万级层流病房对初发急性白血病患者诱导化疗期间医院感染发病率的影响
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摘要
目的探讨万级层流病房对初发急性白血病患者诱导化疗期间医院感染发病率的影响。方法回顾性调查2013年10月—2014年6月某院血液科病房收治的初发急性白血病患者,万级层流病房收治的患者为试验组,普通病房收治的患者为对照组。所有患者均接受标准诱导化疗,接受相同的护理措施,比较两组患者医院感染发病率及病房空气洁净度。结果共收治初发急性白血病患者79例,试验组39例,对照组40例。层流病房房间、走廊空气洁净度(分别为3.57×106/m3、24.46×106/m3)与普通病房(分别为149.36×106/m3、15 854.38×106/m3)比较,差异均有统计学意义(t值分别为45.80、108.70,均P<0.001)。医院感染发病率试验组为23.08%(9/39),对照组为45.00%(18/40),两组比较,差异有统计学意义(χ2=4.219,P=0.040)。医院感染部位试验组主要为胃肠道(5例),对照组主要为下呼吸道(8例)。患者发热持续时间、抗菌药物使用时间及费用,试验组分别为(6.20±2.10)d、(9.35±2.12)d、(27 113.79±1 559.03)元;对照组分别为(10.20±2.90)d,(14.15±3.14)d、(58 566.29±2 217.54)元;两组患者发热持续时间、抗菌药物使用费用比较,差异均有统计学意义(t值分别为1.021、1 377.45,均P<0.05)。结论初发急性白血病患者使用层流病房,可降低其医院感染发病率,减少抗菌药物使用费用。
Objective To evaluate the effect of class 10 000 laminar flow ward on the incidence of healthcare-associated infection(HAI)in patients with initial occurrence of acute leukemia during induction chemotherapy period.Methods Patients with initial occurrence of acute leukemia admitted to a hematological department of a hospital between October 2013 and June 2014 were investigated retrospectively,patients in class 10 000 laminar flow ward was as trial group,in general ward was as control group.All patients received standard induction chemotherapy and the same nursing measures,the incidence of HAI between two groups of patients,and ward air cleanliness were compared.Results A total of 79 patients with initial acute leukemia were received(trial group,n=39;control group,n=40).The average air cleanliness value in rooms and corridors of laminar flow wards were both significantly different with general ward(3.57×106/m3 vs 149.36×106/m3,t=45.80,P<0.001;24.46×106/m3 vs 15 854.38×106/m3,t=108.70,P<0.001).Incidence of HAI between trial group and control group was significantly different(23.08%[9/39]vs 45.00%[18/40],χ2=4.219,P=0.040).The main infection site in trial group was gastrointestinal tract(n=5),in control group was lower respiratory tract(n=8).The duration of fever,duration and cost of antimicrobial use in trial group were(6.20±2.10)d,(9.35±2.12)d,and(27 113.79±1 559.03)yuan respectively,in control group were(10.20±2.90)d,(14.15±3.14)d,and(58 566.29±2 217.54)yuan respectively,difference in duration of fever and cost of antimicrobial use between two groups were all significant(t=1.021,1 377.45,both P<0.05).Conclusion Laminar flow ward can reduce the incidence of HAI in patients with initial occurrence of acute leukemia,and decrease cost of antimicrobial use.
