综合ICU近三年医院感染现状调查分析

Investigation and Analysis on the Trend of Hospital-associated Infection in Comprehensive ICU in Recent Three Years

目的了解综合医院重症监护病房(ICU)医院感染发生特点及趋势,为ICU医院感染防控提供循证依据。方法对2016年1月—2018年12月入住医院综合ICU,且住院时间≥48 h的患者进行医院感染目标性监测,收集感染部位及病原学信息,采用SPSS 21.0统计软件进行统计分析,对比近三年医院感染情况及致病菌变化。结果2016年1月—2018年12月共监测收集2304例住院患者,发生医院感染148人,239例次,医院感染率为6.42%,例次率为10.37%。总住院日数为19475天,中心静脉置管总天数9917,插管人数1318人,使用率50.92%,21人感染,感染率2.12‰。导尿管插管总天数为11292天,置管人数1424人,导尿管插管总使用率为57.98%,25人感染,感染率2.21‰。呼吸机使用总日数7395,呼吸机使用人数1002人,使用率37.97%,47人感染,感染率6.36‰。监测期间共检出509株病原菌,前三位的医院致病菌为鲍曼不动杆菌(95株)、肺炎克雷伯菌(59株)、铜绿假单胞菌(55株)。其中多重耐药菌179株,泛耐药42株,前三位的耐药菌为鲍曼不动杆菌(52株)、铜绿假单胞菌(34株)、屎肠球菌(25株)。近三年医院感染率由8.82%降为5.02%,医院感染例次率由11.94%降至7.60%差别具有统计学意义。结论通过开展医院感染目标性监测,能明显降低综合医院重症监护室感染发生率。

Objective To understand the characteristics and trend of(ICU)hospital infection in intensive care unit(ICU)of general hospital,and to provide evidence-based basis for the prevention and control of ICU hospital infection.Methods From January 2016 to December 2018,the patients admitted to hospital with comprehensive ICU,and hospitalization time≥48 hours were monitored.The infection location and etiological information were collected and analyzed statistically by SPSS 21.0 statistical software.The changes of hospital infection and pathogenic bacteria in the past three years were compared.Results From January 2016 to December 2018,a total of 2304 inpatients were monitored and collected.There were 239 cases of hospital infection,the hospital infection rate was 10.37%.The total number of hospitalization days was 19475 days,the total number of central venous catheterization days was 9917,the number of intubation was 1318,the utilization rate was 50.92%,21 people were infected,the infection rate was 2.12‰.The total number of days of catheterization was 11292 days,the number of catheters was 1424,the total utilization rate of catheterization was 57.98%,25 people were infected,the infection rate was 2.21%.The total number of days of ventilator use was 7395,the number of ventilator users was 1002,the utilization rate was 37.97%,47 people were infected,the infection rate was 6.36‰.A total of 509 strains of pathogenic bacteria were detected during the monitoring period.The first three hospital pathogenic bacteria were Acinetobacter baumannii(95 strains),Klebsiella pneumoniae(59 strains)and Pseudomonas aeruginosa(55 strains).Among them,179 strains were multi-resistant bacteria and 42 strains were pan-resistant bacteria.The first three resistant bacteria were Acinetobacter baumannii(52 strains),Pseudomonas aeruginosa(34 strains)and Enterococcus faecium(25 strains).In the past three years,the hospital infection rate decreased from 8.82% to 5.58%,and the rate of hospital infection decreased from 11.94% to 7.60%.There was significant difference between the tree groups.Conclusions The incidence of infection in intensive care unit of general hospital can be significantly reduced by carrying out target surveillance of hospital infection.