2010—2012年医院感染现患率调查

Prevalence rate of healthcare-associated infection in 2010-2012

目的了解某院医院感染现患情况,为制定医院感染控制措施提供依据。方法采取横断面调查的方法,调查该院2010年6月1日、2011年6月20日、2012年4月16日0∶00—24∶00全院所有住院患者医院感染情况,并对调查资料进行统计分析。结果该院2010—2012年医院感染现患率分别为3.41%、2.32%、1.73%,3年现患率比较,差异无统计学意义(χ2=4.65,P>0.05)。单因素分析结果显示:性别、年龄、泌尿道插管、动静脉插管、气管切开、使用呼吸机及外科手术是医院感染的危险因素;医院感染部位以下呼吸道居首位,占59.65%,其次为泌尿道(15.79%)、手术切口(10.53%)和胃肠道(8.77%);3次调查抗菌药物使用率分别为57.95%、43.17%、40.23%,各组比较,差异有统计学意义(χ2=54.25,P<0.01)。共检出病原体26株,其中铜绿假单胞菌11株(42.31%),鲍曼不动杆菌6株(23.08%),嗜麦芽窄食单胞菌3株(11.54%),大肠埃希菌、金黄色葡萄球菌和真菌各2株(各占7.69%)。结论该院医院感染现患率呈下降趋势。应针对医院感染高危因素采取相应措施,并加强对重点易感部位的干预和抗菌药物的管理。

Objective To investigate the perioperative antimicrobial prophylaxis in patients with hip replacement before and after implementing clinical pathway（CP）,so as to provide rational and effective clinical management path.Methods Perioperative antimicrobial prophylaxis in 120 patients with hip replacement in a hospital between January 2008 and December 2011 was surveyed retrospectively.Sixty patients without implementing CP between January 2008 and December 2009 were as pre-intervention group,and60 patients with CP between January2010 and December 2011 were as post-intervention group.Results The rate of antimicrobial used 0.5-2 hours before operation and duration of post-antimcrobial prophylaxis≤5 days in post-intervention group was significantly higher than that of pre-intervention group respectively（78.33%[47/60]vs 31.67%[19/60],P0.05;91.67%[55/60]vs5.00%[3/60],P0.05）;The top three used antimicrobial agents in pre-intervention group were cefoperazone/sulbactam,cefpiramide,and ceftazidime,which were replaced by cefazolin,cefuroxime,and clindamycin in post-intervention group;the average duration of antimicrobial use,average length of hospital stay and daily expense of antimicrobial agents decreased from（13.25±1.69）days,（17.55±1.60）days,and（193.22±34.70）yuan in pre-intervention group to（4.12±0.87）days,（7.83±1.36）days,and（54.03±9.98）yuan in post-intervention group respectively,the difference between two groups was statistically significant（all P0.01）.Conclusion The implementation of CP can standardize preventive peri-operative antimicrobial use in hip replacement patients,shorten the length of hospital stay,and reduce antimicrobial expense.