2011年常州市15所医院医院感染现患率调查

目的了解常州市市属二级以上医院医院感染现状及相关危险因素，为制定相关政策提供依据。方法采取床旁调查和查阅住院病历相结合的方法，对2011年8月30日常州市市属二级以上15所医院所有住院患者进行医院感染现患率调查。结果15所医院应调查住院患者9 695例，实查9 691例，实查率99.96%。发生医院感染362例，382例次，医院感染现患率和例次感染现患率分别为3.74%和3.94％。检出病原体213株，其中革兰阴性菌占70.42%，革兰阳性菌占17.37%，真菌占11.27%，支原体占0.94%。例次感染现患率最高的科室为重症监护室（38.98％）。感染部位居前5位者依次为下呼吸道（43.72％）、上呼吸道（14.14％）、泌尿系统（11.26％）、手术部位（9.69％）、皮肤软组织（5.50％）。医院感染高危因素有：使用呼吸机（RR 95%CI：11.37～23.34）、有血管通路（RR 95%CI：3.91～6.85）和插导尿管（RR 95%CI：3.57～5.79）。使用抗菌药物患者3 562例，抗菌药物日使用率为36.76％；治疗用药1 831例（51.40％），预防用药1 651例（46.35％），无指征用药80例（2.25％）。结论医院感染现患率调查有助于了解医院感染的发生情况和提高监测的准确性；进一步了解医院感染高危因素及多药耐药菌感染情况，便于针对性地加强医院重点科室、重点部位的目标性监测。

Prevalence survey of healthcare associated infections in 15 hospitals in Changzhou in 2011

Objective To evaluate the prevalence of healthcare-associated infections（HAIs） in 15 hospitals in Changzhou, so as to provide basis for making policy for preventing and controlling HAIs. Methods On August 30, 2011, HAIs in 15 hospitals in Changzhou were surveyed by combination of bedside checking and medical record reviewing. Results 9 695 patients should be surveyed, 9 691 （99. 96%） were actually surveyed,362 patients devel- oped 382 episodes of HAIs, the prevalence rate and case infection rate was 3.74% and 3. 94% respectively. A total of 213 pathogenic isolates were detected, 70. 42% were gram-negative bacteria, 17. 37% were gram-positive bacteria, 11.27~ were fungi, and 0. 94% were Mycoplasma. The highest prevalence of department was intensive care unit （38. 98%）. The top five infection sites were lower respiratory tract （43. 72%）, upper respiratory tract （14. 14%） ,urinary system （11.26%） ,surgical sites （9. 69%）, and skin and soft tissue （5. 50%）. High risk factors for HAIs included the use of ventilator（RR 95%CI, 11.37 - 23. 34）, vascular access （RR 95%CI,3.91 - 6. 85）, and urinary catheterization （RR 95 %CI,3. 57- 5.79）. A total of 3 562 patients used antimicrobial agents, the daily antimicrobial usage rate was 36. 76%, 1 831 （51.40%） of whom received curative use of antimicrobials, and 1 651 （46. 35%） received prophylactic use, 80（2. 25%） used antimicrobial agents without indication. Conclusion Prevalence survey of HAIs is helpful for realizing the occurrence of HAI, improving the accuracy of surveillance, recognizing the risk factors for HAI and multidrug-resistance bacterial infection, and strengthening the targeted surveillance on the key departments.