医院感染现患率调查变化趋势分

目的分析某院连续4次医院感染现患率调查结果的变化趋势。方法分别选取2006、2008、2010和2012年5月某日0∶00-24∶00所有住院患者医院感染情况进行调查。结果应调查患者4 497例，实际调查4 387例，实查率97.55%；发生医院感染184例、209例次，医院感染现患率4.19%，例次现患率4.76%。经趋势χ2检验，2006-2012年医院感染现患率逐次下降，由2006年的5.56%下降至2012年的2.76%（χ2=14.07，P＜0.001）。 感染部位以下呼吸道为主（55.03%），其次为泌尿道（14.83%）和上呼吸道（9.57%）等。抗菌药物总使用率为38.50%，经趋势χ2检验，2006-2012年抗菌药物使用率逐次下降（χ2=5.13，P=0.023）；在治疗和治疗+预防用药中，病原学送检率逐次增高（χ2=40.81，P＜0.001）；抗菌药物单一用药率逐次上升（χ2=23.86，P＜0.001）。发生医院感染患者动静脉插管率、泌尿道插管率、呼吸机使用率和静脉输液率（分别为27.17%、35.33%、13.59%和84.78%）显著高于未发生医院感染患者（分别为9.80%、11.54%、4.33%和63.24%；均P＜0.001）。结论该院抗菌药物合理使用管理成效显著，医院感染控制逐年改进；但各种侵袭性操作相关感染的控制仍需加强，抗菌药物合理使用管理仍存在问题，需要探讨和改进。

Changing trends in point prevalence surveys of healthcare associated infection

ObjectiveTo investigate the changing trends in 4 continuous point prevalence surveys of healthcare associated infection(HAI) in a hospital. MethodsThe occurrence of HAI  among all  hospitalized patients were investigated on a given day from 0:00 to 24:00 in May, 2006,2008, 2010, and 2012 respectively.ResultsA total of 4 497 patients should be investigated, 4 387 (97.55%) patients were actually investigated; 184 patients developed 209 times of HAI, point prevalence rate of HAI was 4.19%, case  prevalence rate was 4.76%. Trend χ2 test showed that HAI prevalence rate decreased gradually from 5.56% in 2006 to 2.76% in 2012（χ2=14.07，P＜0.001）.The main infection site was lower respiratory tract (55.03%),followed by urinary tract（14.83%）and upper respiratory tract（9.57%）.The overall usage rate of antimicrobial agents was 38.50%. Trend χ2 test showed that usage rate of antimicrobial agents decreased gradually from 2006 to 2012（χ2=5.13，P=0.023）；pathogenic detection rate in patients receiving therapeutic and  therapeutic plus prophylactic antimicrobial use increased gradually（χ2=40.81，P＜0.001）；single use of antimicrobial agents increased gradually（χ2=23.86，P＜0.001）. The rate of arteriovenous intubation , urinary catheterization , respirator use, and venous intubation in patients with HAI was significantly higher than those without HAI (27.17% vs 9.80%, 35.33%  vs 11.54%,13.59% vs  4.33% , 84.78% vs 63.24% respectively ,all P＜0.001）.  ConclusionManagement of rational use of antimicrobial agents has been achieved remarkably, control of HAI improved continuously; but control of invasive procedure associated infection  need to be intensified, management of rational use of antimicrobial agents should  be paid  much attention.