某三级甲等综合医院医院感染现患率调查与危险因素分析

Prevalence of nosocomial infections in a three A general hospital and analysis of risk factors

目的了解某三甲综合医院的医院感染流行现状并分析危险因素,为临床控制及降低医院感染提供参考。方法采用横断面调查方法,借助医院感染实时监控系统(NIS)对2013年10月14日的所有在院患者进行医院感染现患率调查;使用SPSS16.0统计软件进行数据分析。结果应查住院患者2 128例,实查2 128例,实查率100.00%;共发生医院感染99例、125例次,医院感染现患率为4.65%、例次感染率为5.87%;医院感染现患率最高的科室是综合ICU,为30.00%;医院感染部位以下呼吸道、上呼吸道、泌尿道为主,分别占38.40%、10.40%和7.20%;医院感染病原菌送检率为92.80%,检出病原菌以革兰阴性菌为主,占69.20%;抗菌药物使用率为42.58%;多因素logistic回归结果显示,住院天数、中心静脉插管、呼吸机使用、气管切开和手术类型是医院感染的独立危险因素。结论医院感染横断面调查可以真实的反映医院感染情况,临床应加强侵入性操作管理,重点预防控制呼吸系统感染和革兰阴性菌感染。

OBJECTIVE To understand the prevalence of nosocomial infections in a three A general hospital and analyze the risk factors so as to provide guidance for clinical control of the nosocomial infections.METHODS By means of the cross-sectional survey,the prevalence rates of nosocomial infections in all the patients who were hospitalized on Oct 14,2013 were investigated by using the real-time monitoring system for nosocomial infections,and the statistical analysis of data was performed with the use of SPSS 16.0software.RESULTS Totally 2 128 hospitalized patients were supposed to be investigated,and 2 128 patients were actually investigated,with the actual investigation rate of 100.00%.The nosocomial infections occurred in 99cases（125case-times）with the prevalence rate of4.65% and the case-time infection rate of 5.87%.The prevalence rate of nosocomial infections was the highest in the general ICU（30.00%）.Of the patients with nosocomial infections,38.40% had the lower respiratory tract infections,10.40% had the upper respiratory tract infections,and 7.20% had the urinary tract infections.The submission rate of the pathogens causing nosocomial infections was 92.80%,the gram-negative bacteria were dominant among the isolated pathogens,accounting for 69.20%.The utilization rate of antibiotics was 42.58%.The results of the multivariate logistic regression analysis indicated that the independent risk factors for the nosocomial infections included the length of hospital stay,central venous catheterization,use of ventilator,tracheotomy,and types of surgery.CONCLUSION The cross-sectional survey of the nosocomial infections can actually reflect the prevalence of the nosocomial infections.It is necessary for the hospital to strengthen the management of invasive operations and focus on the prevention of the respiratory system infections and the gram-negative bacteria infections.