医院感染漏报的监测及其评价研究

Study of monitoring and assessment in unreported nosocomial infections

目的分析医院感染漏报原因,为预防与控制医院感染提供理论依据。方法回顾性调查分析2012年1-12月全院21 750份出院病历资料,采用STATA 7.0软件对医院感染率、漏报率进行统计分析。结果 21 750例出院患者中发生医院感染419例,感染率为1.9%,抽查4 596份病历,医院感染440例,漏报21例漏报率为4.8%;医院感染漏报较高的科室分别为ICU、呼吸内科、神经内科、产科以及心血管科,分别占28.6%、23.8%、14.3%、14.3%、9.5%;医院感染漏报部位依次为下呼吸道、上呼吸道、泌尿道及皮肤软组织,分别占33.3%、23.8%、19.1%、14.3%;医院感染漏报原因与诊断标准掌握不准确、病原体送检率低、医院感染病例监测方法问题以及管理机制等有关。结论医院感染漏报与多种因素有关,医院感染学知识水平与监测方法的提高以及管理机制的完善是降低医院感染病例漏报率的关键,医院感染漏报的监测是评价医疗质量和安全的重要指标。

OBJECTIVE To analyze the causes of unreported nosocomial infections so as to provide theoretical basis for prevention and control of NI.METHODS A retrospective case study was performed to analyze 21,750 hospital medical records from Jan.2012 to Dec.2012.STATA7.0software was used to analyze NI rate and unreported rate.RESULTS A total of 419 patients,out of 21,750 patients,had NI after leaving hospital,with NI rate of1.9%,and 21 cases were failed to report with rate of 5.0%.The departments with high rate of failing to report NI were ICU（28.6%）,respiration（23.8%）,neurology（14.3%）,obstetrics department（14.3%）and cardiovascular（9.5%）.The sites of NI which being failed to report were lower respiratory tract（33.3%）,upper respiratory tract（23.8%）and urine tract（19.1%）and skin and soft tissue（14.3%）.The reason of failing to report were correlated with inaccurateness of diagnostic criteria,low rate of pathogen sending to test,monitoring method for NI patients,and imperfection of management mechanism.CONCLUSIONS The unreported NI is related with various factors.The key factors of reducing NI unreported rate are improving infection knowledge of the relevant staff and monitoring method for NI,and improving management system.Monitoring of unreported NI is an important indicator to evaluate quality and safety of medical care.