重症监护室院内感染监控与管理

Monitoring and Management on Nosocomial Infection in ICU

目的探讨医院重症监护室的院内感染主要原因,提出有效的护理干预措施。方法回顾分析2013年1月-2013年12月医院重症监护室收治的1255例患者的临床资料。结果⑴1255例患者,其中338例患者发生院内感染,院内感染发生率为26.93%。⑵338例院内感染患者,单一细菌感染301例(89.05%),混合感染37例(10.95%),共检测出病原菌379株,其中真菌116株(30.61%)、金黄色葡萄球菌88株(23.22%)、铜绿假单胞菌67株(17.68%)、大肠埃希菌55株(14.51%)、肺炎克雷伯菌43株(11.35%),其他10株(2.64%)。⑶338例院内感染患者,单一部位感染325例(96.15%),多部位感染13例(3.85%),共计感染部位353处,其中下呼吸道149例次(42.21%)、泌尿系统95例次(26.91%)、胃肠道47例次(13.31%)、上呼吸道39例次(11.05%)、其他23例次(6.52%)。⑷不同性别组患者之间院内感染发生率相比差异无统计学意义(P>0.05),但是不同年龄组患者之间、不同急性生理与慢性健康(APACHE-Ⅱ)评分组之间院内感染发生率相比差异有统计学意义(P<0.05)。结论 2013年度我院重症监护室发生的院内感染与患者年龄、基础疾病、病情危重程度等因素有关,针对这种情况,尽早控制病情、合理使用抗生素、严格无菌操作、加强重症监护室管理是控制院内感染发病率的重要手段。Objective To study the main reasons of ICU infection in our hospital,and put forward effective nursing interventions.

Objective To study the main reasons of ICU infection in our hospital, and put forward effective nursing interventions.Methods Retrospective analysis on the clinical data of 1255 cases from January to December in 2013 in ICU department was made.Results 338 cases out of 1255 patients occurred nosocomial infection with incidence rate of 26.93%. In the 338 cases of nosocomial infection, 301 cases were single bacterial infection （89.05%）. 37 cases were mixed infection （10.95%）. A total of 379 strains of bacteria were found, including 116 strains of fungi （30.61%）, 88 strains of staphylococcus aureus （23.22%）, 67 strains of pseudomonas aeruginosa （17.68%）, 55 strains of escherichia coli （14.51%）, 43 strains of klebsiella pneumoniae （11.35%） and 10 other strains （2.64%）. In 338 cases of nosocomial infection, 325 cases were single site infection （96.15%）. 13 cases were multiple sites infection （3.85%）. A total of 353 sites were infected, including 149 cases of lower respiratory tract （42.21%）, 95 cases of urinary system （26.91%）, 47 cases of gastrointestinal tract （13.31%）, 39 cases of upper respiratory tract （11.05%） and other 23 cases （6.52%） The nosocomial infection incidence between different genders was of no significant difference （P 〉 0.05）, but it had statistical significance different age groups and different acute physiology and chronic health （APACHE- II） groups （P 〈 0.05）. Conclusion Nosocomial infection in our ICU department in 2013 was relevant with patients＇ age, basic diseases, severity of illness etc.. As for this issue, disease control, rational use of antibiotics, strict sterile operation, strengthening ICU management are important means to control the incidence of nosocomial infection.