三级综合教学医院医院感染横断面调查结果分析

Cross-sectional survey of nosocomial infections in a three A general teaching hospital

目的通过医院感染现患率调查,有助于了解医院感染的基本情况,为确定科室医院感染的基线水平、制定医院感染控制目标提供有力依据。方法采用横断面调查方法,调查2010-2013年调查日住院患者的医院感染和社区感染现患率、抗菌药物使用及病原学送检率,应用SPSS 19.0软件对数据进行统计分析。结果共调查8 860例住院患者,实际调查8 680例,实查率98.80%,发生医院感染678例、744例次,医院感染现患率7.81%、例次感染率8.57%;发现社区感染1 308例、1 370例次,社区感染现患率15.07%、例次感染率15.78%;医院感染病例共分离病原菌376株,其中细菌305株占81.12%,真菌65株占17.29%,其他病原菌6株占1.59%;4年抗菌药物使用率从37.55%下降至24.90%(P<0.05),预防用药比例显著下降(P<0.01)。结论 4年医院感染和社区感染现患率保持相对稳定水平,革兰阴性菌仍是医院感染主要病原菌,必须采取综合医院感染预防控制措施,进一步降低医院感染发生。

OBJECTIVE To investigate the prevalence rate of nosocomial infections and understand the basic status of nosocomial infections so as to define the baseline level of nosocomial infections in clinical departments and provide guidance for control of the nosocomial infections .METHODS By means of the cross-sectional survey ,the prevalence rates of hospital-acquired infections and community-acquired infections , use of antibiotics , and etiological submission rate of hospitalized patients were investigated on the survey day from 2010 to 2013 ,and the statistical analysis was performed by using SPSS 19 .0 software .RESULTS A total of 8860 hospitalized patients were supposed to investigate and 8680 cases were actually investigated with the actual investigation rate of 98 .80% ;the hospital-acquired infections occurred in 678 （ 744 case-times） cases with the prevalence rate of 7 .81% and the case-time infection rate of 8 .57% ;the community-acquired infections occurred in 1308 （1370 case-times） cases with the prevalence rate of 15 .07% and the case-time infection rate of 15 .78% .Totally 376 strains of pathogens causing the infections have been isolated ,including 305 （81 .12% ） strains of bacteria ,65 （17 .29% ） strains of fungi , and 6 （1 .59% ） strains of other pathogens . During the four years , the utilization rate of antibiotics decreased from 37 .55% to 24 .90% （P〈0 .05）;the proportion of the patients who used prophylactic antibiotics was significantly decreased （P〈 0 .01） .CONCLUSION The prevalence rates of the hospital-acquired infections and community-acquired infections maintain at a stable level in the four years ,and the gram-negative bacteria remain the predominant pathogens causing the nosocomial infections .It is necessary to take comprehensive prevention and control measures so as to further reduce the incidence of nosocomial infections .