综合性医院2012年医院感染现患率调查与质量改进

SURVEY ON PREVALENCE RATE OF NOSOCOMIAL INFECTION IN GENERAL HOSPITAL OF 2012 AND QUALITY IMPROVEMENT

目的收集本院感染(院内及社区感染)及抗菌药物使用情况的数据,与其他同级医院进行横向比较,发现自身存在的问题,为本院下一步医院感染质量改进提供数据支持。方法通过查阅病历、床旁调查、与主管医生电话沟通的方式,调查2012年12月27日所有住院患者(包括当日出院、转科和死亡病例,但不包括当日新入院患者)的现患率情况。结果调查病例452例,发生医院感染12例,12例次,医院感染现患率为2.65%,医院感染例次感染率为2.65%。医院感染现患率最高的科室为综合ICU,医院感染例次感染率为33.33%。社区感染病例数为101例,社区感染率为22.35%。发现医院感染漏报1例,医院感染漏报率8.33%。住院病人抗菌药物使用率为:32.30%,一联、二联、三联或以上抗菌药物使用人数占使用抗菌药物人数的比例分别为:76.71%、22.60%、0.68%。预防性使用抗菌药物比例为:40.41%,治疗性使用抗菌药物比例为:59.59%。治疗性应用抗菌药物的病例中病原送检率为:63.22%,治疗性应用抗菌药物病例送检标本的多重耐药菌检出率为:14.55%,多重耐药菌的检出以革兰氏阴性杆菌为主(铜绿假单胞菌4例,大肠埃希菌3例)。结论本院医院感染现患率与国内某三甲医院的数据接近,但本次现患率调查中发现的问题将纳入2013年医院感染风险评估,供院感委员会委员评分后确定2013年的优先级。

Objective To collect the data of all infection in Clifford Hospital and usage of antibiotics, com- pare with other hospitals at the same level, reveal own problems and provide data support to further quality improve- ment in nosocomial infection. Methods to survey all inpatient prevalence rate of the same - day discharge, referral and death but not the same -day admission on Dec. 27th 2012 through medical record review, bedside survey and tel- ephone communication with attending physicians. Results Of 452 surveyed cases, 12 cases and 12 case - times of nosocomial infection were defined with a prevalence rate of 2.65% and case -time infection rate of 2.65%. General ICU possessed the highest prevalence rate and a case -time infection rate of 33.33%. 101 infected cases were found in community with an infection rate of 22.35%. 1 case failed to be reported with a missing report rate of 8.33%. In- patient usage rate of antibiotics was 32.30%, of which the rate of using single, two, three or more than three antibi- otics were 76.71%, 22.60%, 0.68% respectively. Prophylactic use of antibiotics accounts for 40.41%, while ther- apeutic use for 59.59%. Of cases for therapeutic use, etiological inspection rate was 63.22% and detection rate of MDROs in submitted specimen was 14.55%, with Gram - negative bacilli as major detected MDROs （4 cases of Pseudomonas aeruginosa and 3 cases of Eschericha coli ）. Conclusion Prevalence rate of nosocomial infection in Clifford Hospital is close to certain National Tripple -A hospital, however, problems revealed during this survey should be included in infection control risk assessment for 2013 and scored by Infection Control Committee to identify priorities for 2013.