急诊内科患者医院感染目标性监测分析

Targeted surveillance of patients with nosocomial infections in emergency internal medicine department

目的分析急诊内科患者医院感染发生情况,并提出相应的预防对策。方法采用回顾性调查方法对医院急诊内科220例住院患者的临床资料进行目标性监测,分析器械使用情况及相关感染率,并进行数据对比。结果 220例患者合计住院3591d,发生医院感染43例,感染率为19.5%,日感染率为11.9‰,根据病情严重程度调整日感染率为4.5‰;感染部位以呼吸道为主占60.4%,其次为泌尿系统占27.9%;呼吸机、留置尿管和中心静脉导管的使用率为15.56%、81.25%、33.33%,导管相关性肺部感染、血流感染、泌尿道感染分别为23.8%、2.20%和0;共分离出病原菌119株,其中革兰阴性菌86株占72.27%;革兰阳性菌33株占27.73%。结论急诊内科感染率较高,尤其是呼吸机相关性肺部感染率显著高于国外水平,感染病原菌以非发酵菌为主,病原菌呈多药耐药性,应采取有针对性的干预措施。

OBJECTIVE To analyze the incidence of nosocomial infections in patients of emergency internal medicine department and put forward corresponding prevention countermeasures.METHODS By means of retrospective survey,the targeted surveillance was performed for the clinical data of 220patients who were hospitalized the emergency internal medicine department,then the use of instruments and the incidence of infections were analyzed,and the data were compared.RESULTS Of the 220patients with the total length of hospital stay of 3591days,the nosocomial infections occurred in 43cases with the infection rate of 19.5%and the daily infection rate of 11.9‰,the daily infection rate adjusted according to the severity of illness was 4.5‰.The patients with respiratory tract infections accounted for 60.4%,the patients with urinary tract infections 27.9%.The utilization rate of ventilator was 15.56%,the indwelling catheter 81.25%,the central venous catheter 33.33%.The incidence of the catheter-related pulmonary infections 23.8%,the bloodstream infections 2.20%,the urinary tract infections 0.A total of 119 strains of pathogens have been isolated,including 86（72.27%）strains of gram-negative bacteria and 33（27.73%）strains of gram-positive bacteria.CONCLUSIONThe incidence of infections is high in the emergency internal medicine department,and the incidence of ventilator-associated pulmonary infections is significantly higher in China than that abroad.The non-fermenting bacteria are the predominant pathogens causing infections and are highly multidrug-resistant.It is necessary to take targeted intervention measures.