住院患者医院感染现况调查分析

The Field Survey and Analysis of the Nosocomial Infection for 503 Cases of Inpatients

目的 了解我院医院感染 (NI)现况 .方法 抽检 5 0 3例住院患者病历作现况调查 ,调查项目有年龄、性别、住院天数、NI率、NI分布、感染部位、ICU因素、侵入性诊疗操作、免疫抑制剂、广谱抗生素、化疗、放疗、输血或血制品、恶性肿瘤、慢性病、肝硬化、糖尿病、血液病、尿毒症、昏迷、老年人、新生儿、一次性医疗用品、手术伤口类型、病原学检查 .结果 NI率为 8 75 % ,其中下呼吸道感染 38 6 4%、胃肠道感染 2 2 73%、上呼吸道感染 1 3 6 4% ,泌尿道感染、真菌感染和术后感染均为 6 82 % .培养出病原菌主要为铜绿假单胞菌 2 3 5 3%、真菌、肺炎克雷伯菌均为 1 7 6 5 % ,大肠杆菌 1 1 76 % .调查前被认为的相关危险因素和易感因素经Logistic回归分析有显著性意义 (p <0 0 5 ) .结论 我院NI率低于全国平均水平 ,NI主要是下呼吸道感染 ,其发生主体是中枢神经系统疾病患者 ,神经内外科病房应该作为NI监控的重点 ,应针对较多见的铜绿假单胞菌加强预防及应对措施 .应严格限制侵入性诊疗操作 ,合理应用抗生素和免疫抑制剂 ,尽量减少血液制品的输注 ,加强对慢性病、肿瘤、老年人和新生儿护理等 .

Objective To investigate the nosocomial infection(NI) in our hospital and to find out the control method. Methods 503 patients by retrospective sampling studied for NI were carried out during Jan.2000～Feb.2000.The survey items were:NI rate,NI distribution,infection site,ICU,urinary intubation, A-V intubation endoscope,trachea intubation,respirator,dialysis,encephalocoel intubation,immunizing inhibitor,wide spectrum antibiotics,blood-transfusion,carcinoma,liver cirrrhosis,diabetes,hematopathy,uremia,coma,elderx,neonate,single use medical material,wound type,etiology check,cultivated result,drug sensity,etc.Results NI rate of our hospital was 8.75%,which distributed to those:38 64% were lower breath duct infection,22 73% were gastro-intestine infection,13 64% were upper breath duct infection,6 82% were urineary infection.The result showed that the germs mainly were Ps. aeruginosa ,Fungus,Klebsiella pneumoniae,Escherichia coli which were 23 53%,17 65%,17 65% and 11 76% respectively.Multi-variable logistic regression indicated that those assoiate danger factor had great significance(p< 0 05 ). Conclusions Some mainly were the lower breath duct infection,and the greaten part were the patients with central nervous system disease.It suggested that the ward of neuron-disease should be kept control and should check ordinary for the NI.The prevention and treatment for the Ps.aeruginosa infection should be strengthened.It suggested that rational use of antibiotic and immunizing inhibitor and reduce the blood transfusion,and the unnecessary intrusion.It is important to pay more attention to those patient with chronic disease and cancer,elder,and neonate,etc.