NSICU目标性监测分析

Targeted surveillance of NSICU

目的探讨医院神经外科重症监护病房(NSICU)目标性监测,了解NSICU感染现状,为提高NSICU感染管理水平提供科学依据。方法选取2012年1-12月入住NSICU的240例患者作为研究对象,按照2009年国家卫生部颁发的《感染监测规范》对NSICU进行目标性监测;利用医院感染监控管理软件对监测资料进行汇总分析,采用SPSS 13.0软件对监测数据进行统计处理。结果 240例患者共发生感染65例、72例次,感染率为27.1%、例次感染率30.0%;日感染率为17.2‰;NSICU感染部位以下呼吸道感染和泌尿系感染为主,分别占68.1%和19.4%;全年NSICU接受侵入性操作患者共4 456例,其中呼吸机相关性肺炎发病率为70.1‰,导尿管相关泌尿道感染发病率为4.9‰,血管导管相关性血流感染发病率为3.3‰;240例患者送检标本103份,标本送检率42.9%,送检标本以痰液为主,占63.1%;共分离出病原菌81株,其中革兰阳性菌32株,占39.5%,以金黄色葡萄球菌为主,革兰阴性菌43株,占53.1%,以鲍氏不动杆菌为主;真菌6株,占7.4%,以白色假丝酵母菌为主。结论呼吸机相关性肺炎和泌尿插管相关泌尿道感染为NSICU的主要感染方式,主要病原菌为金黄色葡萄球菌和鲍氏不动杆菌,所以NSICU应重点加强对使用呼吸机及泌尿道插管患者的管理和监控,制定有效对策,减少NSICU感染的发生。

OBJECTIVE To explore the targeted surveillance of neurosurgery intensive care unit （NSICU） and ana- lyze the current status of infections in the NSICU so as to improve the level of control of infections in the NSICU. METHODS A total of 240 patients who were hospitalized the NSICU from Jan 2012 to Dec 2012 were enrolled in the study, then the targeted surveillance of NSICU was performed according to the standards for surveillance of in- fections issued by the Ministry of Health, 2009, the surveillance data were summarized and analyzed with the use of nosocomial infection surveillance and management software, and the obtained surveillance data were statistically analyzed by means of SPSS13.0 software. RESULTS Of the 240 patients, the infections occurred in 65 cases （72 case-times） with the infection rate of 27.1% and the case-time infection rate of 30.0 ‰ the daily infection rate was 17.2‰. Among the patients with infections, 68.1% were with the lower respiratory tract infections, 19.4% the urinary tract infections. Totally 4 456 patients received invasive operation in the whole year; the incidence of ventilator-associated pneumonia was 70.1‰, the incidence of urinary catheter-related urinary tract infections was 4.9‰, and the incidence of vascular catheter-related bloodstream infections was 3.3‰. Totally 103 specimens were submitted from the 240 patients with the submission rate of 42.9%, 63.1% of which were sputum speci- mens. A total of 81 strains of pathogens have been isolated, including 32 （39.5%） strains of gram-positive bacte- ria, 43 （53.1%） strains of gram-negative bacteria, and 6 （7.4 %） strains of fungi; the Staphylococcus aureus was the predominant species of gram-positive bacteria, the Acinetobacter baumannii was dominant among the gram- negative bacteria, and the Candida albicans was the predominant species of fungi. CONCLUSION The ventilator- associated pneumonia and the urinary catheter-related urinary tract infections are the major types of infections in the NSICU; the S. aureus and A. baumannii are the predominant species of pathogens. It is necessary to focus on the management and monitoring of the patients who use ventilator and urinary catheter and formulate effective countermeasures so as to reduce the incidence of infections in the NSICU.