ICU住院患者医院感染目标性监测分析

Study on Objective Surveillance of Nosocomial Infection in ICU Patients

目的通过对ICU住院患者进行监测,掌握患者医院感染现状及各种影响因素,以采取有效防控对策。方法采用前瞻性调查方法,对2006年12月～2007年11月入住本院综合性ICU的患者进行目标性监测,用平均病情严重程度(ASIS)调整法调整医院感染发病率,同时对4种侵入性操作相关感染进行分析。结果239例入住ICU患者发生医院感染27例(11.30%),感染例次33例(13.81%),与同期平均医院感染率(2.61%)相比,差异显著(P<0.01);经ASIS法调整后日感染发病率为6.74‰;使用呼吸机相关的下呼吸道感染为医院感染的主要部位,占57.58%;医院感染病原体主要是条件致病菌,以G-菌为主,占84.38%,耐药率较高。结论ICU医院感染发病率高,是医院感染的高危科室,应重视目标性监测工作,加强相关物品的消毒灭菌与管理,对有侵入性操作的患者进行监控,实施干预,是预防控制ICU医院感染的关键。

Objective To master actuality of nosocomial infection （NI） and various influence factors by monitoring in-patients of intensive care unit （ICU）, to adopt effective control measures. Methods An objective investigation with prospective method was adopted to monitor the occurrence of NI in patients in general ICU between December 2006 and November 2007 , NI rates were adjusted with ASIS method ,four kinds of the invasive procedure-associated infections were analyzed. Results 27 of 239 （11.30%） inpatients developed 33（13.81%） cases of NI,there were significant differences compared with synchronization NI rate（2.61% ）（P 〈 0.01 ）. After adjusted with ASIS method,the daily NI rate was 6.74%0. The lower respiratory tract of ventilator-associated was the most vulnerable site to infection,accounted for 57.58% .The pathogens caused NI were mainly conditional bacteria. Which G- bacteria accounted for 84.38% ,and drug resistance was high. Conclusion NI incidence rate is high in ICU, and ICU is a high-risk departments of NI, attention should be paid to objective investigation ; It is important to strengthen the sterilization and disinfection of related material and the monitor of patients with invasive procedure. Carrying out intervention is critical of prevention and control NI in ICU.