某三级甲等军队医院住院患者医院感染现患率调查

目的了解医院感染现患情况及其相关危险因素，为制定医院感染的预防与控制措施提供依据。方法采用逐床查阅病例和床旁调查相结合的方法，调查2014年11月26日某三级甲等军队医院0：00-24：00所有住院患者的医院感染、病原体检出及抗菌药物使用等情况。结果共调查住院患者1 657例，发生医院感染66例、71例次，医院感染现患率为3.98%，例次现患率为4.28%。医院感染现患率位于前4位的科室为神经外科（24.49%）、血液科（19.05%）、干部病房（13.73%）和烧伤外科（10.91%）。医院感染部位位于前5位的依次为下呼吸道（40.85%）、泌尿道（23.94%）、上呼吸道（12.68%）、手术部位（9.86%）、胃肠道（5.63%）。66例医院感染病例中，共有39例患者送培养标本，送检率为59.09%，共培养病原体48株，其中居首位的为大肠埃希菌（10株，占20.84%），其次为金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌（各7株，各占14.58%）。全院抗菌药物使用率为34.40%，治疗及治疗+预防用药标本送检率为59.28%。年龄（＜2岁或＞60岁）、使用呼吸机、气管切开、使用泌尿道插管、动静脉插管、血液透析及手术是医院感染的危险因素，差异均有统计学意义（均P＜0.05）。结论应加强对医院感染高发的重点科室、重点部位的监测，依据病原学检测结果合理使用抗菌药物，提高病原学送检率，依据医院感染的危险因素采取有效的预防与控制措施。

Prevalence rate of healthcare associated infection in patients in a tertiary first class military hospital

ObjectiveTo investigate the current situation and related risk factors of healthcare associated infection (HAI), so as to provide evidence for making prevention and control measures of HAI. MethodsOn November 26, 2014, a combination method of bedside visiting and medical record reviewing was adopted to survey HAI status, pathogen examination, and antimicrobial application in all hospitalized patients in a tertiary first class military hospital. ResultsA total of 1 657 hospitalized patients were investigated, 66 patients developed 71 times of HAI, HAI rate and HAI case rate were 3.98% and 4.28% respectively. The top 4 departments with HAI prevalence rates were departments of neurosurgery (24.49%）, hematology（19.05%）, cadre ward（13.73%）, and burn surgery（10.91%）. The top 5 HAI sites were lower respiratory tract (40.85%), urinary tract（23.94%）, upper respiratory tract（12.68%）, surgical site（9.86%）, and gastrointestinal tract（5.63%）. Of 66 cases of HAI, 39 (59.09%) patients sent specimens for culture, a total of 48 pathogens were cultured, the major isolated bacteria was Escherichia coli (n=10, 20.84%), followed by Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, each was 7 (14.58 %) respectively. The usage rate of antimicrobial agents was 34.40%, specimen detection rate in patients receiving therapeutic and therapeutic+prophylactic antimicrobial agents was 59.28%. Risk factors for HAI were age <2 years old or >60 years, with respirator, tracheotomy, urinary tract catheterization, arteriovenous catheterization, hemodialysis, and surgery, difference was significant(all P<0.05). ConclusionMonitoring on key departments and key sites of HAI should be strengthened, antimicrobial agents should be used rationally based on pathogenic detection results, specimen pathogenic detection rate should be improved, and effective prevention and control measures needs to be taken according to the risk factors of HAI.