重症监护室住院患者导管相关医院感染调查

目的探讨重症监护室（ICU）患者导管相关医院感染的发生情况。方法采用目标性监测方法，于2006年11月-2007年10月对ICU住院患者的医院感染情况进行监测，同时对使用呼吸机、动静脉插管、留置导尿管3种侵入性操作的使用率及其相关医院感染率进行分析。结果共调查224人次，发生医院感染81例次，医院感染例次率为36．16％。日医院感染发病率为69．53‰，经病情严重程度（ASIS）调整日医院感染后发病率为20．82‰。呼吸机、动静脉插管及导尿管的使用率分别为51．33％、96．22％和96．14％，所致呼吸机相关肺炎、血流感染、泌尿道日感染率分别为45．15‰、6．24‰和8．93‰。呼吸道感染常见病原菌为鲍曼不动杆菌、铜绿假单胞菌及耐甲氧西林金黄色葡萄球菌；血流感染常见病原菌为白假丝酵母菌、溶血葡萄球菌及铜绿假单胞菌；泌尿道感染最常见病原菌为大肠埃希菌、肠球菌属和白假丝酵母菌。结论各类相关导管的使用是造成ICU住院患者发生医院感染最重要的因素，必须制定相应感染预防控制措施以有效降低ICU导管相关医院感染率。

Catheter associated nosocomial infection in ICU patients

Objective To evaluate the incidence of catheter-associated nosocomial infection（NI）in intensive care unit （ICU） patients. Methods Patients in ICU from November 2006 to October 2007 received targeted surveillance. The application of respirators, arteriovenous catheters, urinary catheters and associated NI were monitored and analyze. Results A total of 224 patients received targeted surveillance, the incidence of NI was 36. 16% （81cases）. Daily NI rate was 69. 53‰, which was adjusted to be 20. 82‰ by ASIS. The application rate of respirators, arteriovenous catheters and urinary catheters was 51.33%, 96. 22% and 96. 14% respectively, the daily infection rate of ventilation-associated pneumonia, blood stream infection and urinary tract infection was 45. 15‰, 6. 24‰ and 8. 93‰ respectively. The common bacteria in respiratory tract infection were Acinetobacter baurnannii, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus, The common bacteria in blood stream infection were Candida albicans, Staphylococcus haemolyticus and Pseudornonas aeruginosa , The common bacteria in urinary tract infection were Escherichia coli, Enterococcus and Candida albicans. Conclusion The application of catheters are the leading factors causing NI in ICU patients. Appropriate preventive measures must be taken to reduce cathe- ter-associated NI in ICU patients.