前瞻性调查与医院感染危险因素的病例对照分析

Risk Factors of Nosocomial Infection and Prospective Investigation: A Case-control Study

目的明确医院感染危险因素，评估和指导临床科室的医院感染预防与控制工作，并为目标性监测提供依据。方法对2007-2008年开展的前瞻性调查与医院感染病例回顾性调查所得资料进行筛选，采用1：2病例对照研究方法，对医院感染相关因素进行单因素和多因素Logistic回归分析。结果通过对352例病例和709例对照病例的分析，医院感染部位发生率较高的为下呼吸道（42．60％）、上呼吸道（27．84％）、泌尿道（12．50％）；医院感染病例主要发生在内科病房（64．20％）；在单因素分析中科室、年龄、住院天数、泌尿道插管、使用呼吸机、动静脉插管、使用免疫抑制剂或激素、慢性病、恶性肿瘤、气管切开或插管以及腹腔穿刺引流等11项因素差异有统计学意义（P〈O．05）；多元素分析显示科室、住院天数、泌尿道插管、动静脉插管、慢性病、气管切开或插管和腹腔穿刺引流等7项因素，其中泌尿道插管、动静脉插管和腹腔穿刺引流3项呈负相关（OR〈1）。结论医院感染的发生主要与慢性病、泌尿道插管、动静脉插管、气管切开或插管和腹腔穿刺引流等有关，需加强内科病房以及慢性病患者的预防与控制措施，尽量减少患者住院时间，对各类插管患者继续执行有效诊疗措施。

OBJECTIVE To probe the risk factors of nosocomial infection（NI） in our hospital, evaluate and guide prevention and control in clinical deparments, and provide reference data for targeted surveillance. METHODS The samples of prospective investigation and NI cases from 2007 to 2008 were screened. A case-control study by 1 ： 2 and Logistic regression analysis were used to identify risk factors of NI. RESULTS A study on 352 cases and 709 controls showed that the most frequent sites of NI were the lower respiratory tract（42. 60%）, the upper respiratory tract（27.84%） and the urinary tract （12. 50%）, and the most risk ward was medicine department （64.20%）. Univariate analysis showed that 11 factors were related to NI, including ward, age, duration of hospitalization, urinary catheterization, usage of respirator, arterial or venous catheterization, usage of immunosuppressant or hormone, chronic disease, malignant tumor, tracheal intubation, ahdominocentesis or drainage, etc （P〈0.05）. Multivariate analysis showed that the following factors were the potential risk factors： ward, duration of hospitalization, urinary catheterization, arterial or venous catheterization, chronic disease, tracheal intubation, abdominocentesis or drainage. And NI was negatively associated with 3 factors （OR〈1）, urinary catheterization, arterial or venous catheterization and abdominocentesis were included. CONCLUSIONS The occurrence of NI in our hospital is mainly concerned with chronic disease, urinary catheterization, arterial or venous catheterization, tracheal intubation, abdominocentesis or drainage, etc. The prevention and control measures should be strengthened to the patients in medical wards and continue to carry out effective measures to the patients with invasive operation.