文献詳細
文献概要
特集 医療・福祉施設における感染制御と臨床検査 各論 1.様々な環境下での施設内感染制御
7) 救急医療と感染制御
著者: 竹末芳生1
所属機関: 1兵庫医科大学医学部医学科感染制御学
ページ範囲:P.1327 - P.1331
文献購入ページに移動はじめに
救急医療の問題点は,重症市中感染と他院での重症院内感染の双方を受け入れることであり,他院から搬送される場合は,多剤耐性菌の持ち込み対策として,入院時の監視培養を行っている施設も多い.疾患上特に問題となることは,熱傷患者における感染対策と人工呼吸器管理患者における人工呼吸器関連性肺炎(ventilator-associated pneumonia;VAP)である.本稿ではこれらについて解説する.
救急医療の問題点は,重症市中感染と他院での重症院内感染の双方を受け入れることであり,他院から搬送される場合は,多剤耐性菌の持ち込み対策として,入院時の監視培養を行っている施設も多い.疾患上特に問題となることは,熱傷患者における感染対策と人工呼吸器管理患者における人工呼吸器関連性肺炎(ventilator-associated pneumonia;VAP)である.本稿ではこれらについて解説する.
参考文献
1) Rello J, Soñora R, Jubert P, et al:Pneumonia in intubated patients:role of respiratory airway care. Am J Respir Crit Care Med 154:111-115, 1996
2) Dezfulian C, Shojania K, Collard HR, et al:Subglottic secretion drainage for preventing ventilator-associated pneumonia:a meta-analysis. Am J Med 118:11-18, 2005
3) Griffiths J, Barber VS, Morgan L, et al:Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330:1243, 2005
4) Lorente L, Lecuona M, Galván R, et al:Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used. Infect Control Hosp Epidemiol 25:1077-1082, 2004
5) Vonberg RP, Eckmanns T, Welte T, et al:Impact of the suctioning system(open vs. closed)on the incidence of ventilation-associated pneumonia:meta-analysis of randomized controlled trials. Intensive Care Med 32:1329-1335, 2006
6) Jongerden IP, Rovers MM, Grypdonck MH, et al:Open and closed endotracheal suction systems in mechanically ventilated intensive care patients:a meta-analysis. Crit Care Med 35:260-270, 2007
:Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med 156:466-472, 1997
open system. Intensive Care Med 32:538-544, 2006
9) Delaney A, Gray H, Laupland KB, et al:Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients:a systematic review and meta-analysis. Crit Care 10:R70, 2006
. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia:a randomized study. Crit Care Med 34:396-402, 2006
11) Guerin C, Gaillard S, Lemasson S, et al:Effects of systematic prone positioning in hypoxemic acute respiratory failure:a randomized control trial. JAMA 292:2379-2387, 2004
12) de Smet AM, Kluytmans JA, Cooper BS, et al:Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360:20-31, 2009
13) Houston S, Hougland P, Anderson JJ, et al:Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 11:567-570, 2002
14) Pineda LA, Saliba RG, El Solh AA:Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia:a meta-analysis. Crit Care 10:R35, 2006
15) Mori H, Hirasawa H, Oda S, et al:Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 32:230-236, 2006
16) Kress JP, Pohlman AS, O'Connor MF, et al:Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471-1477, 2000
17) Cook DJ, Walter SD, Cook RJ, et al:Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433-440, 1998
18) Shorr AF, Duh MS, Kelly KM, et al:Red blood cell transfusion and ventilator-associated pneumonia:A potential link? Crit Care Med 32:666-674, 2004
19) Bochicchio GV, Napolitano L, Joshi M, et al:Blood product transfusion and ventilator-associated pneumonia in trauma patients. Surg Infect(Larchmt)9:415-422, 2008
20) Artinian V, Krayem H, DiGiovine B:Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129:960-967, 2006
post-pyloric feeding:a systematic review. Crit Care 7:R46-R51, 2003
掲載誌情報