内蒙古地区医院感染现患率调查分析

目的了解内蒙古地区医院感染现状,为制定医院感染管理措施提供依据。方法采用横断面调查方法,依据全国医院感染监测网2018年医院感染现患率调查要求,内蒙古地区所有三级、二级综合医院和专科医院自愿参加调查,自主选取调查日期填写统一调查表。结果 2018年内蒙古地区共有169所医院参加现患率调查,调查患者61 469例,1 016例(1 100例次)发生医院感染,医院感染现患率为1.65%,例次现患率为1.79%。≥900张床位医院的医院感染现患率较高,为2.60%。医院感染现患率位于前三位的科室为综合ICU(12.70%)、血液病科(6.55%)、儿科新生儿组(5.98%)。医院感染部位主要为下呼吸道(44.82%)、泌尿道(16.82%)、上呼吸道(10.82%)等。抗菌药物使用率为28.04%,不同规模医院的抗菌药物使用率比较,差异有统计学意义(χ2=650.353,P0.001)。治疗性使用抗菌药物患者病原学送检率为36.08%。规模越大的医院的治疗用药病原学送检率越高,差异有统计学意义(χ2=449.309,P0.001)。治疗使用抗菌药物位于前3位的科室为儿科非新生儿组1 821例(98.11%)、呼吸科2 463例(97.62%)和肾病科334(96.53%);预防使用抗菌药物较多的科室为产科484例(82.59%)、妇科395例(66.72%)和骨科1 106例(64.68%)。共检出医院感染病原体457株,其中革兰阴性菌325株(71.12%)、革兰阳性菌82株(17.94%)、真菌30株(6.57%)。医院感染主要病原体为肺炎克雷伯菌(82株)、大肠埃希菌(81株)、铜绿假单胞菌(76株)等。结论本次现患率调查结果较全国及其他地区低。医院感染管理部门可针对重点科室、主要感染部位采取有效的感染预防与控制措施,提高规模较小医院的治疗性使用抗菌药物病原学送检率。

Prevalence rate of healthcare-associated infection in Inner Mongolia

Objective To understand the current situation of healthcare-associated infection(HAI) in Inner Mongolia, and provide basis for formulating management measures for HAI. Methods According to the requirement of national HAI surveillance network in 2018, all tertiary and secondary general hospitals and specialty hospitals in Inner Mongolia voluntarily participated in cross-sectional survey on prevalence rate of HAI, independently selected survey date and filled in unified questionnaire. Results In 2018, a total of 169 hospitals in Inner Mongolia participated in prevalence rate survey, 61 469 patients were investigated. 1 016 patients had 1 100 cases of HAI, prevalence rate and case prevalence rate of HAI were 1.65% and 1.79% respectively. Prevalence rates of HAI in hospitals ≥ 900 beds was 2.60%. The top three departments with higher prevalent rates of HAI were general intensive care unit (ICU) (12.70%), department of hematology (6.55%), and neonatal group of department of pediatrics (5.98%). The main HAI sites were lower respiratory tract (44.82%), urinary tract (16.82%), and upper respiratory tract (10.82%). Antimicrobial usage rate was 28.04%, there was a significant difference in antimicrobial usage rate among hospitals of different sizes (χ²=650.353,P<0.001). Pathogenic detection rate of patients with therapeutic antimicrobial use was 36.08%. The larger scale of hospitals, the higher rate of pathogenic detection in patients with therapeutic antimicrobial use, difference was statistically significant(χ²=449.309,P<0.001). The top three departments with higher therapeutic antimicrobial use were non-neonatal group of department of pediatrics (n=1 821, 98.11%), department of respiratory medicine (n=2 463, 97.62%) and department of nephrology (n=334, 96.53%); department with more antimicrobial use were departments of obstetrics (n=484, 82.59%), departments of gynecology (n=395, 66.72%) and departments of orthopaedics (n=1 106, 64.68%). A total of 457 pathogens causing HAI were detected, including 325 strains (71.12%) of gram-negative bacteria, 82 (17.94%) gram-positive bacteria and 30 (6.57%) fungi. The main pathogens causing HAI were Klebsiella pneumoniae (n=82), Escherichia coli (n=81), and Pseudomonas aeruginosa (n=76). Conclusion The prevalence rate of this survey is lower than the whole country and other regions. HAI management departments can take effective measures to prevent and control infection in key departments and main infection sites, and improve pathogenic detection rate of therapeutic antimicrobial use in small hospitals.