精神病患者医院感染相关危险因素及规范化干预效果分析

Risk factors related to nosocomial infection in psychiatric patients and analysis of standardized intervention effects

目的 调查某医院精神病科患者医院感染率情况,分析医院感染的相关危险因素,总结规范化干预对预防医院感染的价值。方法 回顾性分析2016年6月至2019年1月某院收治的1 400例住院精神病患者的临床医院感染相关资料。以2018年1月1日全院开始实施规范化干预作为时间节点,之前接收的690例患者为对照组,予以常规预防干预;之后接收的710例患者为实验组,予以规范化干预,分析其相关危险因素。结果 实验组患者医院感染发生率为4.65%(33/710),感染漏报率为0.28%(2/710),低于对照组的10.87%(75/690)、2.17%(15/690),差异有统计学意义(P<0.05);两组主要感染部位包括泌尿道、呼吸道以及胃肠道;发生医院感染的主要危险因素为:年龄>60岁、有精神分裂症、合并其他疾病、住院时间≥50 d、使用抗菌药物≥2种、有侵袭性操作以及药物不良反应(OR=2.309、1.670、1.898、1.446、1.203、2.061、1.790,P<0.05),而医院感染的保护性因素为:保护性约束(OR=0.906,P<0.05);实验组患者抗菌药使用率低于对照组,而每床手消毒剂与洗手液日消耗量高于对照组,以上差异均有统计学意义(P<0.05)。结论 精神病患者医院感染率较高,住院时间较长、年龄较大等是其危险因素,而保护性约束是其保护因素。依据其特点采取规范化干预,可有效预防感染发生。

Objective To investigate the nosocomial infection rate of psychiatric patients in our hospital,analyze the risk factors of nosocomial infection,and summarize the value of standardized intervention in preventing nosocomial infection.Methods A retrospective analysis was made on the clinical data of nosocomial infection in 1400 inpatients with psychosis admitted to our hospital from June 2016 to January 2019.On January 1st,2018,the whole hospital began to implement standardized intervention as a time node.Before the time node,690 patients received were taken as the control group,and routine preventive intervention was given.After the time node,710 patients were taken as the experiment group,standardized intervention was given,and then related risk factors were analyzed.Results The incidence of nosocomial infection in the experimental group was 4.65%(33/710),and the false negative rate was 0.28%(2/710),which were lower than those in the control group,10.87%(75/690)and 2.17%(15/690).The difference was statistically significant(P<0.05).The main nosocomial infections in the two groups included the urinary tract,respiratory tract and gastrointestinal tract.The main risk factors for nosocomial infection were:aged over 60 years,schizophrenia,combined with other diseases,hospitalization time 50 days and above,the use of two kinds of antibiotics and above,invasive procedures and adverse drug reactions(OR=2.309,1.670,1.898,1.446,1.203,2.061,and 1.790,P<0.05),and the protective factors of nosocomial infection were protective constraints(OR=0.906,P<0.05).The rate of antibacteria use of the experimental group was lower than that of the control group,the daily consumption of disinfectant and hand sanitizer per bed was higher than that of the control group,and the above differences were statistically significant(P<0.05).Conclusion The nosocomial infection rate of mental patients is high,the length of stay in hospital and the age are the risk factors,and the protective constraints are the protective factors.