重症监护病房搬进层流病区前后的目标性监测及病原菌构成比变化

Moved Into the Intensive Care Unite Before and After the Laminar Flow Objectives of Monitoring Changes and Pathogens Constitute

目的了解ICU导管相关性感染的现状、分析发展趋势,为干预措施的制定提供参考,同时观察ICU从一般病区搬至层流病区前后病原菌构成的变化,为控制医院感染提供依据。方法 2010年开展多重耐药菌前瞻性病例调查,同时开展重症监护病区的目标性监测,根据卫生部ICU目标性监测要求对于每例研究期间人住ICU>48h及出ICU<48h患者进行监测,计算导管使用率及各类导管相关性感染发病率。结果 2010年4～9月ICU共收住患者76人次,发生院内感染22人42人次,感染历次率为55.26%,感染率为28.96%,患者日感染率59.57‰;ICU总住院天数为705d,呼吸机的平均使用率为51.49%,呼吸机相关性肺炎(VAP)的发病率为49.59‰;中心静脉导管的平均使用率为51.21%、中心静脉导管相关性血流感染(CRBSI)的发病率为8.31‰;导尿管的平均使用率为98.01%、导尿管相关性尿路感染(CAUTI)的发病率为8.68‰。病原菌检出观察设ICU.老病区为对照组,ICU新病区为干预组。阴性杆菌占的比例对照组是74.42%,干预组为67.5%,搬后第二季度为47.62%;阳性球菌对照组占16.28%,干预组15.0%,第二季度28.57%;真菌对照组占23.26%,干预组17.5%,搬后第二季度22.22%。结论 ICU易发生以下呼吸道为主的条件致病菌感染,搬进层流病区后阴性杆菌检出比例减少,3个季度降低近27个点;ICU的院内感染以下呼吸道感染为主,搬迁后由78.95%,降到64.29%,搬后第二季度降至48.57%,三个季度比例降了30个点,说明干预措施有效。

objective ICU catheter-related infection status, analyze trends, to develop interventions to provide a reference, while observing the ICU from the general ward after ward moved to laminar flow changes in the composition of pathogens, provide the basis for the control of hospital infection. Methods The prospective multi-resistant bacteria in 2010 to carry out investigation of cases, while the intensive care ward to carry out the objectives of monitoring, according to the objectives of the Ministry of Health ICU monitoring requirements for each patient during the study lived ICU〉 48h and the ICU 〈48h in patients with monitoring, calculation of various types of catheter usage and the incidence of catheter-related infections. Results April to September 2010 ICU patients were admitted to 76 passengers, 22 nosocomial infections occurred 42 times, previous infection was 55.26%, 28.96% infection rate, infection rate in patients on 59.57 %0; ICU total hospital days for 705d, the average ventilation rate of 51.49% use, ventilator-associated pneumonia （VAP） of the incidence rate of 49.59 %o; central venous catheter, the average utilization rate of 51.21%, central venous catheter-related bloodstream infection （CRBSI） the incidence of rate was 8.31%0; catheter, the average utilization rate of 98.01%, catheter-related urinary tract infections （CAUTI） the incidence rate of 8.68 %o. pathogen detection observation set ICU. the old ward of the control group, ICU new disease District for the intervention group. Negative bacilli proportion is 74.42% in control group, the intervention group was 67.5%, moving the second quarter of 47.62%; positive cocci accounted for 16.28% in control group, the intervention group 15.0%, 28.57% in the second quarter; fungal control group accounted for 23.26 %, 17.5% in the intervention group, move the second quarter of 22.22%. Conclusion ICU prone to lower respiratory tract infection mainly opportunistic pathogen, moved into the laminar flow ward to reduce the proportion detected after negative bacilli, three quarters of nearly 27 points lower; ICU nosoeomial infections mainly lower respiratory tract infection, after the removal of from the 78.95%, down 64.29%, moving down 48.57% after the second quarter, three quarters of a percentage drop of 30 points, indicating that interventions effective.