综合重症监护病房患者医院感染目标性监测分析

Targeted Surveillance to Hospital Infection in Intensive Care Unit

目的探讨目标性监测在重症监护病房(ICU)的实施效果,为制定医院感染预防控制措施提供科学依据。方法对2008年1月-2009年12月入住ICU的患者进行目标性监测,用患者平均病情严重程度(ASIS)调整法调整医院感染发病率,重点对3种导管留置患者的医院感染发生率进行研究分析。结果共监测1050例次,发生医院感染279例次(26.57%);与同期平均医院例次感染率(3.02%)相比,差异有统计学意义(P<0.01);日医院例次感染率为34.36‰,经ASIS法调整后日医院例次感染率(8.42‰);2008、2009年日医院例次感染率分别为46.48‰、26.62‰,2009年较2008年下降19.86‰;动静脉插管、使用呼吸机、导尿管留置相关性导管例次感染率分别为(15.36‰、9.58‰)(、45.62‰、24.39‰)、(10.80‰、8.71‰),分别下降5.79‰、21.23‰、2.12‰;医院感染以呼吸机相关性下呼吸道感染为主。结论 ICU患者是医院感染的高危人群,医院感染以3种导管留置患者为主,目标性监测可针对侵入性诊疗操作患者实施全程管理,重点干预诊疗操作中的医疗行为;是减少医院感染的科学监测方法。

OBJECTIVE To inve%tigate the implementation of the targeted surveillance in the intensive care unit,to provide scientific basis for the development of nosocomial infection prevention and control measures. METHODS The targeted surveillance to patients admitted to ICU from Jan 2008 to Dec 2009 was conducted, the incidence of nosocomial infection was adjusted with an average severity of illness score （ASIS） with in patients adjustment method, with emphasis on research and analysis of hospital infection rates in patients with three kinds of catheters. RESULTS Totally 1050 cases were monitored, the infection occurred in 279 cases （26. 57%）. At the same period the the average ease time infection rate was 3.02%, the difference was statistically significant （P〈 0.01） ; the day infection rate was 34.36‰. Using the ASIS method to adjust the daily case-time infection rate to 8.42‰; the daily case-time rates of infection in the hospital in 2008 and 2009 were 46.48‰ and 26. 62‰; compared with 2008, the infection rate decreased by 19. 86‰. The case-time rates of arterio-venous catheter, application of ventilator and indwelling catheter-related bloodstream infection were （15.36‰ and 9. 58‰）, （45.62‰ and 24.39‰） and （10.80‰ and 8.71‰）, decreased by 5.79‰, 21.23‰and 2.12‰, respectively; the ventilator associated lower respiratory tract infection was the main. CONCLUSION The patients in ICU are at high risk of hospital infection, which are the main in patients with 3 kinds of catheter. The targeted surveillance for invasive treatment available for patients with full management, focusing on intervention operations, medical diagnosis and treatment act are the scientific monitoring methods to reduce the hospital infections.