Objective To evaluate the effect of class 10 000 laminar flow ward on the incidence of healthcare-associated infection(HAI)in patients with initial occurrence of acute leukemia during induction chemotherapy period.Methods Patients with initial occurrence of acute leukemia admitted to a hematological department of a hospital between October 2013 and June 2014 were investigated retrospectively,patients in class 10 000 laminar flow ward was as trial group,in general ward was as control group.All patients received standard induction chemotherapy and the same nursing measures,the incidence of HAI between two groups of patients,and ward air cleanliness were compared.Results A total of 79 patients with initial acute leukemia were received(trial group,n=39;control group,n=40).The average air cleanliness value in rooms and corridors of laminar flow wards were both significantly different with general ward(3.57×106/m3 vs 149.36×106/m3,t=45.80,P<0.001;24.46×106/m3 vs 15 854.38×106/m3,t=108.70,P<0.001).Incidence of HAI between trial group and control group was significantly different(23.08%[9/39]vs 45.00%[18/40],χ2=4.219,P=0.040).The main infection site in trial group was gastrointestinal tract(n=5),in control group was lower respiratory tract(n=8).The duration of fever,duration and cost of antimicrobial use in trial group were(6.20±2.10)d,(9.35±2.12)d,and(27 113.79±1 559.03)yuan respectively,in control group were(10.20±2.90)d,(14.15±3.14)d,and(58 566.29±2 217.54)yuan respectively,difference in duration of fever and cost of antimicrobial use between two groups were all significant(t=1.021,1 377.45,both P<0.05).Conclusion Laminar flow ward can reduce the incidence of HAI in patients with initial occurrence of acute leukemia,and decrease cost of antimicrobial use.
引文
[1]郑宇,李啸扬,任雨虹,等.初发急性白血病患者化学治疗后并发血流感染特点及危险因素分析[J].内科理论与实践,2015,10(5):359-364.
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[7]中华医学会血液学分会,中国医师协会血液科医师分会.中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南[J].中华血液学杂志,2012,33(8):693-696.
[8]牛俊丽,李晓芳,申巧红,等.千级无菌层流病房的使用与管理[J].解放军护理杂志,2010,27(4B):582.
[9]练英莲.层流病房管理标准化的研究[J].中华医院感染学杂志,2004,14(3):303-305.
[10]尚晋,魏天南,陈为民.急性白血病患者入住层流洁净病房对化疗后医院感染的影响[J].福建医药杂志,2011,33(6):69-70.
[11]张瑞春,廖丽昇.层流洁净病房在急性白血病化疗中应用效果的评价[J].福建医药杂志,2009,31(6):120-121.
[12]刘桂娟,朱广忠.层流洁净病房患者的医院感染控制[J].中国感染控制杂志,2004,3(4):333-334.
[13]廖丽昇,张瑞春,曲双,等.恶性血液病化疗中的全环境保护及应用效果评价[J].齐齐哈尔医学院学报,2010,31(8):1303-1305.
[2]陆道培.白血病治疗学[M].北京:科学出版社,2003:79.
[3]孙雨梅.急性白血病医院感染的临床分析[J].肿瘤,2006,26(4):402.
[4]王军,张新华,周敏,等.急性白血病化疗后医院感染及抗感染治疗分析[J].临床血液学杂志,2007,20(6):339-340,343.
[5]杨栎,陈鹏.层流床预防恶性血液病化疗后IV度骨髓抑制医院感染的效果[J].解放军医药杂志,2013,25(10):58-60.
[6]陆再英,钟南山.内科学[M].北京:人民卫生出版社,2008:593-599.
[7]中华医学会血液学分会,中国医师协会血液科医师分会.中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南[J].中华血液学杂志,2012,33(8):693-696.
[8]牛俊丽,李晓芳,申巧红,等.千级无菌层流病房的使用与管理[J].解放军护理杂志,2010,27(4B):582.
[9]练英莲.层流病房管理标准化的研究[J].中华医院感染学杂志,2004,14(3):303-305.
[10]尚晋,魏天南,陈为民.急性白血病患者入住层流洁净病房对化疗后医院感染的影响[J].福建医药杂志,2011,33(6):69-70.
[11]张瑞春,廖丽昇.层流洁净病房在急性白血病化疗中应用效果的评价[J].福建医药杂志,2009,31(6):120-121.
[12]刘桂娟,朱广忠.层流洁净病房患者的医院感染控制[J].中国感染控制杂志,2004,3(4):333-334.
[13]廖丽昇,张瑞春,曲双,等.恶性血液病化疗中的全环境保护及应用效果评价[J].齐齐哈尔医学院学报,2010,31(8):1303-1305.