重症监护病房患者医院感染目标监测研究分析

Target monitoring on nosocomial infection in intensive care unit

目的监测ICU医院感染的发病率、危险因素,根据感染的特点研究防控措施。方法采用前瞻性目标监测的方法,专职人员每日观察病情,查看侵入性操作,对患者进行病情分级评定;注重环节质量,将监测收集的资料研究分析。结果监测入住ICU>48 h的313例患者中,医院感染80例次,医院感染发生率25.56%,患者日感染率36.87‰,平均病情严重程度4.38分,调整后日感染发病率为5.84%;感染部位以下呼吸道感染率最高,占87.50%,呼吸机相关性肺炎64例,占80.00%;病情危重E级的患者感染率高达38.95%;总器械使用率184.21‰,呼吸机相关性肺炎的感染发病率45.85‰;检出细菌91株,83株来源于下呼吸道,其中肺炎克雷伯21株,占23.08%;抗菌药物使用率为95.50%;感染率从监测开始至第12个监测月呈下降趋势(2χ=3.96,P<0.05)。结论注重环节质量的前瞻性目标监测在ICU医院感染的控制上有效。

OBJECTIVE To monitor the incidence, risk factors for nosocomial infection in ICU and develop prevention and control measures according to infectious characteristics. METHODS The method of prospective target monitoring was used and the professional personnel observed the condition of patients and checked the invasive operations and classified the patients according to patientrs conditions. The quality of each step was focused on and the collected data was studied and analyzed. RESULTS There were 80 cases with nosocomial infection in 313 patients who were checked in ICU more than 48 hours. The incidence rate of nosocomial infection in ICU patients was 25.56% and the daily infection rate was 36.87~0. The score for average illness seriousness was 4.38, the daily infection rate after adjusting was 5.84%. The lower respiratory tract was the most vulnerable site to infect, accounting for 87. 50% of all nosocomial infection patients, in which 64 cases were ventilatorassociated pneumonia, accounting for 80.00%. Especially, the infection rate was up to 38. 95% in the E-class patients with the severity of illness classification. The total equipment utilization rate per a thousand days was 184.21‰, the incidence of ventilator-associated pneumonia per a thousand days was 45. 85‰. totally 91 strains bacterium were detected, in which 83 strains were in the lower respiratory tract. There were 21 cases of Klebsiella pneumonia, accounting for 23. 08%. The utility rate of antibiotics was 95. 50%. The infection rate gradually declined from the beginning to the twelfth month（χ2 = 3.96 P〈0.05 ）. CONCLUSION Focusing on the quality of each step by prospective target monitoring is effective in ICU infection control.