重症监护病房患者医院感染的相关因素分析及对策

目的：了解重症监护病房（ ICU）住院患者医院感染的特点及影响因素，为制定防控对策提供依据。方法采用目标性监测方法，对2013年1-12月入住ICU的患者进行前瞻性监测，并对监测资料进行统计分析。结果677例患者中，163例发生医院感染，医院感染率为24．1％；感染212例次，感染例次率为31．3％；感染主要部位依次是呼吸道（143例次，67．5％）、血液（28例次，13．2％）和泌尿道（15例次，7．1％）；感染的主要病原菌依次是鲍曼不动杆菌（64株，30．2％）、铜绿假单胞菌（35株，16．5％）和肺炎克雷伯菌（24株，11．3％）。不同年龄、住院时间、入ICU时疾病诊断个数、机械通气时间患者及有无气管插管、深静脉置管、留置导尿管患者医院感染发生率比较差异均有统计学意义（P＜0．05）。结论应针对ICU医院感染的相关因素采取相应的防控对策，严格执行无菌操作规程和消毒隔离制度、加强手卫生、做好侵入性操作的管理，尽量缩短患者的住院时间、合理使用抗菌药物等是降低ICU患者发生医院感染的关键措施。

Monitoring and analysis of the relevant factors and strategies of nosocomial infection in intensive care unit

Objective To investigate the characteristics of nosocomial infections and factors in patients in intensive care unit （ ICU） ,in order to provide a basis for the measures .Methods Using the method of target monitoring , to the patients who were in the ICU from January 2013 to December had a prospective surveillance , statistics and analysis the monitoring data .Results There were 163 cases happened nosocomial infection in 677 cases of patients, hospital infection rate was 24.1%;212 cases of secondary infection , infection cases rate was 31.3%. The main site of infection followed by respiratory tract （ 143 cases, 67.5%）, blood （28 cases,13.2%）, urinary tract （15 cases, 7.1%）.The main pathogen of infection followed by Acinetobacter baumannii （64 strains, 30.2%）, Pseudomonas aeruginosa （35 strains, 16.5%） and Klebsiella pneumoniae （24 strains, 11.3%）.Different age, hospitalization, the number of disease diagnosis at ICU hospitalized , mechanical ventilation time and presence of detaining urethral catheter for endotracheal intubation , deep venous catheterization , indwelling catheters in patients with the incidence of comparative differences were statistically significant （P〈0.05）Conclusions Should take appropriate prevention and control measures for related factors of nosocomial infection in ICU , strict aseptic procedures and disinfection and isolation system , strengthen the hand hygiene , good management of invasive procedures , try to shorten the hospital stay of patients , rational use of antibiotics and so on are the key measures to reduce the nosocomial infections in ICU .