高原地区心血管病医院院内感染现患率调查

目的分析高原地区心血管病医院院内感染发展趋势，对高原地区心血管病医院院内感染控制效果做出评价。 方法随机选择青海省心血管病医院2015年11月5日、2016年11月4日、2017年10月26日0:00至24:00病例数据，采用横断面调查法对住院患者进行现患率调查，分析所选取的1 689例住院患者医院感染现状。 结果2015年至2017年度本院医院感染现患率分别为2.6%(14/536)、2.3%(12/516)和2.04%(13/637)，感染例次率分别为3.2%(17/536)、2.9%(15/516)和2.4%(15/637)，差异均无统计学意义(χ²= 0.422、P= 0.810，χ²= 0.760、P= 0.684)。医院感染部位以下呼吸道为主，其次是上呼吸道和手术部位感染。调查当日抗菌药物使用率分别为18.1%(97/536)、14.1%(73/516)和17.6%(112/637)；抗感染治疗前微生物送检率分别为53%(41/76)、54.2%(32/59)和61.6%(53/86)。感染率呈逐年上升趋势，但影响因素差异无统计学意义；检出病原菌以革兰阴性菌为主(51.4%)，其余依次为革兰阳性菌(28.6%)和真菌(20%)。 结论根据现患率数据分析，高海拔地区心血管病医院院内感染发生率与高原地区环境、心血管疾病特殊性及手术复杂性有关。加强医院感染管理与预防、提高用药前样本送检率、合理使用抗菌药物及减少联合用药率是降低医院感染的重要措施。

Investigation on nosocomial infection prevalence rate in cardiovascular disease hospital at altitude area

ObjectiveTo investigate the trend of nosocomial infection and to evaluate the effect of nosocomial infection control. MethodsData of patients from November 5th, 2015, November 4th, 2016, October 26th, 2017, in Qinghai Provincial Cardiovascular Disease Hospital were selected randomly, and the present incidence rates of inpatients were investigated by cross-sectional survey. The nosocomial infection status of 1 689 inpatients was analyzed. ResultsFrom 2015 to 2017, the prevalence rates of nosocomial infection were 2.6% (14/536), 2.3% (12/516) and 2.04% (13/637), respectively; the infection rates were 3.2% (17/536), 2.9% (15/516) and 2.4% (15/637), respectively, with no significant differences (χ²= 0.422,P= 0.810;χ²= 0.760,P= 0.684). The lower respiratory tract was the main respiratory tract infected site, followed by upper respiratory tract and surgical site infection. The antimicrobial use rates were 18.1% (97/536), 14.1% (73/516) and 17.6% (112/637), respectively, and the rates of microbiological detection before anti-infection treatment were 53% (41/76), 54.2% (32/59) and 61.6% (53/86), respectively. The infection rate increased year by year, but there was no significant difference among the influencing factors. The main pathogens were Gram-negative bacteria (51.4%), the others were Gram-positive bacteria (28.6%) andfungi(20%). ConclusionsAccording to the analysis on prevalence rates, the incidence of nosocomial infection in high altitude area is related to the environment, the particularity of cardiovascular disease and the complexity of operation. To strengthen the management and prevention of nosocomial infection, and increase the rate of sample examination before medication, rational antibiotics application and reduce the rate of combined use of antibiotics are important measures to reduce nosocomial infection.