三亚市三级医院医院感染横断面调查与危险因素分析

Cross-sectional survey of prevalence of nosocomial infections in tertiary hospitals of Sanya and analysis of risk factors

目的了解三亚市医院感染现况,探讨分析医院感染危险因素,为三亚市卫生部门提供制定医院感染控制措施或政策的依据。方法采用横断面调查方法,于2015年6月统一对三亚市三级综合性医院进行医院感染现患率调查,整理数据并对数据质量及有效性进行检查,采用SPSS 20.0软件进行统计分析,计数资料采用率或构成比进行统计描述,数据对比采用χ2检验。结果应查3 170例,实查3 122例,实查率为98.49%;该地区医院感染现患率为5.45%,感染现患率最高为综合ICU占31.25%;感染部位以呼吸道为主,其次泌尿道;感染病原菌前3位依次为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌,分别占18.60%、14.73%、13.18%;单因素分析结果显示,泌尿道置管、动静脉置管、气管切开、气管置管、使用呼吸机、年龄、住院天数、手术、激素、放疗、化疗、免疫抑制剂使用对医院感染的影响,差异均有统计学意义(P<0.01),是医院感染危险因素。结论不同科室不同部位医院现患率不同,应以现患率高的科室及部位为监测重点,加强各医院重点科室、重点部位及主要病原菌的目标性监测,并针对危险因素制定可行的预防控制措施以减少医院感染的发生。

OBJECTIVE To investigate the prevalence of nosocomial infections in Sanya and explore the risk factors for the nosocomial infections so as to provide guidance for control of the nosocomial infections by the health departments of Sanya.METHODS By means of cross-sectional survey,the prevalence rates of nosocomial infections in the tertiary general hospitals of Sanya were investigated in Jun 2015,the data were organized,the quality and effectiveness of the data were examined,the statistical analysis was performed with the use of SPSS20.0software,the count data were statistically described by using rate or constituent ratio,and the comparative analysis of the data was carried out with the use of chi-square test.RESULTS Totally 3 170 cases were expected to be investigated,and3 122 cases were actually investigated.The prevalence rate of nosocomial infections was 5.45%in this area,and the prevalence rate of the infections was the highest（31.25%）in the general ICU.The respiratory tract was the predominant infection site,followed by the urinary tract.The top 3species of pathogens causing the infections were as follows：Klebsiella pneumoniae（18.60%）,Pseudomonas aeruginosa（14.73%）,and Acinetobacter baumannii（13.08%）.The univariate chi-square test analysis indicated that the influencing factors for the nosocomial infections included the urinary tract intubation,arteriovenous intubation,tracheotomy,endotracheal intubation,use of ventilator,age,length of hospital stay,surgery,hormone,radiotherapy,chemotherapy,and use of immunosuppressants,with statistical significance,and they were the risk factors for the nosocomial infections.CONCLUSION The departments and sites vary in the prevalence rate of nosocomial infections.It is necessary to focus on the surveillance of the departments with high prevalence rate,strengthen the targeted surveillance of the key departments,key sites and major species of pathogens,and formulate the feasible prevention measures according to the risk factors so as to reduce the incidence of the nosocomial infections.