中国医院感染监测工作的发展及变化趋势

Development and changing trend in monitoring of healthcare-associated infection in China

目的总结三十年来我国医院感染监测活动所取得的成效,探索医院感染监测的变化趋势,寻找适合我国医院感染监测的新模式。方法抽取13个省(自治区、直辖市)及军队系统综合性医院194所,采用问卷调查的方式调查其医院感染监测工作开展情况。结果 194所医院审核后数据可用医院为184所(94.85%)。二级、三级医院医院感染发病率分别为0.78%、1.58%,两组比较,差异有统计学意义(P<0.01)。以2006年为界线分为两个阶段,2006年以前、2006—2016年开展各项监测的医院累计比率:环境卫生学监测分别为73.91%、100.00%,消毒效果监测分别为69.57%、97.28%,全面综合性监测分别为64.67%、98.91%,手术部位感染监测分别为13.04%、94.57%,ICU医院感染监测分别为4.89%、87.50%,新生儿医院感染监测分别为1.75%、60.82%,多重耐药菌监测分别为5.43%、95.65%,手卫生依从性监测分别为2.17%、93.48%,抗菌药物监测分别为15.22%、87.50%。三级医院医院感染暴发事件报告的比率为33.33%(37所),高于二级医院16.44%(12所),差异有统计学意义(P=0.01)。结论我国医院感染监测起步较晚,但发展较快。我国医院感染监测系统仍然存在缺陷,医院感染病例漏报率仍较高,医院感染暴发报告率低。

Objective To summarize the effectiveness in monitoring activities for healthcare-associated infection（HAI）in China in the past 30 years,explore the changing trend in HAI monitoring,find a new model for the monitoring of HAI in China.Methods A total of 194 comprehensive hospitals and military hospitals in13 provinces（autonomous regions,municipalities）were selected,questionnaire survey was adopted to investigate the situation of HAI monitoring.Results Of 194 hospitals,184（94.85%）had available data after being checked,incidence of HAI in secondary and tertiary hospitals were 0.78% and 1.58% respectively,difference was significant（P〈0.01）.Monitoring was divided into two stages,cumulative percentage of each monitoring activity before 2006 and during 2006-2016 were respectively as follows：environmental hygiene were 73.91% and 100.00%,disinfection efficacy 69.57% and 97.28%,overall comprehensive monitoring 64.67% and 98.91%,surgical site infection（SSI）13.04% and 94.57%,ICU HAI 4.89% and 87.50%,neonatal HAI 1.75% and 60.82%,multidrug-resistant organisms（MDROs）5.43% and 95.65%,hand hygiene compliance 2.17% and 93.48%,antimicrobial agents15.22% and 87.50%.The reporting rate of HAI outbreak in tertiary hospitals was higher than secondary hospitals（33.33% [n=37]vs 16.44%[n=12],P=0.01）.Conclusion The monitoring of HAI in China starts late,but develops rapidly,defects still exist in HAI monitoring system,reporting rate of HAI cases is still high,reporting rate of HAI outbreak is low.