三级综合医院医院感染现患率调查分析

Survey on prevalence of nosocomial infections in a level 3general hospital

目的了解三级综合医院医院感染实际情况,探讨医院感染流行病学特征及高危因素,评价2009-2013年医院感染持续质量改进成效及不足,以利于促进医院感染预防与控制。方法采用电子病历与床旁调查相结合的方法,对2013年7月11日0∶00-24∶00所有住院患者进行调查,并汇总分析调查结果,数据采用SPSS16.0统计软件进行处理。结果应查1 812例、实查1 800例,实查率为99.34%,医院感染40例、41例次,医院感染现患率2.22%,例次感染率2.28%;重症监护病房医院感染率高达18.57%;医院感染部位以下呼吸道为主,占60.97%;抗菌药物的使用率为26.94%,治疗及治疗+预防使用抗菌药物占73.60%,预防用药占26.40%;抗菌药物以一联用药为主,占88.45%;治疗性使用抗菌药物病原学送检率为36.49%。结论应加强重点科室、重点环节、高危人群的医院感染预防与控制,提高治疗性使用抗菌药物病原学送检率,指导合理使用抗菌药物,加强医院感染集束化管理措施的落实,以降低医院感染发生率。

OBJECTIVE To understand the actual situation of nosocomial infections in a level 3 general hospital and discuss the epidemiology characteristics and high risk factors of nosocomial infections, evaluate achievements in the continuous quality improvement of nosocomial infections and disadvantages in recent years （2009-2013） so as to promote the nosocomial infection prevention and control. METHODS All the patients who were hospitalized between 0 ： 00 and 24： 00 on Jul. llth were investigated by the review of electronic medical records combined with the bedside investigation. The investigation results were summarized and analyzed with the statistical software SPSS 16. 0. RESULTS Totally 1 812 cases were expected to be investigated, and 1 800 cases were actually investigated with the actual investigation rate of 99.34%, the prevalence rate of nosocomial infections was 2.22% （40 cases of nosocomial infections） and the case-time infection rate was 2. 28% （41 case-times of nosocomial infections）. The nosocomial infection rate in the intensive care ward was as high as 18. 57%. The lower respiratory tract was the main infection site, accounting for 60.97 %. The utilization rate of antibiotics was 26.94%. The patients with therapeutic and preventiveS- therapeutic use of antimicrobial drugs accounted for 73.60% ; the patients with single use of antibiotics were dominant, accounting for 88.45%. The submission rate of the bacterial culture for therapeutic antibiotics was 36.49%. CONCLUSIONS It is necessary to strengthen the prevention and control of nosocomial infections in the key departments, the important link, and the high-risk groups, and enhance the etiological examination to guide the reasonable use of antibiotics, and strengthen the implementation of cluster management measures for nosocomial infections so as to reduce the incidence rate of nosocomial infections.