医院新建院区的医院感染特点与防控对策

Characteristics of nosocomial infections and control measures in new-built hospital

目的研究医院新建院区的医院感染特点及防控对策,降低医院感染发生率。方法通过医院感染和多药耐药菌病例电子监测系统收集医院新建院区2017年7月-2017年12月所有医院感染病例和多药耐药菌检出病例的相关信息,统计分析医院感染发生率、Ⅰ类手术切口感染发生率、多药耐药菌检出率及菌种构成、感染高危科室、感染部位构成等指标,采取组织培训、建章立制、前瞻监控等措施进行干预。结果共监测住院患者7 322例次,发生医院感染病例70例次,医院感染发生率为0.96%,Ⅰ类手术切口感染发生率为0.43%;医院感染发生科室以重症医学科2例次为主,各科室的医院感染发生情况比较,差异有统计学意义(P<0.05);感染部位以下呼吸道感染32例次占45.71%为主,其次是泌尿道感染16例次占22.86%;多药耐药菌检出97株,医院感染占18.56%,社区感染占51.55%;ESBL大肠埃希菌占31.96%,多药耐药肺炎克雷伯菌占26.80%,耐甲氧西林金黄色葡萄球菌(MRSA)占14.43%。结论早期干预,规范设计医院建筑布局流程,系统培训各类人员,建立医院感染管理规章制度及质量控制标准,前瞻监测微生物信息,及时指导临床防控工作,可加快新建院区规范化、标准化、科学化建设进程,有效降低新建院区的医院感染风险。

OBJECTIVE To investigate the characteristics of nosocomial infections and prevention and control meas- ures in new-built hospital, so as to reduce the incidence of nosocomial infections. METHODS The cases of nosoco- mial infections and multidrug-resistant organisms in our new-built hospital from Jul. 2017 to Dec. 2017 were col- lected by nosocomial infection/multidrug-resistant organisms case electronic monitoring system. The incidence of nosoeomial infections, surgical site infection rate of type I incision, detection rate of multidrug-resistant organisms and their properties, the high-risk infection of departments and the composition of the infection sites were calculat- ed. The organizational training, establishment of rules and prospective monitoring measures were carried out to in- tervene. RESULTS A total of 7322 hospitalized patients were investigated. The incidence of nosocomial infection was 0.96%（70 cases）, and surgical site infection rate of type I incision was 0.43%. The main nosocomial infection department was intensive care unit, which were 2 cases, and there were significant differences in the incidence of nosocomial infection in various departments （P〈0.05）. The main infection site was the lower respiratory tract in- fection （32 cases）, accounting for 45.71%, followed by urinary tract infection （16 cases）, accounting for 22.86%. Totally 97 strains of multidrug-resistant organisms were detected. Among them, hospital acquired infection ac- counted for 18.59%, and community infection accounted for 51.55%. ESBL-producing Escherichia coli accounted for 31.96 ~, multidrug-resistant Klebsiella pneumoniae accounted for 26.80% and methicillin-resistant Staphylo- coccus aureus accounted for 14.43%. CONCLUSION Early intervention, standardized design of hospital building layout process system, training of personnel, establishment of hospital infection management regulations and quality control standards, prospective monitoring of microbial information, and timely guidance for clinical pre- vention and control work, can speed up the process of normalization, standardization and scientific, effectively re- ducing the risk of hospital infection in new-built hospitals.