临床专家参与下的医院感染监测模式研究

Surveillance mode of nosocomial infections with participation of clinical experts

目的探讨临床专家参与下的医院感染病例监测模式,为进一步从临床角度降低感染风险奠定基础。方法 2014年4-12月建立感染疑难病例专家团队,2015年1-4月专家对感染疑难病例进行审阅,从临床的角度发现医院感染诊断与预防控制中的问题与难点进行分析。结果建立了8个专业领域分工专家团队,对268份疑难病例进行审阅,发现漏报病例28例漏报率为10.44%,误报病例18例误报率6.71%,临床医院感染诊断中存在相关指标提示感染病程中对临床症状不描述,未依据培养结果使用或调整抗菌药物、过度使用抗菌药物等造成医院感染诊断困难,医院感染预防与控制中存在基础疾病及免疫状态控制不佳、导管留置时间过长、侵入性操作护理不当等问题。结论专家参与模式下的医院感染监测模式,可以从临床角度探讨医院感染预防控制工作,提高临床医院感染预防与控制能力。

OBJECTIVE To explore the surveillance mode of nosocomial infections cases with the participation of clinical experts so as to lay foundation for reduction of risk of infections from the clinical perspective.METHODS An expert team for difficult cases of infections was established from Apr 2014 to Dec 2014,the experts reviewed the difficult cases of infections so as to find out the problems in the diagnosis,control,and prevention of nosocomial infections from the clinical perspective and analyze the difficulties.RESULTS The expert teams involving 8professional fields were established,and 268 difficult cases were reviewed;28cases were failed to report,with the failed report rate of 10.44%,and 18 cases were false reports,with the false report rate of 6.71%.The problems existed in the clinical diagnosis of nosocomial infections,including the related indexes indicating the clinical symptoms were not described during the course of infections,use or adjustment of drug administration without conforming to the culture results,difficult diagnosis of nosocomial infections induced by excessive use of antibiotics,underlying diseases and poor control of immune state existing in the control and prevention of nosocomial infections,prolonged catheter indwelling time,and inappropriate nursing for invasive operation.CONCLUSION The surveillance mode of nosocomial infections with participation of clinical experts may facilitate the discussion of the control and prevention of nosocomial infections and improve the ability of clinical control and prevention of nosocomial infections.