综合ICU医院感染目标性监测与分析

［摘要］目的了解综合重症监护室（ICU）医院感染及相关导管感染发生情况，以便加强管理。 方法采用目标性监测方法，确定监测方案，设计ICU医院感染个案监测内容和日志登记表，于2012年5月—2013年5月对综合ICU住院患者进行前瞻性调查，并对监测结果进行统计分析。 结果共调查868例患者，发生医院感染65 例次，例次感染率为7.49%；患者日感染率为21.49‰，调整日感染率为7.26‰。呼吸机相关性肺炎、导尿管相关尿路感染、中心静脉插管相关血流感染的日感染率分别为23.91‰、3.46‰、6.12‰。医院感染部位以呼吸道（占67.69%）为主。分离病原菌65株，以革兰阴性杆菌为主（53株，占81.54%），多呈现多重耐药性。结论综合ICU医院感染率高，各类相关导管的使用是造成ICU住院患者医院感染重要的因素。ICU目标性监测是一种科学、有效的方法，能及时反映感染控制工作的薄弱环节，有利于针对性地做好医院感染控制工作。

Targeted monitor on healthcare associated infection in a general intensive care unit

ObjectiveTo investigate the occurrence of healthcare associated infection(HAI) and catheter related infection in a general intensive care unit(GICU) ,so as to strengthen the management. MethodsTargeted monitor method was adopted, monitor scheme was established , personal monitor contents and forms were designed, hospitalized GICU patients were investigated prospectively between May 2012 and May 2013, and surveyed data were analyzed.ResultsA total of 868 patients were investigated, 65 times (7.49%) of HAI occurred; infection rate per day was 21.49‰, adjust infection rate per day was 7.26‰. Infection rate of ventilator associated pneumonia , catheter associated urinary tract infection ,and central venous catheter related bloodstream infection per day was 23.91‰, 3.46‰, and 6.12‰, respectively; the main infection site was respiratory tract ( 67.69%). Sixty five isolates of pathogens were detected, 81.54%（n=53）of pathogens were gram negative bacilli, and with multidrug resistance.ConclusionHAI rate is high in GICU , the use of various types of catheters is an important factor for HAI in GICU patients. Targeted monitoring on ICU is a scientific and effective method , it can timely reflect the weak links of infection control practice and promote HAI control .