重症监护病房医院感染目标性监测与干预效果分析

Targeted monitoring and intervention of nosocomial infection in intensive care unit

目的:评价重症监护病房(intensive care unit,ICU)实施医院感染目标性监测与干预措施的效果。方法:通过目标性监测,同时推行综合性感染控制干预措施,掌握2011-2012年综合性ICU的住院患者医院感染发生情况、危险因素及医院感染变化趋势。结果:2011年和2012年ICU的感染率分别为21.8%、16.7%,例次感染率分别为22.7%、18.0%,经病人病情平均严重程度调整,调整后的日感染率分别为5.7‰、4.4‰(χ2=0.321,P=0.865),调整的日感染例次率5.9‰、4.7‰(χ2=0.560,P=0.454)。2011年和2012年呼吸机相关性肺炎的感染率分别为29.0‰、20.1‰,中心静脉导管相关血流感染分别为1.8‰、1.2‰,导尿管相关泌尿道感染率分别为1.3‰、0.7‰。采取干预措施后,2012年多重耐药菌的检出率总体呈下降趋势,耐甲氧西林金黄色葡萄球菌的检出率明显下降,且有统计学差异(χ2=9.05,P=0.029)。结论:实施目标性监测,采取有效干预措施,利于降低ICU医院感染的发生。

Objective：To evaluate the effect of implementing targeted nosocomial infection monitoring and intervention in intensive care unit（ICU）.Methods：Nosocomial infection condition of hospitalized patients,risk factors and nosocomial infection changing trend in comprehensive ICU from 2011 to 2012 were mastered by targeted nosocomial infection monitoring and intervention.Results：Infection rates of ICU in 2011 and 2012 were 20.9% and 16.7 % and case infection rates were 22.7% and 18.0%.After average severity of illness score adjustion,adjusted daily infection rates were 5.7 ‰ and 4.4 ‰（χ ^2 =0.321,P=0.865）and adjusted daily infected cases rates were 5.9 ‰ and 4.7 ‰（χ ^2 =0.560,P=0.454）.Infection rates of ventilator-associated pneumonia in 2011 and 2012 were 29.0 ‰ and 20.1 ‰.Infection rates of central venous catheter-related bloodstream were 1.8 ‰ and 1.2 ‰.Infection rates of catheter related urinary tract were 1.3 ‰ and 0.7 ‰.In 2012,the overall detection rate of multi-drug resistant bacteria was in downward trend and detection rate of methicillin-resistant staphylococcus aureus was decreased after taking interventions,with statistically significant differences（χ^ 2 =9.05,P=0.029）.Conclusions：Implementation of targeted monitoring and infection control measures can effectively reduce the incidence of nosocomial infection ICU.