万级层流病房对初发急性白血病患者诱导化疗期间医院感染发病率的影响

Effect of class 10000 laminar flow ward on the incidence of healthcare-associated infection in patients with initial occurrence of acute leukemia during induction chemotherapy period

目的探讨万级层流病房对初发急性白血病患者诱导化疗期间医院感染发病率的影响。方法回顾性调查2013年10月—2014年6月某院血液科病房收治的初发急性白血病患者,万级层流病房收治的患者为试验组,普通病房收治的患者为对照组。所有患者均接受标准诱导化疗,接受相同的护理措施,比较两组患者医院感染发病率及病房空气洁净度。结果共收治初发急性白血病患者79例,试验组39例,对照组40例。层流病房房间、走廊空气洁净度(分别为3.57×106/m3、24.46×106/m3)与普通病房(分别为149.36×106/m3、15 854.38×106/m3)比较,差异均有统计学意义(t值分别为45.80、108.70,均P<0.001)。医院感染发病率试验组为23.08%(9/39),对照组为45.00%(18/40),两组比较,差异有统计学意义(χ2=4.219,P=0.040)。医院感染部位试验组主要为胃肠道(5例),对照组主要为下呼吸道(8例)。患者发热持续时间、抗菌药物使用时间及费用,试验组分别为(6.20±2.10)d、(9.35±2.12)d、(27 113.79±1 559.03)元;对照组分别为(10.20±2.90)d,(14.15±3.14)d、(58 566.29±2 217.54)元;两组患者发热持续时间、抗菌药物使用费用比较,差异均有统计学意义(t值分别为1.021、1 377.45,均P<0.05)。结论初发急性白血病患者使用层流病房,可降低其医院感染发病率,减少抗菌药物使用费用。

Objective To evaluate the effect of class 10 000 laminar flow ward on the incidence of healthcare-associated infection（HAI）in patients with initial occurrence of acute leukemia during induction chemotherapy period.Methods Patients with initial occurrence of acute leukemia admitted to a hematological department of a hospital between October 2013 and June 2014 were investigated retrospectively,patients in class 10 000 laminar flow ward was as trial group,in general ward was as control group.All patients received standard induction chemotherapy and the same nursing measures,the incidence of HAI between two groups of patients,and ward air cleanliness were compared.Results A total of 79 patients with initial acute leukemia were received（trial group,n=39;control group,n=40）.The average air cleanliness value in rooms and corridors of laminar flow wards were both significantly different with general ward（3.57×106/m3 vs 149.36×106/m3,t=45.80,P〈0.001;24.46×106/m3 vs 15 854.38×106/m3,t=108.70,P〈0.001）.Incidence of HAI between trial group and control group was significantly different（23.08%[9/39]vs 45.00%[18/40],χ2=4.219,P=0.040）.The main infection site in trial group was gastrointestinal tract（n=5）,in control group was lower respiratory tract（n=8）.The duration of fever,duration and cost of antimicrobial use in trial group were（6.20±2.10）d,（9.35±2.12）d,and（27 113.79±1 559.03）yuan respectively,in control group were（10.20±2.90）d,（14.15±3.14）d,and（58 566.29±2 217.54）yuan respectively,difference in duration of fever and cost of antimicrobial use between two groups were all significant（t=1.021,1 377.45,both P〈0.05）.Conclusion Laminar flow ward can reduce the incidence of HAI in patients with initial occurrence of acute leukemia,and decrease cost of antimicrobial use.