Publication: Kardiyovasküler cerrahi girişim yapılan çocuklarda solunum yoluyla ilgili nozokomiyal etkenlerin saptanması
Abstract
Araştırmamız İ.Ü. Kardiyoloji Enstitüsü Cerrahi Yoğun Bakım Ünitesi'nde 20.06.1999-16.07.2000 tarihleri arasında kardiyovasküler cerrahi girişim yapılan ve cerrahi yoğun bakım ünitesinde yatan 0-5 yaş gurubu açık kalp ameliyatı olan entübe çocuklarda solunum yoluyla ilgili nozokomiyal enfeksiyon etkenlerinin saptanması amacıyla prospektif ve deneysel olarak planlanmıştır. Araştırmamızın örneklem gurubunu cerrahi yoğun bakım ünitesinde yatan, açık kalp ameliyatı olmuş, en az 48 saat entübe kalan 0-5 yaş grubu 30 çocuk oluşturmuştur. Verilerin toplanmasında literatür bilgisi doğrultusunda araştırmacı tarafından geliştirilen Hasta İzlem Formu kullanılmıştır. Hastalardan preoperatif ve postoperatif dönemde alınan örneklerin kültür sonuçları hasta izlem formuna kayıt edilmiştir. Elde edilen veriler istatistiksel yönden yüzdelik, aritmatik ortalama, standart sapma, x2 ve student-t testi ile değerlendirilmiştir. Araştırmamızda preoperatif dönemde burun ve boğaz sürüntüsü örneklerinde üreyen patojen mikroorganizmaların türlerine göre dağılımı incelendiğinde hastaların en sık (%33.3) Candida sp. ile kolonize olduğu saptandı. Araştırmamızda postoperatif dönemde aldığımız örneklerin kültüründe patojen mikroorganizma üremesi incelendiğinde hastaların %56.6'ının mide mayinde , %53.3 ' ünün aspirasyon katater ucu+mayinde, %20'inin ventilatör borularında, %13.3' ünün ambularında üreme olduğu, oksijen nemlendirici sıvılarında ise üreme olmadığı saptanmıştır (p< 0,001). Hastaların postoperatif dönem aspirasyon katater ucu+mayi ve mide mayi örneklerinde saptanan patojen mikroorganizma üreme başlangıçlarının entübasyon süreleriyle ilişkisi istatistiksel olarak anlamlı bulunmamıştır (p>0.05). Araştırmamızda postoperatif dönem hastalardan aldığımız örneklerin kültürlerinde en çok gram negatif çomak üremesi olduğu, bunlardan da özellikle Enterobacter sp. (%25.2), P. aureginosa (%23.4) ve K. pneumoniae (%11,1) ile yoğun kolonizasyon olduğu saptanmıştır. Araştırma sonucumuz göstermiştir ki cerrahi yoğun bakım ünitesinde ki entübe çocukların mide ve alt solunum yolu patojen mikroorganizmalarla yoğun biçimde kolonize olmaktadır. Çocukların hospitalizasyon süreci içinde hemşirelik bakımında ve uygulanacak girişimlerde aseptik teknik ilkelerinin uygulanması, enfeksiyon kontrol önlemlerinin alınması, kolonizasyon nedeniyle gelişebilecek nozokomiyal enfeksiyonların önlenmesinde büyük önem taşımaktadır.
DETERMINATION OF CAUSES OF NOSOCOMIAL INFECTIONS RELATED TO RESPIRATORY TRACT, IN THE CHILDREN UNDERGOING CARDIOVASCULAR SURGERY This study was prospective and experimentally planned to determine the causes of nosocomial infections related to respiratory tract in the 0-5 aged children who are undergoing open heart surgery, intubated, and hospitalized at the surgical intensive care unit (SICU), and it took place at the surgical intensive care unit of Istanbul University, Cardiology Institute between 20.06.1999 and 16.07.2000) Our sample group consists of 0-5 aged, 30 children who had open-heart surgery and intubated (mechanically ventilated) longer than 48 hours in the SICU. In the collection of the data, the patient information form developed by the researcher according to literature was used. The results of sample cultures, which are collected during the preoperative and postoperative period, were recorded to the patient information form. The obtained data were evaluated with the test of percentage, mean, standard deviation chi-square and sduden-t. In our research, when we examine the distribution of the pathogen microorganisms cultivating in the preoperative period samples sweep of nasal an throat according to their kinds, results showed that patients were mostly colonized by the Candida sp. (33.3%) When pathogen microorganism cultivation were examined in the postoperative period samples' culture, there were cultivation in 56.6 % of the patients in gastric fluid, 53.3% in aspiration catheter end+fluid, 20% in ventilation tubes. 13.3% in anbus, and not in the oxygen moisturizer liquids(p<0.001). There is not statistically meaningful correlation between pathogen microorganism cultivation starting times in aspiration catheter end+fluid and gastric fluid samples of patients in post operative period and intubation times (p>0.05). In the cultures of the samples taken from patients, gram negative rods were mostly found, especially intensive collonization of Enterobakter sp. (25.2%), P. aureginosa (23.4%), and K. pneumoniae (11.1%) were found. Results of our study show that intubated children's stomach and lower respiratory tract are colonized intensively by the pathogen microorganisms in the SICU. It is substantial to take precautions for infection and apply aseptic technique principles, to prevent nosocomial infections ,which can develop because of colonization during the hospitalization of children in the nursing care and procecedures.
DETERMINATION OF CAUSES OF NOSOCOMIAL INFECTIONS RELATED TO RESPIRATORY TRACT, IN THE CHILDREN UNDERGOING CARDIOVASCULAR SURGERY This study was prospective and experimentally planned to determine the causes of nosocomial infections related to respiratory tract in the 0-5 aged children who are undergoing open heart surgery, intubated, and hospitalized at the surgical intensive care unit (SICU), and it took place at the surgical intensive care unit of Istanbul University, Cardiology Institute between 20.06.1999 and 16.07.2000) Our sample group consists of 0-5 aged, 30 children who had open-heart surgery and intubated (mechanically ventilated) longer than 48 hours in the SICU. In the collection of the data, the patient information form developed by the researcher according to literature was used. The results of sample cultures, which are collected during the preoperative and postoperative period, were recorded to the patient information form. The obtained data were evaluated with the test of percentage, mean, standard deviation chi-square and sduden-t. In our research, when we examine the distribution of the pathogen microorganisms cultivating in the preoperative period samples sweep of nasal an throat according to their kinds, results showed that patients were mostly colonized by the Candida sp. (33.3%) When pathogen microorganism cultivation were examined in the postoperative period samples' culture, there were cultivation in 56.6 % of the patients in gastric fluid, 53.3% in aspiration catheter end+fluid, 20% in ventilation tubes. 13.3% in anbus, and not in the oxygen moisturizer liquids(p<0.001). There is not statistically meaningful correlation between pathogen microorganism cultivation starting times in aspiration catheter end+fluid and gastric fluid samples of patients in post operative period and intubation times (p>0.05). In the cultures of the samples taken from patients, gram negative rods were mostly found, especially intensive collonization of Enterobakter sp. (25.2%), P. aureginosa (23.4%), and K. pneumoniae (11.1%) were found. Results of our study show that intubated children's stomach and lower respiratory tract are colonized intensively by the pathogen microorganisms in the SICU. It is substantial to take precautions for infection and apply aseptic technique principles, to prevent nosocomial infections ,which can develop because of colonization during the hospitalization of children in the nursing care and procecedures.