精神病患者医院感染的影响因素分析

Influencing factors for nosocomial infections in patients with psychoses

目的探讨精神病患者医院感染的有关因素,为制订干预措施提供依据。方法对2014年1月-2015年12月住医院精神科的患者进行调查研究,采用各科室上报的感染报表为基本数据,在研究前对相应的病例作进一步核对后将感染病例与非感染病例的影响因素进行对照研究并进行统计分析。结果 8 618例住院、出院患者中发生医院感染197例,感染率为2.29%;感染例次254次,例次感染率为2.95%;主要感染病种为精神分裂症(36.55%)和老年痴呆(14.72%),感染科室集中在重精神病区;感染部位以呼吸道(65.75%)和泌尿道(12.60%)为主;检测病原菌72株,以革兰阴性菌为主,抗菌药物使用率为17.06%。结论住院时间长,年龄大,合并躯体疾病,病区环境不良及个人卫生差是发生感染的危险因素,侵入性操作增加了感染机会,改善住院环境,精准治疗,清除症状,规范侵入性操作,科学管理,创新治疗方法,合理使用抗菌药物是预防和控制医院感染的重要措施。

OBJECTIVE To explore the influencing factors for the nosocomial infections so as to put forward intervention measures. METHODS The patients with psychoses who were hospitalized the psychiatrics department from Jan 2014 to Dec 2015 were enrolled in the study, the baseline data were collected from infection report forms that were subjected by the departments, a controlled study was conducted for the influencing factors for the infection cases and non-infection cases after the corresponding cases were further checked up, and the statistical analysis was performed. RESULTS Of 8 618 patients who were hospitalized and discharged, 197 had the nosocomial infections, with the infection rate 2.29 % ; 254 case-times of patients had the nosocomial infections, with the case-time infection rate 2.95 %. Among the patients with the nosocomial infections, the patients with schizophrenia accounted for 36.55 %, and the patients with Alzheimer＇s disease accounted for 14.72 % ; the majority of the patients with the infection were from severe psychiatric ward; the patients with respiratory tract infection accounted fro 65.75%, and the patients with urinary tract infection accounted for 12.60%. A total of 72 strains of pathogens were isolated, among which gram-negative bacteria were dominant. The utilization rate of antibiotics was 17.06%. CONCLUSION The risk factors for the infection include the long length of hospital stay, advanced age, complication with physical disease, unfavorable ward environment, and poor personal hygiene; the invasive operation leads to the increase of risk of the infection. It is an effective way to improve the hospitalization environment, conduct accurate treatment, clear symptoms, carry out standardized invasive operation and scientific management, innovate treatment method, and reasonably use antibiotics so as to prevent and control the nosocomial infection.