某三甲综合医院2010—2016年医院感染现患率调查结果

目的了解医院感染现状及病原菌变化趋势，评价医院感染管理控制措施的效果，为提高医院感染管理水平提供依据。方法采用床旁调查和个案调查相结合的方法，对某三甲综合医院2010-2016年每年7、8月中某一天的所有住院患者进行医院感染现患率调查。结果2010-2016年共调查患者8 434例，发现医院感染419例、476例次，医院感染现患率、例次现患率分别为4.97%、5.64%，各年医院感染现患率为3.77%～6.16%，差异无统计学意义（χ2=10.98，P＞0.05），其中重症医学科医院感染现患率为50.91%，以下呼吸道感染为主（51.47%）。引起医院感染居前5位的病原菌为鲍曼不动杆菌（14.62%）、铜绿假单胞菌（14.62%）、肺炎克雷伯菌（13.08%）、大肠埃希菌（10.38%）、金黄色葡萄球菌（7.31%）。调查日抗菌药物使用率为33.09%，抗菌药物使用率、预防性抗菌药物使用率分别从 2010 年的47.92%、49.19%，下降至2016年的26.62%、18.26%，治疗性使用抗菌药物细菌培养送检率从 2010 年的 5.16% 上升至 2016 年的 50.00%，差异均具有统计学意义（χ2值分别为 279.44、265.21、246.26，均P＜0.001）。结论该院近7年的医院感染现患率无显著变化，抗菌药物使用逐年规范，但治疗性使用抗菌药物病原学送检率仍有待提高。

Survey on prevalence rates of healthcare associated infection in a tertiary first class hospital in 2010-2016

ObjectiveTo understand status of healthcare associated infection(HAI) and changing trend of pathogens, evaluate the efficacy of HAI management and control measures, and provide basis for improving HAI management level.MethodsCombination of bedside survey and individual case survey was adopted to investigate the prevalence rates of HAI occurred among all hospitalized patients in a tertiary first class hospital at a given day in July August in each year of 2010-2016.ResultsFrom 2010 to 2016, a total of 8 434 patients were surveyed, 419 patients had 476 cases of HAI, HAI rate and HAI case rate were 4.97% and 5.64% respectively，HAI prevalence rates were 3.77%-6.16%，difference was not significant(χ2=10.98，P＞0.05）, prevalence rate of HAI in intensive care unit was 50.91%, mainly was lower respiratory tract infection(51.47%). The top 5 pathogens causing HAI were Acinetobacter baumannii (14.62%), Pseudomonas aeruginosa (14.62%), Klebsiella pneumoniae (13.08%), Escherichia coli (10.38%), and Staphylococcus aureus(7.31%). Antimicrobial usage rate on the survey day was 33.09%, antimicrobial usage rate and antimicrobial prophylaxis decreased from 47.92% and 49.19% in 2010 to 26.62% and 18.26% in 2016 respectively, bacterial culture rate in patients receiving therapeutic antimicrobial use increased from 5.16% in 2010 to 50.00% in 2016, differences were all statistically significant (χ2 =279.44, 265.21, 246.26, respectively, all P＜0.001）.ConclusionIncidences of HAI didn’t change significantly in recent 7 years, usage of antimicrobial agents has been standardized year by year, but pathogenic detection rate in patients receiving therapeutic antimicrobial use needs to be improved.