中西医结合科患者医院感染情况分析

Analysis of nosocomial infection in patients with integrated traditional Chinese and western medicine

目的探讨中西医结合科住院患者医院感染危险因素并分析对策。方法选取河北大学附属医院2015年1月至2017年12月中西医结合科住院患者6326例,统计分析医院感染的发生率、标本来源、致病菌、药敏结果等相关因素。结果脑血管病患者医院感染118例(3.12%),居首位。分离出致病菌81株,其中革兰阴性菌49株(60.49%),革兰阳性菌22株(27.16%),真菌10株(12.35%)。其中标本来源前3位的是痰标本30株(37.03%),血液28株(34.57%),尿液8株(9.88%)。发生医院感染182例,居前3位的是下呼吸道感染121例(66.48%),泌尿道感染26例(14.29%),上呼吸道感染10例(4.40%);药敏试验提示革兰阴性杆菌对常见的青霉素类及一、二代头孢均有很高的耐药率,对于三、四代头孢菌素以及碳青霉烯类等药物也有一定的耐药。结论应采取综合干预措施如缩短住院时间、积极治疗原发病、提高医护质量、改善医院环境、提高患者抵抗力、合理应用抗菌药物等降低中西医结合科住院患者医院感染率。

Objective To explore the risk factors of nosocomial infections in integrated traditional Chinese and western medicine department and analyze the countermeasures.Methods 6 326 cases of hospitalized patients in Integrative Medicine Department of Hebei University from January2015 to December,2017 were selected.The incidence of nosocomial infection,sources of samples,pathogenic bacteria and drug sensitivity were statistically analyzed.Results118 patients (3.12%) had nosocomial infection in cerebrovascular disease.81 strains of pathogenic bacteria were isolated,including 49 strains of Gram-negative bacteria (60.49%),22 strains of Gram-positive bacteria (27.16%) and10 strains of fungi (12.35%).Among them,30 (37.03%) sputum specimens,28 (34.57%) blood specimens and 8 (9.88%) urine specimens were the top three sources.Nosocomial infection occurred in182 cases.The top three were lower respiratory tract infection in121 cases (66.48%),urinary infection in26 cases (14.29%) and upper respiratory tract infection in10 cases (4.40%).Drug susceptibility tracttest showed that Gram-negative bacilli had high resistance rate to common penicillins and first and second generation cephalosporins, and also to third and fourth generation cephalosporins and carbapenems.Conclusion Comprehensive interventions such as shortening hospitalization time, actively treating primary diseases, improving the quality of medical care, improving hospital environment, improving patient resistance, and rational use of antibiotics should be taken to reduce the incidence of nosocomial infection of inpatients in integrated traditional Chinese and western medicine.