肿瘤医院重症监护病房医院感染目标性监测

Targeted monitoring on healthcare-associated infection in intensive care unit of a tumor hospital

目的了解某肿瘤医院重症监护病房(ICU)医院感染目标性监测结果及特点,为制定医院感染预防控制措施提供科学依据。方法对2013年1—12月入住该院ICU的患者进行目标性监测,采用患者平均病情严重程度(ASIS)调整法调整医院感染发病率,统计3种侵入性操作相关感染发病率、医院感染病原菌及多重耐药菌分布情况。结果共监测ICU患者455例,总住院日数2 483 d,发生医院感染52例,医院感染发病率为11.43%,日发病率为20.94‰,经ASIS调整后日发病率为6.29‰。医院感染以呼吸系统感染最高(占63.46%),其次为泌尿系统感染(占19.23%);呼吸机相关性肺炎(VAP)发病率为12.08‰、导管相关血流感染发病率为0.95‰、导尿管相关尿路感染发病率为4.07‰。共检出病原菌181株,其中革兰阴性菌135株(74.59%),革兰阳性菌33株(18.23%),真菌13株(7.18%);检出多重耐药菌33株(18.23%)。结论 ICU是医院感染的高发科室且感染发病率高,主要为呼吸道感染,以革兰阴性菌为主。开展目标性监测,能及时反映感染控制工作的不足,有利于制定切实有效的防控与干预措施,减少医院感染的发生。

Objective To understand the results and characteristics of targeted monitoring of healthcare-associated infection（HAI）in an intensive care unit（ICU）of a tumor hospital,so as to provide scientific basis for formulating measures of prevention and control of HAI.Methods Patients who admitted to an ICU from January to December2013 were performed targeted monitoring,incidence of HAI was adjusted with an average severity of illness score（ASIS）,three types of invasive procedure-related infection,distribution of pathogens,and multidrug-resistant organisms were monitored.Results A total of 455 patients were monitored,the total patient-days were 2 483 days,52 cases of HAI occurred,incidence of HAI was 11.43%,incidence of HAI per 1 000 patient-days was 20.94‰,after the adjustment with ASIS,incidence of HAI per 1 000 patient-days was 6.29‰.The main infection site was respiratory system（63.46%）,followed by urinary system（19.23%）;Incidence of ventilator-associated pneumonia per1 000 ventilation-days,catheter-related bloodstream infection per 1 000 catheter-days,and catheter-associated urinary tract infection per 1 000 urinary catheter days were 12.08‰,0.95‰,and 4.07‰respectively.A total of 181 pathogenic isolates were detected,74.59%（n=135）of which were gram-negative bacteria,18.23%（n=33）were grampositive bacteria,and 7.18%（n=13）were fungi;18.23%（n=33）were multidrug-resistant strains.Conclusion ICU is the high risk department of the occurrence of HAI,the main infection is respiratory tract infection,the major pathogen is gramnegative bacteria.Targeted monitoring can timely reflect the deficiency in infection control practice,is helpful for formulating effective prevention and intervention measures,and reducing the occurrence of HAI.