ICU感染的相关危险因素分析

Analysis of Relevant Risk Factors of ICU Infection

目的 分析综合ICU医院感染的特点,探讨如何有效预防与控制医院感染.方法 对东莞市石龙人民医院2010～2012年综合ICU医院感染病例进行回顾性分析.结果 2010～2012年综合ICU住院人数881人,发生感染242例次,感染率27.47％,≥60岁患者占57.85％,男性69.83％,总住院天数超过20 d的患者占73.97％,人均入住ICU天数≥60岁者为30.80 d,＜60岁者为19.70 d;医院感染患者主要原发疾病为：脑血管系统疾病29.75％、颅脑及多发性创伤24.79％、呼吸系统疾病17.77％、心血管系统疾病15.70％;主要部位为：下呼吸道57.85％、泌尿道16.53％、手术切口和皮肤软组织感染13.22％;医院感染共检出病原菌213株,以革兰阴性菌为主,占61.03％,主要为肺炎克雷伯氏菌、铜绿假单胞菌、鲍氏不动杆菌;革兰氏阳性菌占19.25％,以葡萄球菌为主,其中MRSA 13株,占31.71％.结论 加强重点部位、重点人群的监测,规范使用抗生素,加强病区管理,缩短住院时间和置管时间,及时采取干预措施,提高医务人员感染控制意识及水平,对降低医院感染发病率有重要意义.

Objective To analyze the characteristics of nosocomial infection in comprehensive ICU and investigate how to effectively prevent and control ICU infection. Methods Nosocomial infection ca- ses in comprehensive ICU from 2010 to 2012 were analyzed retrospectively. Results 242 cases were in- fected in 881 ICU patients from 2010 to 2012,infection rate was 27.47% ,of which patients over 60 years was 57.85% and male patients was 69.83%. The rate of total hospitalization days over 20 was 73.97% and the mean hospitalization days were 30.80 for patients over 60 year old and 19.70 for those less than 60 years old. The major diseases of nosocomial infection patients were cerebrovascular disease （29.75%） , craniocerebral trauma and multiple injures （24.79%） , respiratory diseases （ 17.77% ） , angiocardiopathy （15. 70% ）; the main sites of nosocomial infection were lower respiratory tract （57.85%）, urinary tract （ 16.53% ） , operative incision, skin and soft tissue （ 13.22% ） ; a total of 213 streams of organisms were isolated in our survey and the gram-negative bacterium accounts for 61.03% , the detected strain number were mainly klebsiella pnumoniae aeruginosa, acinetobacter; the gram-positive bacterium accounted for 19.25% , staphylococcus was the main pathogenic bacteria. 13 strains of MRSA （31.71% ） and 50 strains of fungus were detected. Conclusion It is of meaningful importance to reduce the infection rate in hospital by paying close attention to the susceptible patients and location, using antibiotics rationally, reducing hospitalization days and indwelling catheter time, taking intervention timely, meanwhile improving the level of awareness and control of infection of medical staff.