2014年全国医院感染横断面调查报告

Nationwide cross-sectional survey on healthcare-associated infection in 2014

目的掌握全国医院感染现患情况,建立医院感染相关指标体系。方法采用横断面调查方法,床旁调查和病历调查相结合,全国医院感染监测网医院及其他自愿参加调查的医院按照统一的调查方案进行调查,调查其医院感染现患情况。结果 1 766所医院的资料进入统计,共调查患者1 008 584例,发生医院感染26 972例,医院感染现患率为2.67%,抗菌药物使用率为35.01%。不同床位数医院医院感染现患率、抗菌药物使用率比较,差异均有统计学意义(χ2值分别为1 599.21、3 458.40,均P<0.01)。医院感染部位主要为下呼吸道(47.53%)、泌尿道(11.56%)和手术部位(10.41%)。共分离病原体13 784株,居前5位的病原体为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌。Ⅰ类手术患者手术部位感染现患率为1.01%;Ⅰ类切口手术患者预防性抗菌药物使用率为27.99%,不同床位数医院Ⅰ类切口手术患者预防性抗菌药物使用率比较,差异有统计学意义(χ2=400.34,P<0.01);治疗使用抗菌药物细菌培养送检率为45.89%,不同床位数医院细菌培养送检率比较,差异有统计学意义(χ2=9 189.90,P<0.01)。≥900张床位的医院医院感染现患率最高(3.36%),抗菌药物使用率最低(32.35%),细菌培养送检率最高(56.03%)。结论此次横断面调查多维度指标显示我国医院感染管理取得显著成效;同时,计算出各指标的百分位数分布,便于各单位进行医院感染相关工作的自我评价。

Objective To investigate the nationwide prevalence of healthcare-associated infection（HAI）,and establish the related indexes of HAI.Methods A cross-sectional survey was conducted through combination of bedside investigation and medical record reviewing,the prevalence of HAI in hospitals of National HAI Surveillance System and other hospitals voluntarily participated in the survey were investigated according to unified survey program.Results A total of 1 008 584 patients in1 766 hospitals participated in the survey,26 972 cases of HAI occurred,prevalence rate of HAI was 2.67%,antimicrobial usage rate was 35.01%.Difference in prevalence rates of HAI and antimicrobial usage rates among hospitals with different number of beds were both significant（χ^2=1 599.21,3 458.40,respectively,both P〈0.01）.The main infection sites were lower respiratory tract（47.53%）,urinary tract（11.56%）and surgical site（10.41%）.A total of 13 784 pathogenic strains were isolated,the top five pathogens were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,and Staphylococcus aureus.Prevalence rate of HAI and prophylactic antimicrobial usage rate in patients receiving operation of classⅠincision were 1.01% and27.99% respectively,difference in prophylactic antimicrobial usage rates in patients receiving operation of classⅠincision at hospitals with different number of beds were significant（χ^2=400.34,P〈0.01）;among patients receiving antimicrobial prophylaxis,percentage of specimens sending for bacterial detection was 45.89%,difference in bacterial detection rates in hospitals with different number of beds were significant（χ^2=9 189.90,P〈0.01）.Hospital with more than900 beds had the highest prevalence rate of HAI（3.36%）,lowest usage rate of antimicrobial agents（32.35%）,and highest bacterial detection rate（56.03%）.Conclusion Multiple indexes of this cross-sectional survey revealed that HAI management in China has achieved remarkable results;meanwhile,calculation of the percentile distribution of each index is convenient for selfevaluation for HAI-related work in each hospital.