综合医院ICU目标性监测分析与干预

Targeted monitoring and interventions in ICU of general hospital

目的了解医院ICU导管相关医院感染以及呼吸机相关性肺炎感染现状,采取相应措施进行预防控制,以降低其感染率。方法采用前瞻性监测方法对医院2012年1-12月入住ICU并有留置导管及呼吸机的患者进行监测,对监测数据进行统计处理。结果 2012年1-12月ICU 1 500例患者发生医院感染155例、209例次,感染率为10.33%、例次感染率为13.93%;其中目标性监测患者中感染80例、109例次,感染率为5.33%、例次感染率为7.27%;感染部位为下呼吸道为主,占41.63%,其次为血液和泌尿系感染,分别占30.14%、24.88%;ICU导管相关感染以中心静脉导管相关性血流感染(CRBSI)为主,占39.45%,其次是导尿管相关尿路感染(UTI)和呼吸机相关性肺炎(VAP),分别占33.94%和26.61%;呼吸机相关性肺炎千导管日感染率最高,为4.23‰,其次为中心静脉导管和导尿管,分别为4.12‰和3.71‰;共检出病原菌106株,其中革兰阴性菌58株占54.72%,革兰阳性菌31株占29.24%,真菌17株占16.04%。结论 ICU患者病情危重,住院时间长,抗菌药物使用级别高、时间长,侵入性操作多,容易发生医院感染;加强ICU的探视管理、积极评估导管的必要性,及时拔管、严格执行手卫生、合理使用抗菌药物、严格执行无菌技术操作等措施以降低ICU医院感染的发生率。

OBJECTIVE To investigate the current status of catheter-associated nosocomial infections and ventilatorassociated pneumonia in the ICU and take corresponding prevention measures so as to reduce the infection rate. METHODS By means of prospective surveillance, the patients who underwent catheterization and used ventilation in the ICU from Jan to Dec 2012 were monitored, and the monitoring data were statistically analyzed. RESULTS From Jan to Dec 2012, the nosocomial infections occurred in 155 （209 case-times） of 1 500 ICU patients with the infection rate of 10.33% and the case-time infection rate of 13.93%, among which there were 80 （109 case-times ） cases under the targeted monitoring, with the infection rate of 5.33%, the case-time infection rate 7.27%. Of the patients with nosocomial infections, 41.63 %were with lower respiratory tract infections, 30.14 % with bloodstream infections, 24.88 ~ with urinary tract infections. Among the patients with catheter-associated infections in the ICU, 39.45% were with central venous catheter-associated bloodstream infections, followed by the urinary catheter-associated urinary tract infections （33.94%） and ventilator-associated pneumonia （VAP） （26.61 %）. The thousand-catheter-day infection rate of VAP was the highest （4.23‰）, followed by the central venous catheter-associated infections （4.12‰） and the urinary catheter-associated urinary tract infections （3.71‰）. A total of 106 strains of pathogens have been isolated, including 58 （54.72%） strains of gram-negative bacteria, 31 （29.24%） strains of gram-positive bacteria, and 17 （16.04%） strains of fungi. CONCLUSION The illness condition of the ICU patients is severe, with the length of hospital stay long, the grade of used antibiotics high, the time of use of antibiotics long, the invasive procedures frequent, which tends to result in the nosocomial infections. It is necessary to strengthen the management of visiting to the ICU, actively evaluate the feasibility of catheterization, extubate in a timely manner, strictly implement the hand hygiene, reasonably use antibiotics, and rigidly carry out theaseptic techniques so as to reduce the incidence of nosocomial infections in the ICU.