NICU患儿医院感染危险因素分析及对策

Study of risk factors and strategies of nosocomial infection in NICU children

目的探讨新生儿重症监护病房(NICU)医院感染相关的危险因素,研究其预防策略,为降低感染率提供科学依据。方法选择2010-2012年入住NICU救治的6383例新生儿,以是否发生医院感染,各取486例分别作为病例组和对照组,基于logistic回归模型采用SPSS19.0软件进行分析。结果产程延长、低出生体重儿、小于胎龄儿、机械通气、抗菌药物使用>7d、脐静脉置管、使用激素、胃肠外营养、危重程度<70分、反应低下、高胆红素血症、呼吸困难、窒息、羊膜早破、羊水粪染、早产、置胃管、PICC、住院>14d等19个因素为相关危险因素,其中有9个因素是独立高危因素,Waldχ2值>10及Exp(β)值位于前3位的是早产、低出生体重儿和危重度<70分。结论现阶段随着NICU标准化建设,医院感染主要危险因素趋向免疫功能低下的众多原发病,只有降低原发病易感性,才能进一步降低感染发生率。

OBJECTIVE To discuss the risk factors related to nosocomial infection in NICU and study its preventive strategies, and provide scientific basis for reducing the infection rates. METHODS All the children treated in NICU from 2010 to 2012 were selected, and were divided into two groups of case group and the control group according to the occurrence of nosocomial infection, with 486 cases in each group respectively, then were analyzed based on the logistic regression model. RESULTS Nineteen related risk factors were found, including prolonged labor, low birth weight infant, small gestational age （SGA）, mechanical ventilation, antibiotics 〉7 days, umbili-cal venous catheters （UVC）, using of hormones, total parenteral nutrient （TPN）, critical degree 〈70 scores, decreased responsiveness, hyperbilirubinemia, dyspnea, asphyxia, premature rupture of amniotie membrane, meconium staining amniotic fluid （MSAF）, premature birth, gastric tube placing, PICC, hospitalization date 〉14 days, and 9 of them were independent high risk factors. The factors that Wald chi-square value 〉 10 and Exp （B） value ranks the top three were premature, low birth weight infant and critical degree 〈 70 points. CONCLUSION At this stage, with the standardization in the construction of NICU, the main risk factors of nosocomial infection tend to be many immunocompromised protopathy diseases. Only by reducing the susceptibility of the protopathy diseases can the rate of nosocomial infection be further reduced.