住院患者医院感染病原学类型与相关因素的关系

Pathogenic bacteria causing nosocomial infections in hospitalized patients and related factors

目的分析基层医院住院患者合并医院感染的病原学类型、特征与病房环境、医疗设施的主要相关因素的关系,为有效地预防和控制基层医院的医院感染提供可靠依据。方法选取2011年1-9月医院住院患者为监测对象,对医院感染的患者进行病原学检查,对发生感染患者所住病房的空气、床单位及物品、所使用的医疗设施进行微生物学监测。结果共监测住院患者18 037例,发生医院感染225例,感染率为1.25%;病原学结果显示,革兰阴性菌占52.05%,革兰阳性菌占31.51%和真菌占16.44%;革兰阴性菌主要为大肠埃希菌占28.94%、铜绿假单胞菌18.42%、鲍氏不动杆菌10.53%;革兰阳性菌主要为金黄色葡萄球菌占34.78%、溶血葡萄球菌21.74%、表皮葡萄球菌21.74%;而病房环境的菌种以藤黄微球菌、表皮葡萄球菌等革兰阳性球菌为主,其次为枯草芽胞杆菌黑色变种芽胞等革兰阳性杆菌;医疗设施的菌种以蜡样芽胞杆菌、枯草芽胞杆菌黑色变种芽胞等革兰阳性杆菌为主,其次为表皮葡萄球菌等革兰阳性球菌;各种菌种类型的构成比在空气、枕头、棉被、床头柜差异均有统计学意义。结论加强病房环境、常用医疗设施的清洁消毒,提高医务人员手卫生执行力、减少不必要的侵入性操作、严格无菌操作,是降低医院感染发生的重要手段和措施。

OBJECTIVE To analyze the correlation between the species and distribution of the pathogenic bacteria causing nosocomial infections in the hospitalized patients and the ward environment and the medical facilities so as to provide reliable bases for the effective prevention and control of nosocomial infections in grass-roots hospital.METHODS The patients who were enrolled in the hospital from Jan to Sep 2011 were selected as the monitoring subjects,the etiological examination of the patients with infections was performed,the air of the ward,bed unit and objects and the used medical facilities were set as the microbiologic monitoring indexes.RESULTS Of totally 18 037 case-times of hospitalized patients monitored,nosocomial infections occurred in 227 patients with the infection rate of 1.26%;the etiological examination showed that the gram-negative bacteria accounted for 52.01%,higher than 31.51% of gram-positive bacteria and 16.44% of the fungi;Escherichia coli（28.94%）,Pseudomonas aeruginosa（18.42%）,and Acinetobacter baumannii（10.53%） were the predominant species of gram-negative bacteria;Staphylococcus aureus（34.78%） and S.haemolyticus（21.74%）,and S.epidermidis（21.74%） were the predominant gram-positive bacteria;Micrococcus luteus and S.epidermidis were the predominant species of gram-positive cocci in the ward,followed by Bacillus subtilis and other gram-positive bacilli;medical facilities to Bacillus cereus bacteria,Bacillus subtilis and other gram-positive bacilli,followed by the gram-positive bacilli such as black variant spores of Bacillus subtilis;Cereus and black variant spores of Bacillus subtilis were predominant species of gram-positive bacilli on the medical facilities,followed by the gram-positive cocci such as S.epidermidis;the difference in the constituent ratio of the bacterial species between the air,pillow,quilts and the bedstands was statistically significant.CONCLUSION It is an effective measure to reduce nosocomial infections that the cleaning and disinfection of the ward environment as well as the commonly used medical facilities should be intensified,the invasive operation should be reduced and the aseptic operation should be performed strictly.