| BackgroundHospital infection is also called the hospital acquired infection or nosocomialinfection, the patients safety pose a great threat.β-lactamase refers to catalyze thehydrolysis of6-6-aminopenicillanic acid (6-APA) and7-7-aminocephalosporanicacid(7-ACA) and N-acyl derivatives of β-lactam ring amide enzyme inactivation.Since the last century eighty’s ESBL, many areas of the world are constantly newESBL were reported, each country of ESBL producing bacteria was significantlydifferent. As a result of ESBL producing strains causing infection incidence continuesto rise, ESBL in popular around the world more and more serious, and even in somehospital outbreaks, especially for production of complex ESBL strains caused bynosocomial infection reports. Production of ESBL infection continues to grow, moreclinical and scientific workers to ESBL strain ESBL producing strains and attention,has a wide spectrum of resistance, to clinical anti infection treatment has caused greatdifficulties. The reason may be widespread clinical use of third generationcephalosporins and other extended-spectrumβ-lactam antibiotics, due to Escherichiacoli and Klebsiella pneumoniae can be induced by antibiotics or in antibacterial drugselective pressure to produce a ESBL bacteria.Bacteria produce beta-lactamase is bacterialβ-lactam antibiotics resistancemechanism. βAmidase is divided into chromosomal mediated drug resistance plasmidmediated enzyme and enzyme hydrolysis of two categories, according to the object isdivided into penicillin,Cephalosporins enzyme, broad-spectrum enzyme and enzyme four kindsextended-spectrum. Extended-spectrum β-lactamases (extended spectrum Betalaetamase, ESBL) is a kind of third generation cephalosporins and aztreonam,βacylinside Beta-lactam antibiotic with strong hydrolysis enzyme. Because ESBL producing bacterialβ-lactamase genes located on the matter Grain, throughtransformation, transduction, transposition, conjugative transfer and integration of theresistance in different bacteria In the transmission, causing resistance to bacterialepidemic. Extended-spectrum β-lactamases (ESBL) is able to inactivate the narrowspectrum And broad-spectrum cephalosporin, single ring antibiotics and anti G-colipenicillin antibiotics such asβ-lactamases.In recent years our country of neonatalnosocomial infections is rising year by year in the grim situation, the neonatal ward isin critically ill children care And treatment of specific regions, many children for thecritically ill, immune function is very low, is the hospital infection of susceptible. Thecrowd, so it is an urgent need to find the source of infection and cut off the route oftransmission, clinical care and hospital infection with Reliable evidence.ObjectiveIn order to understand the Changchun regional neonatal infection bacteria in theanalysis of ESBL, ESBL infection related factors, infection and drug resistance; takeprospective nursing measures, effectively lowered ESBL bacteria causing nosocomialinfection rate. Guide for nosocomial infection and nursing measures taken to providea scientific basis. At the same time for clinical anti infection treatment provides therational use of antibiotics in reference, and studies on the mechanism of bacterialresistance has important significance. As of ESBL producing strains of resistance, thetransfer of resistant gene and the distribution of research to provide a simple, specificway.MethodThis study is divided into two steps. The first part, on the2011January-12months new admitted699patients were hospitalized for screening, collected within24hours and72-96hours in nasopharyngeal swab and stool specimens for detection.Understanding of neonatal ward ESBL bacteria infection status, analysis of infectionfactors. The second part, on the2012January-2012year in October of690inpatientswere studied and compared, in two groups of patients in primary disease, treatmentmethod under the same circumstances, take different nursing intervention measures. The control group adopted conventional nursing measures, the observation group inaddition to routine nursing measures and to take admission in isolated-Detection-isolation, execute special nursing, contact with water to wash before wearing glovesprospective nursing intervention measures. Collected in24hours and72hours-96hours of patients with faecal specimens and nasopharyngeal swab specimens fordetection. The specimens to the scientific research room of ESBL producing strains ofbacterial culture, drug sensitivity test, biochemical identification and ESBL geneanalysis. Comparing the two groups of patients with nosocomial infection. Designed aunified form for recording patient condition, carries on statistics processing.ResultThe1portion of the first study found that in2011January to December in72to96hours in patients with nasopharyngeal swab specimens and stool specimens of ESBLbacteria detection of stool samples positive rate was increased by39.37%,nasopharyngeal swab specimens positive rate was increased by17.57%, there is theoccurrence of nosocomial infection. Nosocomial infection and seasonal distributionand the three and second generation cephalosporin use; and gender, age, clinicaldiagnosis, parents’ cultural level.The2portion of the second study found that in2012the observation group and thecontrol group in72to96hours of ESBL infection difference. Observation group thanin the control group, the total positive rate decreased by22.6%, the positive rate ofstool specimens decreased22.36%, nasopharyngeal swab specimens positive rate10.04%; medical staff, medical personnel, white hair coat patients nursing appliances,two groups were not detected in bacteria. The air in the ward of bacteria in two groupswere significantly positive rate is1.06%, no change. Controls temperature box surfacedetection of bacteria, the positive rate was1.06%(1/94). The patients in theobservation group clothing positive rate decreased by2.13%(2/94), the patients inthe observation group positive rate decreased by4.26%(4/94clothes), were notstatistically significant. The observation group the positive rate of hands of medical staff is reduced by7.45%(7/94), with statistical significance.The3observation group and control group disease of newborn extension turns over towithout the difference. Being out of hospital time and hospitalized expense existingdifference. Counts number of days that two groups of newborns are hospitalized,observation group patient on average hospitalization number of days7.0days, controlgroup patient on average hospitalization number of days11days. The observationgroup4days leaves the hospital compared with the control group ahead of time.Observation group on average each patient hospitalization expense3894.5Yuan,control group on average each patient hospitalization expense5973.1Yuan,observation group on average each patient saving of expense2078.6Yuan.Conclusion1ESBL producing strains in neonatal infections are not uncommon. From a few hoursto28days after birth, can the onset, peak incidence age6~15days;2ESBL producing strains in the prehospital can infection;3nosocomial infections have obvious seasonal winter spring;4hands of medical staff can spread bacteria ESBL;5of the third and second generation cephalosporins is the use of neonatal disease riskfactors in real estate ESBL bacteria;6take care interventions can make ESBL fungi positive rate was significantlyreduced, so that patients discharged4days ahead of schedule, cost savings of2078.6yuan. |
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