神经内科医院感染干预措施效果分析

Efficacy of intervention measures to nosocomial infections in neurology department

目的分析神经内科医院感染特点,采取针对性干预措施并评价干预效果。方法采用前瞻性监测与回顾性调查相结合的方法,调查神经内科2007-2008年住院患者的医院感染发生情况,作为干预前资料;2009-2010年对神经内科开展目标性监测,采取干预措施,并将干预前与干预后进行对照分析。结果 2007-2010年神经内科共收住院患者5849例,发生医院感染259例、282例次,医院感染发生率4.4%、例次感染率4.8%;感染部位居前3位的依次为下呼吸道、上呼吸道和泌尿道感染;采取干预措施后,医院感染率为3.3%～3.7%、抗菌药物使用率为66.5%,均低于干预前的5.2%～5.8%、70.2%,差异均有统计学意义(P<0.01),感染病例细菌培养送检率干预前为30.41%,干预后为48.65%,差异也有统计学意义(χ2=8.940,P<0.01)。结论神经内科通过落实手卫生、尿管相关泌尿道感染的预防、呼吸机相关性肺炎的预防以及抗菌药物的合理使用等干预措施,医院感染预防控制工作取得显著成效,但对呼吸道感染的预防控制以及抗菌药物的使用管理仍然是医院感染预防与控制中的重点和难点。

OBJECTIVE To take the targeted interventions to prevent nosocomial infections in the neurology department and evaluate the efficacy.METHODS A prospective surveillance combined with retrospective investigation was conducted for the incidence of nosocomial infections in the patients in the department of neurology from Jan 2007 to Dec 2008,which was set as the data before the interventions.The targeted monitoring was performed in the department of neurology from 2009 to 2010,the interventions were taken,the results were compared before and after the interventions.RESULTS Of totally 5849 hospitalized patients in department of neurology in 2007-2010,nosocomial infections occurred in 259 patients（282 case-times） with the infection rate of 4.4%,and the case-time infection rate of 4.8%.The main nosocomial infection sites were the lower respiratory tract,upper respiratory tract,and urinary tract.After the interventions,both the infection rate（3.3%-3.7%） and utilization rate of antibiotics（66.5%） were lower than 5.2%-5.8% and 70.2% before the interventions.the differences were statistically significant（P0.01）.The submission rate of bacterial culture increased from 30.4% before the interventions to 48.65%,after the interventions,the difference was also statistically significant（χ2=8.940,（P0.01）.CONCLUSION The control of nosocomial infections has made great achievements through the implementation of hand hygiene,prevention of the catheter-related urinary tract infection and ventilator-associated pneumonia and the reasonable use of antibiotics,however,the prevention of respiratory tract infections and administration of antibiotics remain the key points in the prevention and control of nosocomial infections.