ICU分隔式病房与开放式病房的医院感染比较

Nosocomial infections in separated wards and open wards of ICUs:a comparative study

目的比较重症监护病房(ICU)分隔式病房与开放式病房的医院感染,探讨分隔式病房对医院感染的预防控制作用。方法以2013年7月-2014年6月入住ICU的患者为研究对象,入住分隔式病房(A区)的患者814例为观察组,入住开放式病房(B区)的患者295例为对照组,前瞻性观察两组的医院感染,同时比较两组患者临床资料及医护人员手卫生依从性。结果共观察患者1 109例,发生医院感染158例,总感染率14.25%;其中A区患者814例,发生医院感染103例,感染率为12.65%,B区患者295例,发生医院感染55例,感染率为18.64%,两者比较差异有统计学意义(P<0.05);两组患者感染部位均以下呼吸道感染为主,其次为泌尿道和血流感染,A区泌尿道感染率3.44%和血流感染率0.49%,低于B区的6.10%和2,37%,差异有统计学意义(P<0.05);两组医院感染病原菌均为肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌。结论分隔式病房比开放式病房的医院感染率低,分隔式病房可降低医院感染风险,建议在设计建筑ICU时尽量采用分隔式病房。

OBJECTIVE To compare the incidence of nosocomial infections in the separated wards and open wards of intensive care units （ICUs） and explore the role of separated wards in control of the nosocomial infections. METHODS The patients who were hospitalized the ICUs from Jul 2013 to Jun 2014 were recruited as the study ob-jects, then 814 patients who were hospitalized the separated wards （ward A ） were assigned as the observation group, 295 patients who were hospitalized the open wards （ward B） were chosen as the control group;the pro-spective survey was conducted for the prevalence of nosocomial infections in the two groups of patients;the clinical data of the patients and the hand hygiene compliance of health care workers were observed. RESULTS A total of 1 109 patients have been investigated, the nosocomial infections occurred in 158 cases with the total infection rate of 14. 25%;the nosocomial infections occurred in 103 of 814 patients in the ward A with the infection rate of 12. 65%and occurred in 55 of 295 patients in the ward B with the infection rate of 18. 64%, there was statistically signifi-cant difference between the two （P〈0. 05）. The lower respiratory tract was the predominant infection site of both groups, followed by the urinary tract and bloodstream infection;the incidence of urinary tract infections was 3. 44% in the ward A, lower than 6. 10% in the ward B;the incidence of bloodstream infections was 0. 49% in the ward A, lower than 2. 37% in the ward B, there was statistically significant difference （P〈0. 05）. The K lebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa were the pathogens causing nosocomial in-fections in the two groups of patients. CONCLUSION The incidence of nosocomial infections is lower in the separa-ted ward than in the open ward, and the separated ward can reduce the risk of nosocomial infections. It is sugges-ted that the separated ward should be take into consideration for the design of ICU.