2013年医院感染现患率调查及危险因素分析

目的了解某院医院感染的现状以及抗菌药物的使用情况。方法采用横断面调查的方法，对2013年8月21日该院所有住院患者医院感染现患率、抗菌药物使用情况以及病原学送检率进行调查。结果共调查住院患者2 238例，发生医院感染104例，126例次，医院感染现患率为4.65%，例次现患率为5.63%。医院感染部位居前4位的是下呼吸道（28.57%）、上呼吸道（18.25%）、泌尿道（7.94%）和胃肠道（4.76%）；标本送检率为91.35%（95/104），标本来源以痰液（26.32%）居首位，其次为血液（25.26%）、尿液（10.53%）等。抗菌药物使用率为24.58%，其中治疗、预防+治疗、预防用药分别占36.55%、45.09%和18.36%；抗菌药物单一、二联和三联用药率分别为75.82%、20.91%、3.27%。危险因素分析结果显示，年龄（＜15岁或＞60岁）、各种侵入性操作（气管切开、使用呼吸机、泌尿道插管、动静脉置管和血液透析）、抗肿瘤化学治疗是医院感染的危险因素。结论医院感染现患率调查有助于了解医院感染和抗菌药物使用情况，以及发生医院感染的高危因素和高危科室，为后期有效开展医院感染目标性监测提供有力的依据。

Prevalence rate and risk factors of healthcare associated infection in 2013

ObjectiveTo investigate healthcare associated infection(HAI) prevalence and antimicrobial use in a hospital. MethodsHAI prevalence rate, antimicrobial use and pathogen detection in all inpatients on August 21, 2013 were investigated with cross sectional survey method.  ResultsA total of 2 238 inpatients were investigated, 104 patients developed 126 times of HAI, HAI prevalence rate and case rate was 4.65% and 5.63% respectively; the top four sites for HAI were lower respiratory tract (28.57%), upper respiratory tract(18.25%), urinary tract(7.94%) and gastrointestinal tract(4.76%).Rate of specimens delivered for detection was 91.35%(95/104), the main specimen was sputum (26.32%),followed by blood (25.26%) and urine (10.53%). Antimicrobial usage rate was 24.58%, therapeutic, prophylactic plus therapeutic, and prophylactic use accounted for 36.55%, 45.09%, and 18.36% respectively; the usage rate of single, combination of 2, and 3 antimicrobial agents accounted for 75.82%,20.91% and 3.27% respectively. Risk factors of HAI were age (<15 or >60 years), all kinds of invasive procedures (tracheotomy, mechanical ventilation, urinary catheterization, arteriovenous  intubation, hemodialysis), and anti tumor chemotherapy.  ConclusionSurvey on HIA prevalence helps to know the occurrence of HAI and usage of antimicrobial agents, as well as risk factors and high risk departments of the occurrence of HAI, it also provides basis for subsequent targeted monitor on HAI.