重症监护病房医院感染目标性监测探讨

目的分析我院重症监护病房（ICU）患者医院感染的发生情况及危险因素,探讨降低感染率的途径。方法采用目标性监测方法对我院2011年1月~2012年7月收治ICU的患者进行监测,建立医院感染监测日志并根据患者临床病情予以分级评定,同时对3种侵入性操作的相关性感染进行分析。结果 239例ICU住院患者中发生医院感染22例（9.21%）,33例次（13.81%）,日医院感染发病率为23.81‰,日医院感染例次率为35.71‰,患者病情平均严重程度3.54分,经ASIS法调整后,日医院感染发病率为6.73‰,日医院感染例次率为10.09‰;3种侵入性操作中使用呼吸机相关的日感染率（44.03‰）居首位,留置尿管相关日感染率（10.93‰）次之;医院感染部位以下呼吸道为主（57.58%）,医院感染的细菌主要为革兰氏阴性菌（61.22%）,真菌感染率（34.69%）也逐渐升高。结论 ICU医院感染发病率高,进行目标性监测可及时准确获得ICU医院感染资料,掌握ICU院感特点和发展规律,有效控制宿主和医源性两方面的危险因素,可降低医院感染率,减少耐药菌株的产生。

Discussion on the objective monitoring of nosocomial infections in patients in intensive care unit

Objective To analyse the nosocomial infection （NI） status and risk factors in hospital intensive care unit （ICU）,to discuss the method of reduce infection rates. Methods An objective surveillance method was adopted to monitor the occurrence of NI in patients in our hospital from Jan 2011 to Jul 2012. NI rates were adjusted with ASIS method. Three kinds of the invasive procedure associated infections were analyzed. Results Twenty-two of 239 inpatients （9.21%）, 33 cases time （13.81%） developed NI. The daily NI rate and nosocomial case infection rate was 23.81‰ and 35.71‰,after adjusted with A-SIS method,the daily NI rate and nosocomial case infection rate was 6.73‰ and 10.09‰ respectively. During three kinds of the invasive procedure associated nosocomial infections,the daily NI rate of ventilator associated pneumonia （44.03‰ ） was in the first place,urinary catheter associated infection （10.93‰） second.Nosocomial infection in the lower respiratory tract was mainly （57.58%）,consisting mainly of nosocomial infection bacteria mainly Gram-negative bacteria （61.22%）,the incidence of fungal infection （34.69% ） also gradually increased. Conclusion Through objective monitoring, the ICU nosocomial infection data can get timely and accurately. Mastering the sense of ICU hospital characteristics and law of development, effective control of both the host and iatrogenic risk factors, can reduce the nosocomial infection rate and the generation of drug-resistant strains.