ICU患者医院感染目标性监测研究

Objective investigation of nosocomial infection in ICU

目的了解ICU医院感染发病特点和规律.方法采用目标性监测的方法,前瞻性地研究2004～2005年ICU患者医院感染发病情况,用ASIS法调整医院感染发病率,并对侵入性操作相关感染进行分析.结果3 560例住院患者中,发生医院感染274例次,医院感染例次发病率为25.97%,经ASIS法调整后,日医院感染发病率为18.64‰.3种侵入性操作相关感染,日感染率分别为呼吸机相关肺炎118.59‰、留置导尿管相关泌尿道感染17.26‰,动静脉插管相关血液感染11.59‰.环境卫生学监测显示呼吸机相关物品微生物感染阳性率为18.18%.结论ICU是医院感染重点部门,应重视目标性监测工作;必须加强呼吸机相关物品的消毒灭菌管理,降低呼吸机相关肺炎的发病率;真菌是留置导尿管相关泌尿道感染的主要致病菌,必须重视抗菌药物的合理使用;加强医务人员手和穿刺部位消毒对控制动静脉插管相关血液感染至关重要.

Objective To study the law of nosocomial infection in ICU. Methods Studied prospectively the nosocomial infection of ICU patients from Feb. 2004 to Jan. 2005 using the method of objective investigation,regulated the nosocomial infection rate by the method of ASIS,analyzed the invasive procedure and the associated infection rate. Results Among 3 560 in-patients in ICU, 274 suffered from nosocomial infection,the rate was 25.97 %, the day nosocomial infection rate was 18. 64‰ after regulated by the method of ASIS. The nosocomial infection rate associated with 3 invasive procedure were ventilator associated pneumonia （VAP）118. 59‰,uretheral catheter associated urinary infection 17. 26‰, vascular catheter associated blood infection 11.59‰, environment sanitation monitor showed that the organism pollution positive rate of ventilator associated material was 18.18%. Conclusions Objective investigation in ICU should be paid attention to ;To reduce the rate of VAP,the sterilization and disinfection of ventilator associated material should be strengthened;Fungus was the main pathogen of uretheral catheter associated urinary infection ,and antibacterial medicine should be used properly;It was important for medical staff to wash hand properly and to disinfect the puncture site thoroughly in order to decrease the associated blood infection rate.