2007-2009年内科系统医院感染监测分析

Surveillance of Nosocomial Infection in Departments of Internal Medicine 2007-2008

目的了解内科系统医院感染的现状及分布特点,为预防和控制医院感染提供科学依据。方法采用前瞻性监测与回顾性调查相结合的方法,对2007年1月-2009年12月入住内科的21 156例患者进行监测,数据使用Excel 2003和SPSS15.0软件进行统计分析。结果医院感染率3.1%,例次感染率3.4%,医院感染漏报率0.1%;感染部位居前3位的依次为下呼吸道感染(33.2%)、上呼吸道感染(32.5%)和胃肠道感染(12.5%);不同科室医院感染发生率不同(χ2=388.551,P=0.000),以肿瘤血液科最高(9.0%);不同季节住院患者医院感染发生率不同(χ2=11.755,P=0.008),以第四季度最高(4.1%);3年心内科和呼吸内科医院感染发生率呈上升趋势(分别为χ2=19.632,P=0.000;χ2=10.574,P=0.005),而神经内科呈下降趋势(χ2=11.638,P=0.003);检出的病原菌以革兰阴性菌为主,占54.5%。结论针对医院感染现况,调整监测方案,加强重点科室医院感染管理,降低呼吸道感染,提高病原学送检率,才能有效降低医院感染发生率。

OBJECTIVE To explore the characteristics and status of nosocomial infection （NI） in the departments of internal medicine,to provide scientific bases for prevention and control of the nosocomial infection. METHODS A prospective surveillance combined with retrospective investigation was conducted among 21 156 patients from Jan 2007 to Dec 2009. Data were analyzed with Excel 2003 and SPSS 15.0 software. RESULTS The incidence rate of NI was 3.1%, and the case-time infection rate was 3.4%. The fail to report rate was 0. 1%. The main NI sites were in lower respiratory tract （33.2%）, upper respiratory tract （32.5%） and gastrointestinal tract （12.5%）. The rate was the highest in the departments of hematology and oncology （9.0 %） （X^2= 388.551, P = 0. 000） and the highest was in the fourth quarter of the year （4.1%） （X^2=11.755,P=0.008）. In the last three years, the rates of NI were on the rise in the departments of cardiology and respiratory medicine （respectively,x^2=19. 632 ,P =0. 000 and X^2=10. 574,P=0. 005）, but it was on a declining curve in department of neurology（x^2=11. 638,P =0. 003）. Most of the detected pathogens were Gram-negative bacteria, accounting for 54.5%. CONCLUSION Adjusting the surveillance programs according to the status, strengthening the NI management in the key departments, lowering the respiratory tract infection and increasing the delivering rate of etiology can effectively reduce the rate of NI.