2013年医院感染现患率调查及危险因素分析

Prevalence rate and risk factors of healthcare-associated infection in 2013

目的了解某院医院感染的现状以及抗菌药物的使用情况。方法采用横断面调查的方法,对2013年8月21日该院所有住院患者医院感染现患率、抗菌药物使用情况以及病原学送检率进行调查。结果共调查住院患者2 238例,发生医院感染104例,126例次,医院感染现患率为4.65%,例次现患率为5.63%。医院感染部位居前4位的是下呼吸道(28.57%)、上呼吸道(18.25%)、泌尿道(7.94%)和胃肠道(4.76%);标本送检率为91.35%(95/104),标本来源以痰液(26.32%)居首位,其次为血液(25.26%)、尿液(10.53%)等。抗菌药物使用率为24.58%,其中治疗、预防+治疗、预防用药分别占36.55%、45.09%和18.36%;抗菌药物单一、二联和三联用药率分别为75.82%、20.91%、3.27%。危险因素分析结果显示,年龄(<15岁或>60岁)、各种侵入性操作(气管切开、使用呼吸机、泌尿道插管、动静脉置管和血液透析)、抗肿瘤化学治疗是医院感染的危险因素。结论医院感染现患率调查有助于了解医院感染和抗菌药物使用情况,以及发生医院感染的高危因素和高危科室,为后期有效开展医院感染目标性监测提供有力的依据。

Objective To investigate healthcare-associated infection（HAI）prevalence and antimicrobial use in a hospital.Methods HAI prevalence rate,antimicrobial use and pathogen detection in all inpatients on August 21 , 2013 were investigated with cross-sectional survey method.Results A total of 2 238 inpatients were investigated, 104 patients developed 126 times of HAI,HAI prevalence rate and case rate was 4.65% and 5.63% respectively;the top four sites for HAI were lower respiratory tract （28.57%）,upper respiratory tract（18.25%）,urinary tract （7.94%）and gastrointestinal tract（4.76%）.Rate of specimens delivered for detection was 91 .35%（95/104）,the main specimen was sputum （26.32%）,followed by blood （25.26%）and urine （10.53%）.Antimicrobial usage rate was 24.58%,therapeutic,prophylactic plus therapeutic,and prophylactic use accounted for 36.55%,45.09%, and 18.36% respectively;the usage rate of single,combination of 2,and 3 antimicrobial agents accounted for 75.82%,20.91 % and 3.27% respectively.Risk factors of HAI were age （〈15 or 〉60 years）,all kinds of inva-sive procedures （tracheotomy,mechanical ventilation,urinary catheterization,arteriovenous intubation,hemodialy-sis）,and anti-tumor chemotherapy.Conclusion Survey on HIA prevalence helps to know the occurrence of HAI and usage of antimicrobial agents,as well as risk factors and high-risk departments of the occurrence of HAI,it also provides basis for subsequent targeted monitor on HAI.