呼吸内科老年患者发生医院感染的影响因素与预防措施分析

Influencing factors for nosocomial infections in elderly patients of respiratory medicine department and prevention measures

目的分析呼吸内科老年患者发生医院感染的影响因素,感染部位及病原菌分布特点,为制定预防措施提供依据。方法选取2011年5月-2016年5月于医院呼吸内科接受检查的>60岁老年受检者1500例为研究对象,其中1000例出现感染,500例未见感染,回顾性调查患者的临床资料,分析发生感染的相关因素,采用多因素Logistic回归分析确定感染的影响因素,进而制定针对性治疗及预防措施。结果老年呼吸内科感染部位主要分布于上呼吸道、下呼吸道、泌尿生殖道、胃肠道以及手术部位,其中下呼吸道的占比最大,占35.20%;经单因素分析发现治疗史(气管镜、肺穿刺、胸腔插管)、住院次数、长期卧床、吞咽困难、侵入性操作均为老年呼吸内科患者发生感染的影响因素,经Logistic回归分析显示,气管镜、肺穿刺、住院次数、吞咽困难、侵入性操作均为老年呼吸内科患者发生感染的独立相关因素;检出病原菌种类主要为革兰阴性菌,以肺炎克雷伯菌为主。结论医院感染与气管镜、肺穿刺、住院次数、吞咽困难、侵入性操作有关,在患者住院期间应规范操作,采用一次性医疗器械,并根据老年呼吸内科感染相关因素,进行针对性诊断与预防。

OBJECTIVE To investigate the influencing factors for nosocomial infections in elderly patients of respiratory medicine department and observe the infections sites and distribution of pathogens so as to put forward the prevention measures.METHODS A total of 1500 elderly people who were more than 60 years old and received examination in the respiratory medicine department from May 2011 to May 2016 were recruited as the study objects,of whom 1000 had infections,and 500 did not have infections.The clinical data of the patients were retrospectively investigated,the related factors for the infections were analyzed,the multivariate logistic regression analysis was performed to determine the influencing factors for the infections so as to put forward the targeted treatment and prevention measures.RESULTS The upper respiratory tract,lower respiratory tract,urogenital tract,gastrointestinal tract and surgical site were the major infection sites of the elderly patients of respiratory medicine department;the proportion of the elderly patients with lower respiratory tract infections was the highest（35.20%）.The univariate analysis showed that the treatment history（bronchoscopy,lung puncture,thoracic intubation）,number of times of hospitalization,long bedridden time,dysphagia and invasive operation were the influencing factors for the infections in the elderly patients of respiratory medicine department;the logistic regression analysis indicated that the bronchoscopy,lung puncture,number of times of hospitalization,dysphagia and invasive operation were the independent related factors for the infections in the elderly patients of respiratory medicine department.The gram-negative bacteria were dominant among the isolated pathogens,and Klebsiella pneumoniae was the predominant species.CONCLUSION The incidence of the nosocomial infections is associated with the bronchoscopy,lung puncture,number of times of hospitalization,dysphagia and invasive operation.It is necessary to carry out standard operation for the patients during hospital stay,use disposable medical instruments and conduct the targeted diagnosis and prevention on the basis of the related factors for the infections in the elderly patients of respiratory medicine department.