北京某康复医疗机构医院感染调查

Investigation of nosocomial infection in a rehabilitation medical institution of Beijing and countermeasures

目的探讨康复医疗机构医院感染发生情况、感染特征及影响因素，分析医院感染控制和预防的重点，指导临床实践。方法采用回顾性调查的方法，统计2008年1月至2010年12月北京某三级康复医疗机构住院患者各年度、各病区的医院感染率、感染部位以及侵入性操作与医院感染发生率的关系。结果该康复机构2008--2010年医院感染率分别为2．92％，2．17％，1．67％，2009年及2010年医院感染率均低于2008年，差异均有统计学意义（x2分别为4．169，16．292；P〈0．05），2009年与2010年医院感染率比较，差异无统计学意义（P〉0．05）；2008--2010年各年度儿童脑瘫康复科和脑血管病康复科的医院感染发病率均高于普通临床科室，差异均有统计学意义（x2分别为69．299，17．828，8．618，33．336，8．182，18．138；P〈0．01），而脊髓损伤康复科的医院感染率与普通临床科室比较，差异无统计学意义（P〉0．05）。在普通临床科室中，67．02％的感染病例曾接受过侵袭性操作，康复科室中则以脊髓损伤康复科较为明显，有36．84％的感染病例曾接受过侵袭性操作，而儿童脑瘫康复科的医院感染与侵袭性操作无任何关系。结论康复医疗机构中，医院感染的发生率呈逐年下降趋势，在各年度内儿童脑瘫康复和脑血管病康复患者的感染率相对较高，但脊髓损伤康复患者的感染与侵袭性操作关系较密切。

Objective To investigate the situation, characteristics and influence factors of nosoeomial infection in rehabilitation medical institutions, analyze important points during nosocomial infection control and prevention, and guide clinical practice. Methods Retrospective review was used to obtain indexes include the nosocomial infection rate, infection site and the relation between invasive operation and nosocomial infection rate in a third-level rehabilitation medical institution from January, 2008 to December, 2010. Results The nosocomial infection rate of this institution was respectively 2.92% , 2.17% and 1.67% from 2008 to 2010. Both the rates of 2009 and 2010 were lower than that of 2008, and the differences were statistically significant （x2 = 4. 169,16. 292 ,respectively; P 〈 0.05 ）, while the difference between the rate of 2009 and 2010 was not statistically significant （ P 〉 0.05 ）. The nosocomial infection rates in Rehabilitation Departments for children with cerebral palsy and patients with cerebrovascular disease were higher than that of general clinical sections every year from 2008 to 2010, and the differences were statistically significant （~2 = 69. 299,17. 828,8. 618, 33. 336,8. 182,18. 138 ,respectively;P 〈 0.01 ）, while the difference between the Rehabilitation Departments for patients with spinal cord injury and general clinical sections was not statistically significant（ P 〉 0.05 ）. In general clinical sections, 67.02% of infected cases had received invasive operations while in Rehabilitation Departments, especially for patients with spinal cord injury, 36.84% had received invasive operations, and there was no relation between nosocomial infection in Rehabilitation Departments for children with cerebral palsy and invasive operations. Conclusions In rehabilitation medical institutions, the nosocomial infection rates show a tendency to decline. Every year from 2008 to 2010, the rates in Rehabilitation Departments for children with cerebral palsy and patients with cerebrovascular disease are relatively higher, while the relation between infections in Rehabilitation Departments for patients with spinal cord injury is relatively closer.