2016～2018年某院ICU医院感染目标性监测及干预

Target Surveillance and Intervention of Nosocomial Infection in ICU from 2016 to 2018

目的分析我院ICU医院感染现状,为医院感染管理提供依据。方法制定ICU医院感染目标性监测方案,采用前瞻性监测方法对我院2016~2018年ICU患者进行目标性监测,每季度根据监测结果进行实时干预。结果通过监测及干预,连续三年ICU医院感染发病率、医院感染例次发病率、日感染发病率、调整医院感染发病率、调整医院感染例次发病率以及调整日感染发病率均呈逐年下降趋势(P<0.05)。神经系统和呼吸系统疾病类ICU住院患者的医院感染发病率分别为10.83%、3.31%。ICU医院感染部位以呼吸道为主,占70.67%。呼吸机、导尿管、中心静脉导管的使用率分别为33.90%、71.92%、22.73%,三管相关发病率分别为10.00‰、1.49‰、1.81‰。呼吸机使用率与VAP发病率有相关性(r=1.00,P<0.001)。医院感染前3位病原菌分别为肺炎克雷伯菌(占30.23%)、鲍曼不动杆菌(占23.26%)、铜绿假单胞菌(占10.47%)。结论持续开展ICU医院感染目标性监测,有利于针对高危因素及薄弱环节及时采取干预措施,从而有效降低医院感染发病率。神经系统疾病类和呼吸系统疾病类患者是院感防控关注的重点人群,器械相关性感染(特别是VAP)、多重耐药菌感染是干预的重点环节。

Objective To analyze the status of hospital infection in ICU in our hospital and provide evidence for hospital infection management.Methods The target surveillance program for ICU hospital infection was established.The prospective monitoring method was used to monitor the ICU patients in our hospital from 2016 to 2018.The monitoring results were based on the monitoring results.Results Through monitoring and intervention,the incidence of ICU hospital infection,the incidence of nosocomial infection,the incidence of daily infection,adjusting the incidence of nosocomial infection,adjusting the incidence of nosocomial infection and adjusting the incidence of daily infection have been decreasing year by year.(P<0.05).The incidence of nosocomial infections in hospitalized patients with ICU and respiratory diseases was 10.83%and 3.31%,respectively.The infection site of ICU hospital was mainly respiratory tract,accounting for 70.67%.The ventilator,catheter,and central venous catheter use rates were 33.90%,71.92%,and 22.73%,respectively,and the three tube-related morbidity rates were 10.00‰,1.49‰,and 1.81‰,respectively.There was a correlation between ventilator usage and VAP incidence(r=1.00,P<0.001).The three pathogens in the hospital were Klebsiella pneumoniae(30.23%),Acinetobacter baumannii(23.26%),and Pseudomonas aeruginosa(10.47%).Conclusion The continuous target surveillance of ICU nosocomial infection is conducive to timely interventions for high-risk factors and weak links,thus effectively reducing the incidence of nosocomial infections.Patients with neurological diseases and respiratory diseases are the focus of prevention and control of hospitals.Instrument-related infections(especially VAP)and multi-drug resistant infections are the key links of intervention.