and the difference was statistically significant(P<0.05).In addition,the use of antibacterial hand sanitizer and no-hand sanitizer after intensive management was significantly increased compared with that before intensive management,while the incidence of NI was significantly lower than that before intensive management.Conclusion:The enhanced hand hygiene management system can significantly improve the awareness and compliance of hand hygiene among staff in the NICU,thereby effectively reducing the incidence of NI. |
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