重症监护病房医院内感染监测结果分析及管理策略

The analysis and management strategy of hospital infection in intensive care unit

目的了解和掌控ICU医院感染的发生率及其危险因素,探讨有效防治医院感染的管理策略。方法调查我院2008年6月至2009年10月期间ICU收治的1 689例患者,分析医院感染发生率、发生部位、分离出的病原菌及药敏试验结果,分析医院感染发生的原因及防控策略。结果1 689例患者中医院感染总发生率为19.2%,主要发生部位依次为肺部感染(51.9%)、上呼吸道感染(24.1%)、泌尿道感染(11.7%)、胃肠道感染(10.5%)、血液感染(1.2%)、手术切口感染(0.6%);呼吸机、气管切开、留置尿管、中心静脉置管等侵入性操作是发生医院内感染的重要危险因素;原发疾病中以呼吸系统疾病并发医院内感染率最高(35.4%),其次为神经系统疾病(17.2%),消化系统疾病(13.1%),内分泌系统疾病(12.0%),急性中毒(9.54%),外伤(8.61%);ICU医院感染的病原微生物以革兰氏阴性菌为主,占73%,革兰氏阳性菌占23.2%,真菌占3.8%;另外,革兰氏阴性菌的耐药率较高。结论ICU发生医院感染的几率高,以肺部感染为主,患者病情急重及侵袭性操作是医院感染的重要原因,医院感染的病原菌以革兰氏阴性菌为主,并且耐药率高;ICU是控制医院感染的重中之重,必须加强管理。

Objective To understand and control the incidence rate and risk factors for hospital infection in intensive care unit（ICU） and explore effect management strategy for prevention and cure hospital infection.Methods Totally 1689 patients hospitalized in ICU were investigated from June 2008 to October 2009.The incidence rate,position,pathogenic bacteria and susceptibility test for hospital infection in ICU were analyzed.Meanwhile,the risk factors and management strategy for hospital infection were analyzed.Results The total incidence rate of hospital infection in ICU was 19.2%.The infection position was in order pulmonary（51.9%）,upper respiratory（24.1%）,urinary tract（11.7%）,gastrointestinal（10.5%）,blood（1.2%） and operation incision（0.6%）.The virulence operation such as breathing machine,incision of trachea,urinary canal detain,central vein detain were important risk factors for hospital infection.The primarily diseases were mainly in order respiratory system（35.4%）,nervous system（17.2%）,digestive system（13.1%）,endocrine system（12.0%）,acute poisoning（9.54%）,external injury（8.61%）.The pathogenic microorganism for hospital infection in ICU was mainly in G-bacterium（73%）,G＋ bacterium（23.2%）,eumycete（3.8%）.Moreover,the drug fast rate of G-bacterium was higher.Conclusions The incidence rate of hospital infection in ICU is higher and mainly in pulmonary infection.The urgent patient＇s condition and invasion operation are the important causes for hospital infection.The pathogenic bacteria of hospital infection are mainly in G-bacterium and the drug fast is higher.So,controlling the hospital infection of ICU is the most important,and the management for this must be strengthened.