综合医院急诊科患者医院感染的潜在因素调查

目的 探讨综合医院急诊科危重患者医院感染的潜在因素及预防措施。方法 调查分析2000年1月-2001年12月急诊科危重抢救患者入院诊断、侵人性操作、医院感染率、危险因素、感染部位及菌群分布数据。结果 急诊科危重患者医院感染率为21．8％，以下呼吸道感染为最高，占53．5％；其医院感染潜在危险因素为患者严重的基础疾病、频繁的侵入性检查与治疗操作，广谱抗生素的预防与治疗性应用、皮质激素的应用等；医院感染病原菌包括耐甲氧西林葡萄球菌、肠球菌、产超广谱β—内酰胺酶细菌、铜绿假单胞菌和不动杆菌等耐药细菌。结论 必须重视急诊科医院感染，强化医护人员无菌观念，改善、净化环境，减少侵入性操作，加强抗生素的使用管理，切实控制和降低医院感染发病率。

Potential Factors of Nosocomial Infection in Emergency Department of General Hospital

OBJECTIVE To explore the potential factors and the prevention measures of nosocomial infections in critical patients in emergency department of general hospital. METHODS The clinical materials of critical patients from Jan 2000 to Oct 2001 in our emergency department were reviewed and the data of hospitalization diagnosis, invasive operation history, nosocomial infection rate, risk factors, place of infection and organism distribution were analyzed. RESULTS Of all the cases, the nosocomial infection rate was 21.8%. The lower respiratory tract infection occurred most frequently with rate of 53.5%. The potential risk factors were serious underlying disease, frequent invasive operation for inspecting or treating purpose, application of broad-spectrum antibiotics for preventing or treating purpose, application of glucocorticoid, etc. The causative agents included MRSA, Enterococcus spp, ESBLs-producing bacteria, Pseudomonas aeruginosa, Acinetobacter spp, etc. CONCLUSIONS Special attention should be paid to nosocomial infection in emergency department. For effective control and reducing its occurring rate, enhancing the sterilization idea for clinicians, improving and cleansing hospital environment, reducing invasive operation and reinforcing management of antibiotics application are strongly recommended.