综合性ICU患者医院感染情况及危险因素监测分析

Surveillance and analysis of nosocomial infections and risk factors in integrated ICU

目的了解综合性ICU患者的医院感染情况及危险因素,以便采取相应措施控制综合性ICU的医院感染。方法采用前瞻性目标监测方法,分析2008年1～12月入住综合性ICU的患者医院感染情况。结果330例综合性ICU住院患者中,发生医院感染111例,感染发病率为33.64%,患者日感染率为25.92‰。平均病情严重程度评分为4.40分,调整患者日医院感染发病率为5.89‰。与使用呼吸机、动静脉插管、留置尿管相关的感染发生率为36.17‰、5.38‰、3.69‰。感染部位以下呼吸道为主;病原菌分布以革兰阴性杆菌感染为主,其次为革兰阳性球菌感染;呼吸机、动静脉插管、泌尿道插管和免疫抑制剂的使用是医院感染的危险因素(P<0.05);有侵入性操作者与无侵入性操作者相关部位感染率差异有统计学意义(P<0.01)。结论综合性ICU患者医院感染发生率较高,应加强对综合ICU的医院感染监管力度,从而逐步降低医院感染的发生率。

Objective To investigate the incidence of nosocomial infections（NI）in integrated intensive care unit（ICU）patients and its risk factors in order to take measures to prevent infections.Methods Nosocomial infections of ICU patients in Qilu Hospital of Shangdong University from January to December 2008 were investigated and analyzed using the method of prospective investigation.Results Of the 330 patients investigated,111（33.64%）suffered from NI,and the NI rate per day was 25.92‰.The average severity of illness score was 4.40 and the adjusted day infection rate was 5.89‰.The associated NI rates in ventilator,vascular catheter and urinary catheter were 36.17‰,5.38‰ and 3.69‰ respectively.The main infection site was the lower respiratory tract,and the main bacteria were Gram negative bacilli and Gram positive cocci.The risk factors for NI included the using of ventilator,vascular catheter,urinary catheter and immunosuppressant（P〈0.05）.The lower respiratory tract infection rate was significantly higher in patients using a ventilator than in those not using a ventilator（P〈0.01）.Conclusions Nosocomial infection rate in patients of integrate ICU is high.In order to gradually reduce the incidence of nosocomial infection,intervention and management of traumatic operation should be paid close attention.