1例气性坏疽病例报告
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摘要
目的通过对医院收治的1例气性坏疽患者的诊疗及其医院感染防控效果观察,探讨此类疾病的院内感染防控路径。方法某男性患者阴囊肿胀伴破溃流脓半月余于2018年2月24日入院。结合案例的具体特点,依据现有法规,采取一系列有步骤的防控措施。结果患者因阴囊肿胀伴破溃流脓就诊,当地医院抗炎治疗,效果不明显,并逐渐出现皮肤苍白、紧张发亮,破溃流脓,局部呈黑紫色,出现液体水泡,流出恶臭味液体,局部组织失去弹性,急诊来我院,以"阴囊气性坏疽"收入院。入院后在腰麻下接受清创术,手术过程顺利。术后无菌操作下每日换药,阴囊部感染得到控制并逐渐好转。并于3月5日在某医院创伤中心会诊,3月8日在感染控制后接受阴囊部成形术,术后恢复好。结论阴囊气性坏疽在临床上极为罕见,因而针对性的医院感染防控措施缺乏现成的经验。医院各部门配合和无缝衔接,采取主动预防,措施得力,得以保证未出现院内感染的情况。由此可见,院内感染可防可控,对于此类罕发事件,不必恐慌和过度防护。采取合理、有效的感染控制措施,是控制医院感染、保障医疗安全的关键。
OBJECTIVE To observe the diagnosis,radical treatments and the proactive infection control measures of 1 case with gas gangrene of scrotum in a hospital,so as to provide the control and prevention programs for this type of infection in the hospital.METHODS A male patient with penile swelling accompanied by ulceration and pus lasting for more than half a month was admitted to the hospital on Feb.24,2018.According to the existing laws and regulations,a series of prevention and control measures were taken step by step,combining with the analysis of the case.RESULT The patient visited the hospital and received anti-inflammatory treatment in the local hospital,but the effect was not obvious.And pale skin,increased tension,ulceration,frank purulence,local blisters,odor liquid,and loss of local tissue elasticity occurred gradually.The patient came to the hospital emergency department with a diagnosis of scrotum gas gangrene.After conduction of a debridement,the infection was under control and gradually improved under the daily dressing change with sterile technique.The patient received a consultation on Mar.5,underwent scrotoplasty on Mar.8,and recovered well.CONCLUSION Gas gangrene of the scrotum is extremely rare in clinical practice.There is a lack of ready-made experience in targeted prevention and control measures of nosocomial infection.The various departments of our hospital cooperated,took effective defense measures actively,and ensured reducing and lowering the risk of infection transmission.Prevention and control of nosocomial infection with rare diseases should be free from blind panic and overprotection.Taking reasonable and effective measures is the key to control nosocomial infection and finally to achieve health care security.
OBJECTIVE To observe the diagnosis,radical treatments and the proactive infection control measures of 1 case with gas gangrene of scrotum in a hospital,so as to provide the control and prevention programs for this type of infection in the hospital.METHODS A male patient with penile swelling accompanied by ulceration and pus lasting for more than half a month was admitted to the hospital on Feb.24,2018.According to the existing laws and regulations,a series of prevention and control measures were taken step by step,combining with the analysis of the case.RESULT The patient visited the hospital and received anti-inflammatory treatment in the local hospital,but the effect was not obvious.And pale skin,increased tension,ulceration,frank purulence,local blisters,odor liquid,and loss of local tissue elasticity occurred gradually.The patient came to the hospital emergency department with a diagnosis of scrotum gas gangrene.After conduction of a debridement,the infection was under control and gradually improved under the daily dressing change with sterile technique.The patient received a consultation on Mar.5,underwent scrotoplasty on Mar.8,and recovered well.CONCLUSION Gas gangrene of the scrotum is extremely rare in clinical practice.There is a lack of ready-made experience in targeted prevention and control measures of nosocomial infection.The various departments of our hospital cooperated,took effective defense measures actively,and ensured reducing and lowering the risk of infection transmission.Prevention and control of nosocomial infection with rare diseases should be free from blind panic and overprotection.Taking reasonable and effective measures is the key to control nosocomial infection and finally to achieve health care security.
引文
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[2]Srivastava I,Aldape MJ,Bryant AE,et al.Spontaneous C.septicum gas gangrene:a literature review[J].Anaerobe,2017,48:165-171.
[3]中华人民共和国卫生部.医疗机构消毒技术规范[S].中华人民共和国卫生部,2012.
[4]中华人民共和国卫生部.医院隔离技术规范[S].中华人民共和国卫生部,2009.
[5]中华人民共和国国务院.医疗废物管理条例[S].中华人民共和国卫生部,2003.
[6]Taylor GM,Hess DV.Fournier gangrene:a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female[J].Oxf Med Case Reports,2018,2018(2):omx094.
[7]白涛.现代创伤诊断学[M].广州:人民军医出版社,1996:7.
[8]马亦林,李兰娟.传染病学[M].第五版.上海:上海科学技术出版社,2011:545.
[9]Singh A,Ahmed K,Aydin A,et al.Fournier's gangrene.A clinical review[J].Arch Ital Urol Androl,2016,88(3):157-164.
[10]Wang S,Liu L.Gas gangrene following implant removal after the union of a tibial plateau fracture:a case report[J].BMCMusculoskelet Disord,2018,19(1):254.
[11]Milanese G,Quaresima L,Dellabella M,et al.A conservative approach to perineal Fournier's gangrene[J].Arch Ital Urol Androl,2015,87(1):28-32.
[12]Dagur G,Lee MY,Warren K,et al.Critical manifestations of pneumoscrotum[J].Curr Urol,2016,9(2):62-66.
[13]Nyirenda D,Ten Ham-Baloyi W,Williams R,et al.Knowledge and practices of radiographers regarding infection control in radiology departments in Malawi[J].Radiography(Lond),2018,24(3):e56-e60.
[14]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[15]Sydnor ER,Perl TM.Hospital epidemiology and infection control in acute-care settings[J].Clin Microbiol Rev,2011,24(1):141-173.