专科医院住院患者医院感染综合性监测结果分析

Comprehensive monitoring of hospitalized patients with nosocomial infections in a specialist hospital

目的了解胸科医院医院感染的发生率及科室分布,为预防和控制医院感染、提高医院感染管理水平提供科学依据。方法由专职人员利用医院信息系统(HIS)及临床检验系统(LIS)对2012-2013年住院患者实施前瞻及动态的综合性监测,统一由临床医师填写"医院感染病例报告卡"。结果 2012-2013年共监测住院患者39 808例,发生医院感染1 021例,感染率为2.56%,送检865例,送检率为84.72%,漏报197例,漏报率19.29%;感染率、送检率及漏报率最高的科室均为心脏外科;医院感染高发部位为下呼吸道,其次是血流、上呼吸道、手术切口部位及泌尿道;2012-2013年医院感染病例中共检出病原菌798株,以革兰阴性菌为主,占72.93%,其次为真菌、革兰阳性菌,分别占15.66%、11.41%;前5位致病菌依次为肺炎克雷伯菌、鲍氏不动杆菌、白色假丝酵母菌、阴沟肠杆菌、铜绿假单胞菌;标本主要来源于痰液、血液及伤口分泌物。结论通过综合性监测,可掌握住院患者医院感染的特点,针对重点科室感染高发部位进行目标性监测,降低感染率。

OBJECTIVE To investigate the incidence of nosocomial infections and the distribution of departments so as to provide scientific basis for control of nosocomial infections and improvement of management of nosocomial infections.METHODS The prospective and dynamic comprehensive monitoring was carried out for the patients who were hospitalized from 2012 to 2013by using hospital information system（HIS）and clinical laboratory system（CLS）,and the report cards of nosocomial infections cases were filled out by the clinicians.RESULTS Of totally 39808 hospitalized patients who were monitored from 2012 to 2013,1 021 patients had nosocomial infections,with the infection rate of 2.56%;a total of 865 patients were submitted,with the submission rate of 84.72%,and 197 patients were missed to report,with the missing report rate of 19.29%.The cardiac surgery department had the highest infection rate,submission rate,and missing report rate.The lower respiratory tract was the predominant infection site,followed by the bloodstream,upper respiratory tract,surgical incision,and urinary tract.A total of798 strains of pathogens were isolated from the patients with nosocomial infections,of which 72.93% were gramnegative bacteria,15.66% were fungi,and 11.41% were gram-positive bacteria.The Klebsiella pneumoniae,Acinetobacter baumannii,Candida albicans,Enterobacter cloacae,and Pseudomonas aeruginosa ranked the top five species of pathogens.The sputum,blood,and wound secretions were the major specimen sources.CONCLUSIONIt is an effective way to understand the characteristics of the nosocomial infections in the hospitalized patients through the comprehensive monitoring and carry out the targeted surveillance of the infection sites prevalent in the key departments so as to reduce the infection rate.