ICU医院感染统计与研究

Prospective Study of Nosocomial Infection in ICU

目的 了解重症监护病房 (ICU)医院感染的发病情况 ,为ICU医院感染提出有效合理的控制措施。方法 对ICU住院病人进行为期一年的前瞻性调查 ,计算各种感染率 ,评价各种危险因素。结果 共监测 780人 ,医院感染例次率 12 6 9%。外科ICU和呼吸内科ICU感染率较高。感染部位以下呼吸道感染最多 ,占 6 5 7% ,其次为胃肠道 10 .1%和上呼吸道 8 1%。下呼吸道感染病人中 ,呼吸机相关占 6 9% ;胃肠道感染病人中 ,抗生素相关占 70 %。医院感染病原菌以铜绿假单胞菌、金黄色葡萄球菌、真菌比较多见。基础疾病为慢性阻塞性肺病、脑出血、脑外伤和心肌梗塞的患者较易发生医院感染。结论 ICU医院感染率明显高于同期全院的平均医院感染率。各ICU医院感染率的高低与病情严重程度、疾病类型、治疗手段、消毒隔离措施有关。因此应加强对危重病人的护理 ,尽可能减少侵入性操作 ,严格执行无菌技术操作规范 ,合理使用抗生素以减少医院感染的发生。

Objective To study the inv asion of the nosocomial infection in intensive care unit(ICU) and suggest some effective control measures. Methods Prospective investigations were conducted on all the patients in ICU during 2001. All kinds of rates were calculated and various risk factors were evaluated. Results 780 patients had been investigated. The nosocomial infection rate was l2.69%. The infection rate of surgical ICU and respiratory ICU were high er than that of the others. The lower respiratory tract infection constituent rat io was 65.7%, gastrointestinal tract was 10.1%, upper respiratory tract was 8.1%. There′r e 69% related to the use of respirator among the patients who had lower respiraor y tract infection, 70% related to the use of antibiotics among that had gastrointes tinal tract infection. The main pathogens were pseudomonas aeruginosa, staphylococcus aureus and fungi. The patients whose basic diseases were chronic obstructive pu lmonary disease and cerebral hemorryhage were easy to get the nosocomial infection. Conclusion The nosocomial infection rate of ICU was evidently higher than the rate of average of the whole hospital in the same period. Nosocomial infection was related to the condition and kind of the disease, the treatment way and sterilization and isolation method. We can reduce the infection by decreasing insertion operation, obeying the aseptic operating s tandard and rational antibiotics utilization.