某教学医院呼吸重症监护病房医院感染目标性监测

目的了解某教学医院新建呼吸内科重症监护病房(RICU)住院患者医院感染状况,为新建ICU医院感染的预防与控制提供依据。方法采取前瞻性目标性监测方法,对2014年1—12月入住某院RICU的患者进行医院感染目标性监测,并对监测结果进行统计分析。结果共监测住院患者561例,发生医院感染43例、44例次,医院感染发病率为7.66%,例次发病率为7.84%,例次日发病率为6.26‰,调整例次日发病率为1.79‰。医院感染部位以泌尿道为主(20例,占45.46%),其中呼吸机相关肺炎(VAP)、血管导管相关血流感染(CRBSI)、导尿管相关泌尿道感染(CAUTI)分别为13、2和18例,发病率分别为2.73‰、1.57‰和3.78‰。上半年(1—6月)患者医院感染日发病率与下半年(7—12月)比较,差异有统计学意义(4.59‰VS 7.89‰;u=-1.75,P=0.04)。共分离病原菌47株,以革兰阴性菌为主(26株,占55.32%)。结论 ICU医院感染以器械相关感染为主,应加强对侵入性操作的评估和严格管理;在ICU进行目标性监测,可及时发现医院感染控制的薄弱环节,有利于针对性制定防控措施,降低ICU医院感染发病率。

Targeted monitoring on healthcare associated infection in a respiratory intensive care unit of a teaching hospital

ObjectiveTo investigate the incidence of healthcare associated infection (HAI) in patients in a respiratory intensive care unit (RICU) of a teaching hospital, and provide reference for HAI prevention and control.MethodsAll patients admitted to this RICU from January to December 2014 were surveyed with prospective targeted monitoring method, surveyed data were analyzed statistically.ResultsA total of 561 patients were surveyed, 43 patients developed 44 times HAI, HAI rate and HAI case rate were 7.66% and 7.84% respectively, incidence of HAI and adjusted incidence of HAI per 1 000 patient days were 6.26‰ and 1.79‰ respectively. The main infection site was urinary tract (45.46%, n=20). Incidence of ventilator associated pneumonia (VAP), catheter related bloodstream infection （CRBSI）,and catheter associated urinary tract infection (CAUTI) per 1 000 catheter days were 2.73‰(n=13),1.57‰(n=2), and 3.78‰(n=18) respectively. Incidence of HAI per 1 000 patient days between the first and second half year of 2014 was significantly different（4.59‰ vs 7.89‰；u=-1.75，P=0.04）. A total of 47 pathogenic strains were isolated, the main pathogens were gram negative bacteria(n=26,55.32%).ConclusionThe major HAI in RICU is device associated infection, it is necessary to strengthen the management of invasive procedures; targeted monitoring can find the weak links of infection control practice and helpful for taking effective prevention and control measures to reduce the incidence of HAI in ICU.