外科重症监护室预防器械相关感染的干预性研究

目的了解某院外科重症监护室（SICU）医院感染发生情况，尤其是器械相关感染率，以及干预措施实施的效果。方法对2007-2009年入住SICU超过48 h的患者进行前瞻性监测，监测内容包括医院感染率及器械相关感染［呼吸机相关性肺炎(VAP)、中心静脉插管相关血流感染(CLABSI)、泌尿道插管相关尿路感染(CAUTI)］率及相应器械使用率。根据调查中发现的问题采取针对性干预措施，比较措施实施前后的感染率。结果3年间共调查SICU内患者639例，发生医院感染129例次，感染例次率20.19％。其中器械相关感染77例（VAP 52例、CLABSI 12例、CAUTI 13例），占59.69％。通过采取干预措施，医务人员手卫生的依从性逐年提高，2007、2008和2009年手卫生产品每患者住院日使用量分别为41.59 mL/HD、82.71 mL/HD、84.33 mL/HD；VAP感染率明显下降，由2007年27.17 /1 000机械通气日降至2009年的9.09 /1 000机械通气日（χ2＝2.79，P＝0.00），CLABSI、CAUTI感染率无明显变化。结论SICU医院感染发病率和器械相关感染率较高，但可通过干预措施的有效实施，使其相应的感染得到有效控制。

Research of interventions for device associated infection in surgical intensive care unit

Objective To understand the incidence of heahhcare-associated infection（HAl）, particularly the de vice-associated （DA） infection, and the effectiveness of implementing infection control interventions in surgical intensive care unit （SICU）. Methods Prospective surveillance of patients who had been in SICU for more than 48 hours from January 1, 2007 to December 31, 2009 were conducted. The main monitoring programs were incidence of HAI and DA infection including ventilator-associated pneumonia （VAP）, central line-associated bloodstream in fection （CLABSI）, and urinary catheter-associated urinary tract infection （CAUTI） rates and their corresponding device utilization（DU） rate. Interventions were carried out according to the existent problems, infection rales before and after carrying out intervention measures were compared. Results A total of 039 patients in SICU were surveyed, there were 129 （20. 19%） cases of HAIs, including 77 （59. 69%）DA infections （52 VAP, 12 CLABSI, 13 CAUTI） . Through carrying out the interventions, the compliance of hand hygiene of heahhcare workers increased year by year, the usage of hand hygiene products per hospitalization day from 2007 to 2009 were 41.59 mL/HD, 82.71 mL/HD and 84. 33 mL/HD respectively; The incidence of VAP decreased from 27. 17 per 1 000 mechanical are high, but it can be reduced effectively through carrying out appropriate interventions.