重症监护病房患者医院感染的相关因素分析及对策

Monitoring and analysis of the relevant factors and strategies of nosocomial infection in intensive care unit

目的：了解重症监护病房（ ICU）住院患者医院感染的特点及影响因素，为制定防控对策提供依据。方法采用目标性监测方法，对2013年1-12月入住ICU的患者进行前瞻性监测，并对监测资料进行统计分析。结果677例患者中，163例发生医院感染，医院感染率为24．1％；感染212例次，感染例次率为31．3％；感染主要部位依次是呼吸道（143例次，67．5％）、血液（28例次，13．2％）和泌尿道（15例次，7．1％）；感染的主要病原菌依次是鲍曼不动杆菌（64株，30．2％）、铜绿假单胞菌（35株，16．5％）和肺炎克雷伯菌（24株，11．3％）。不同年龄、住院时间、入ICU时疾病诊断个数、机械通气时间患者及有无气管插管、深静脉置管、留置导尿管患者医院感染发生率比较差异均有统计学意义（P＜0．05）。结论应针对ICU医院感染的相关因素采取相应的防控对策，严格执行无菌操作规程和消毒隔离制度、加强手卫生、做好侵入性操作的管理，尽量缩短患者的住院时间、合理使用抗菌药物等是降低ICU患者发生医院感染的关键措施。

Objective To investigate the characteristics of nosocomial infections and factors in patients in intensive care unit （ ICU） ,in order to provide a basis for the measures .Methods Using the method of target monitoring , to the patients who were in the ICU from January 2013 to December had a prospective surveillance , statistics and analysis the monitoring data .Results There were 163 cases happened nosocomial infection in 677 cases of patients, hospital infection rate was 24.1%;212 cases of secondary infection , infection cases rate was 31.3%. The main site of infection followed by respiratory tract （ 143 cases, 67.5%）, blood （28 cases,13.2%）, urinary tract （15 cases, 7.1%）.The main pathogen of infection followed by Acinetobacter baumannii （64 strains, 30.2%）, Pseudomonas aeruginosa （35 strains, 16.5%） and Klebsiella pneumoniae （24 strains, 11.3%）.Different age, hospitalization, the number of disease diagnosis at ICU hospitalized , mechanical ventilation time and presence of detaining urethral catheter for endotracheal intubation , deep venous catheterization , indwelling catheters in patients with the incidence of comparative differences were statistically significant （P〈0.05）Conclusions Should take appropriate prevention and control measures for related factors of nosocomial infection in ICU , strict aseptic procedures and disinfection and isolation system , strengthen the hand hygiene , good management of invasive procedures , try to shorten the hospital stay of patients , rational use of antibiotics and so on are the key measures to reduce the nosocomial infections in ICU .