综合重症监护病房导管相关感染目标性监测分析

Targeted monitoring on catheter-associated infection in general intensive care unit

目的监测重症监护病房(ICU)患者导管相关感染发病情况,为采取相关预防与控制措施提供依据。方法采用目标性监测方法,调查某三级综合医院2012年1月—2013年12月入住综合ICU且使用了导尿管、血管导管,以及气管插管使用呼吸机的患者医院感染发病情况。结果共调查综合ICU导管置管住院患者299例,总住院日数为2 700 d,发生医院感染41例、48例次,医院感染发病率为13.71%、例次发病率为16.05%,日感染发病率为15.19‰;其中发生导管相关感染者37例、44例次;其他医院感染分别为血流感染、皮肤软组织感染、抗菌药物相关性腹泻及带状疱疹各1例。导尿管相关泌尿道感染(CAUTI)发病率为2.94‰,血管导管相关血流感染(CRBSI)发病率为2.12‰,呼吸机相关肺炎(VAP)发病率为15.72‰。结论导管相关感染是ICU内导管置管患者医院感染的主要类型,且主要以VAP为主。

Objective To monitor the incidence of catheter-associated infection （CAI）in patients in general inten-sive care unit （ICU）,and provide basis for taking proper prevention and control measures.Methods Targeted monitoring method was conducted,incidence of healthcare-associated infection （HAI）among patients receiving urinary catheterization,intravascular catheterization,and tracheal intubation in the general ICU of a tertiary hospital between January 2012 and December 2013 were surveyed.Results A total of 299 ICU patients with catheterization were investigated,the overall hospitalization days were 2 700 days,41 patients developed 48 episodes of HAI, incidence of HAI was 13.71%,case incidence was 16.05%,incidence of HAI per 1 000 catheter days was 15.19‰,37 patients developed 44 episodes of CAI;the other types of HAI were blood stream infection（n=1）,skin and soft tissue infection（n = 1 ）,antibiotic-associated diarrhea（n = 1 ）,and herpes zoster（n = 1 ）.Incidence of catheter-associated urinary tract infection （CAUTI）,catheter-related bloodstream infection （CRBSI）,and ventilator-associated pneumonia （VAP ） per 1 000 catheter days were 2.94‰,2.12‰,and 15.72‰ respectively. Conclusion CAI is the main HAI type in ICU patients with catheterization,and the major is VAP.