使用床旁听诊器对重症监护病房医院感染发病率的影响

Impact of the use of stethoscopes on the incidence of nosocomial infection in intensive care unit

目的 :探讨使用听诊器对重症监护病房医院感染发病率的影响。方法 :选择2014年6月1日起入住我院综合性重症监护病房(ICU)并于2015年3月30日前转出ICU或死亡的患者,总计611例,根据床位分为干预组(n=296,使用床旁听诊器进行听诊)和对照组(n=315,使用医生自带的听诊器进行听诊)。所有听诊器均在每日查房前用75%乙醇擦拭表面1次。观察记录研究期间所有对象的医院感染情况及部位、感染病原菌、生命体征和转归,转出ICU后随诊48 h,汇总数据进行统计分析。结果 :干预组医院感染的发病率较对照组显著降低(9.5%vs 14.9%,P<0.05),主要表现在医院获得性下呼吸道感染的发病率较对照组明显降低(4.4%vs 8.6%),并且明显缩短ICU住院时间(12.2±9.3 d vs 14.2±8.8 d),但在其他部位的院内感染、28 d病死率方面无统计学差异。结论 :使用床旁听诊器能显著降低综合性ICU医院感染的发病率。

Objective： To investigate the impact of the use of stethoscopes on the incidence of nosocomial infection（NI） in intensive care unit（ICU）. Methods： A total 611 inpatients were divided into an intervention group（n=296, using a stethoscope special for each patient） and a control group（n=315, using a doctor＇s private stethoscope） according to the number of bed. The surface of these stethoscopes was wiped with a cotton impregnated with 75% alcohol solution everyday before wardround. The incidence of NI, the sites of infection, common pathogens and outcomes were observed and the data were statistically analyzed. Results： The incidence of NI was significantly lower in the intervention group than in the control group（9.5% vs 14.9%,P〈0.05）, especially in the incidence of acquired lower respiratory tract infection（4.4% vs 8.6%）. The time for ICU stay was also significantly shorter in the intervention group than in the control group（12.2±9.3 vs 14.2±8.8 days, P〈0.05）. However, there were no statistical differences in the incidence of NI in other sites and the 28-day mortality. Conclusion： The incidence of NI in a general ICU can be obviously reduced by the use of a special stethoscopes for each patient.