综合干预措施在新生儿重症监护中心院内感染防控中的作用

目的 探讨实施多重耐药菌主动筛查、医护人员手卫生依从性监测及抗菌药物使用质量控制等综合干预措施在新生儿重症监护中心（NICU）院内感染防控中的作用.方法 选择2011年5月1日至2013年4月30日于广东省妇幼保健院NICU住院治疗的10 577例新生儿为研究对象,并按照住院日期,将其分为干预前组（n=4 122,住院日期为2011年5月1日至2012年4月30日）和干预后组（n=6 455,住院日期为2012年5月1日至2013年4月30日）.本研究遵循的程序符合广东省妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书.对干预后组采取院内感染综合干预措施.结果 两组院内感染例数发生率（6.23％ vs.5.31％）和例次感染率（7.52％ vs.6.35％）比较,差异有统计学意义（χ^2=3.99和5.42;P＜0.05）.两组患儿胃肠道、血液系统、呼吸道、泌尿道等部位感染发生率比较,差异均无统计学意义（P＞0.05）,而皮肤软组织感染发生率比较（5.81％ vs.2.68％）,差异有统计学意义（χ^2=4.46,P＜0.05）.院内感染病原菌构成方面,干预前组院内感染病原菌主要为大肠埃希菌（29.52％）和肺炎克雷伯菌（25.71％）,干预后组以肺炎克雷伯菌为主（36.50％）,两组肺炎克雷伯菌感染发生率比较,差异有统计学意义（χ^2 =3.92,P＜0.05）.干预后组产超广谱β-内酰胺酶（ESBL）菌和耐甲氧西林金黄色葡萄球菌（MRSA）合计隔离率可达90.25％.两组医护人员手卫生依从性比较（70.32％ vs.84.10％）,差异有统计学意义（χ^2=50.98,P＜0.001）.两组抗菌药物使用率、药物敏感送检率及特殊类型抗菌药物使用的药师会诊率比较,差异均有统计学意义（χ^2 =87.58,440.14,-;P＜0.05）.结论 对NICU进行多重耐药菌主动筛查、医护人员手卫生依从性监测、抗菌药物使用质量控制等

Effects of Integrated Intervention for the Prevention and Control of Nosocomial Infection in Neonatal Intensive Care Unit

Objective To investigate effects of implementation of integrated intervention measures such as the active screening of multidrug-resistant bacteria,monitoring of hand hygiene compliance and antibiotic application on prevention and control of nosocomial infection in neonatal intensive care unit （NICU）.Methods From May 2011 to April 2013,a total of 10 577 infants were included in this study,and divided into pre-intervention group（n=4 122,hospitalization date from May 1st,2011 to April 30th,2012）and post-intervention group（n=6 455,hospitalization date from May 1st,2012 to April 30th,2013）according to their hospitalization date.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Guangdong Women and Children Hospital of Guangzhou Medical College.Informed consent was obtained from each participants＇ parents.Results There had significant differences in infection rates （6.23% vs.5.31%） and case infection rates（7.52% vs.6.35%） of NICU between two groups（χ^2 =3.99,5.42 ;P〈0.05）.There were no significant differences between two groups on infections of gastrointestinal tract,blood and lower respiratory tract（P〉0.05）.But there had significant difference on skin and soft-tissue between two groups（χ^2 =4.46,P〈0.05）.Escherichia coli（29.52 %） and Klebsiella pneumoniae （25.71%） were two of the most common bacteria in nosocomial infection patients in pre-intervention group.Klebsiella pneumoniae（36.50%） in post-intervention group was obviously higher than that of pre-intervention group （χ^2 =3.92,P 〈 0.05）.Conclusions Implementation of integrated intervention measures such as active screening of multi-drug resistant bacteria,monitoring of hand hygiene compliance and antibiotic application have an effect on reducing the incidence rate of nosocomial infections in NICU.