某院重症烧伤患者医院感染相关因素调查

Risk factors for healthcare-associated infections of severe burn patients

目的调查烧伤重症监护室住院患者发生医院感染的相关危险因素,为降低重症烧伤患者医院感染发病率提供参考依据。方法回顾性调查某三级甲等综合医院烧伤重症监护室2016-2017年住院患者,对相关危险因素进行调查分析。结果共调查烧伤患者220例,其中发生医院感染41例,医院感染发病率为18. 63%;医院感染例次数为54,例次感染率为24. 54%。医院感染部位主要是血液,占83. 33%;其次是下呼吸道和皮肤软组织。医院感染病原菌主要为革兰阴性菌,占63. 46%;其次是革兰阳性菌,占26. 92%和真菌,占9. 62%。年龄、性别、重症监护时间、手术次数、气管切开、中心静脉置管时间、使用有创呼吸机、糖尿病和烧伤面积等调查因素与医院感染发生有关。年龄、住院时间、中心静脉置管时间和烧伤面积是重症烧伤患者医院感染的独立危险因素。结论为减少重症烧伤患者医院感染的发生,需做好大面积烧伤及高龄患者护理,规范中心静脉置管操作,加强烧伤重症监护室消毒。

Objective To investigate the risk factors related to healthcare-associated infection( HAI) in severe burn patients of the intensive care unit( BICU),so as to provide reference for further reducing the HAI in severe burn patients.Methods Burn patients in the Intensive Care Unit of a tertiary first-class comprehensive hospital from January 2016 to December 2017 were surveyed retrospectively,and possible risk factors of HAI were analyzed.Results Among 220 severe burn patients,41 suffered HAI,with the incidence of 18.63%.The number of cases was 54,with the case incidence of 24.54%.The main HAI sites were blood( 83.33%),followed by the lower respiratory tract and skin soft tissue.The main pathogens of HAI were gram-negative bacteria( 63.46%),gram-positive bacteria( 63.46%) and fungi( 9.62%).The univariate analysis result showed that age,gender,length of BICU stay,operation times,tracheotomy,central venous catheterization,mechanical ventilation,diabetes,burn area were all related with the occurrence of HAI;Multivariate logistic regression analysis showed that age,length of BICU stay,central venous catheterization,burn area were all risk factors for HAI in severe burn patients.Conclusion Strengthening the management of large area burns and elderly patients,shorting the time of BICU stay,and reducing unnecessary central venous catheterization,can reduce the occurrence of HAI in severe burn patients.