2010年新生儿重症监护室医院感染目标性监控

Targeted monitoring on healthcare-associated infection in a neonatal intensive care unit in 2010

目的对新生儿重症监护室(NICU)医院感染实行目标性监控,探讨其危险因素及有效的预防控制措施。方法采用前瞻性调查方法,按照《医院感染监测规范》要求,对某院2010年1—9月入住NICU的所有新生儿进行目标性监测并针对性地采取控制措施,同时对医院感染危险因素进行分析。结果共调查638例新生儿,发生医院感染67例(10.50%),69例次(10.82%),日感染率为8.29‰。医院感染部位以下呼吸道为主,占63.77%,其中56.82%为呼吸机相关性肺炎;血流感染占21.74%。检出革兰阴性(G-)菌41株(65.08%),革兰阳性(G+)菌21株(33.33%),真菌1株(1.59%);其中肠杆菌科细菌占63.49%(40/63),多重耐药株占66.67%(42/63)。医院感染危险因素为出生体重≤1 500 g、气管插管机械通气及持续时间≥3 d、预防性使用抗菌药物及用药时间≥5 d;不使用抗菌药物为有益因素。结论开展医院感染目标性监测可详细了解监测对象的医院感染情况及相关危险因素,并针对危险因素采取有效措施,降低医院感染率。

Objective To evaluate the risk factors and effective prevention and control measures on healthcare-associated infection（HAI） in neonates in a neonatal intensive care unit（NICU） through the targeted monitor.Methods All neonates who admitted to NICU from January to September 2010 were monitored prospectively according to the Standard for healthcare-associated infection surveillance,control measures were taken,and risk factors were analyzed.Results A total of 638 neonates were surveyed,67 neonates（10.50%） developed 69 times（10.82%） infection,infection rate per day was 8.29‰.Lower respiratory tract infection accounted for 63.77%,56.82% of which was ventilator-associated pneumonia;bloodstream infection accounted for 21.74%.Gram-negative bacteria,gram-positive bacteria and fungi accounted for 65.08%（41 isolates）,33.33%（21）,and 1.59%（1） respectively;Enterobacteriaceae accounted for 63.49%（40/63）,multidrug-resistant organisms accounted for 66.67%（42/63）.Risk factors were birth weight ≤1 500g,endotracheal intubation mechanical ventilation and continuous time ≥ 3d,prophylactic use of antimicrobial drugs and duration time ≥ 5d;no use of antimicrobial agents was beneficial factor.Conclusion Targeted monitoring on HAI can get detailed information on HAI status and related risk factors of patients,and is helpful to reduce HAI rate through proper measures according to related risk factors.