血液肿瘤患者医院感染特点分析及干预效果研究

Hospital infection profile and intervention effect in patients with hematologic malignancy

目的观察并分析血液肿瘤疾病患者的医院感染特点,同时探讨洁净病房对感染的干预方式和效果。方法通过调查2018年6月-2019年7月上海交通大学医学院附属仁济医院血液科病房收治且接受化疗的血液肿瘤患者,回顾性分析患者临床资料,包括患者年龄、性别、疾病类型、一般情况、伴发基础疾病、住院时间、是否发生医院感染、治疗费用等。在血液科洁净病区内配置各型号EKEAIR~?禹科移动空气灭菌站(简称灭菌站),搭配新风系统和风淋装置,使血液科病区空气质量达到国家卫生标准。入住普通病房的血液肿瘤患者定为对照组,入住洁净病房的血液肿瘤患者定为观察组。比较两组患者医院感染发生率、住院天数、治疗费用等指标的差异。结果共计129例患者入组研究,其中观察组76例,对照组53例。对照组与观察组在性别、是否发生感染、住院天数和住院总费用指标的差异有统计学意义(P <0.05)。观察组感染发生率、住院时间和住院总费用低于对照组(P<0.001)。发生感染与未发生感染的患者在疾病种类、是否入住洁净病房、住院天数和住院总费用指标上差异有统计学意义(P<0.05)。来源于髓系造血细胞的髓样肿瘤发生感染的概率高于来源于淋巴细胞的淋巴样肿瘤患者(P=0.039);发生感染的患者住院时间和住院总费用高于未发生感染的患者(P <0.001)。Cox分析结果显示,剔除年龄、性别、疾病种类等混杂因素的影响后,是否入住洁净病房为影响感染发生的主要因素,对照组与观察组相比危险性增加1.644倍(P=0.030)。对照组患者发生感染的累计风险高于观察组。结论血液肿瘤患者发生的医院感染具有一定临床特征,对于不同疾病可采用不同方案进行感染管理及预防。采用灭菌站辅助新风系统和风淋装置共同构成的洁净病房可以显著降低血液肿瘤患者的医院感染发生率,同时缩短住院时间,减少医疗费用,提高了医疗质量,值得在临床加以推广并进一步验证。

Objective To review and analyze the characteristics of nosocomial infections and the effect of intervention in patients with hematologic malignancy.Methods A retrospective study was performed on the patients with hematologic malignancy who received chemotherapy in department of hematology,Renji Hospital,School of Medicine,Shanghai Jiaotong University from June 2018 to July 2019.The clinical data such as age,sex,disease type,general condition,underlying diseases,length of hospital stay,incidence of hospital infection,and treatment cost were collected retrospectively.EKEAIR~? mobile air sterilization stations were equipped in the clean ward.All the patients with hematologic malignancy admitted to the general ward were designated as control group,and those admitted to the clean ward were designated as intervention group.Incidence of hospital infections,length of stay,and treatment cost were compared between the two groups.Results A total of 129 patients were enrolled in our study,including 76 in intervention group and 53 in control group.The patients in the two groups showed significant difference in sex,incidence of infection,length of stay,and total hospital cost (P <0.05).Intervention group had significantly lower incidence of infection,length of stay and total hospital cost than control group (P<0.001).There was statistical difference between the patients with and those without infection in disease type,stay in clean ward,length of stay,and total hospital cost (P<0.05).The patients with myeloid neoplasm derived from myeloid hematopoietic cells was more likely to have hospital infection than the patients with lymphoid neoplasm derived from lymphocytes (P=0.039).Cox analysis showed that stay in clean ward was the major factor affecting the occurrence of hospital infection after adjusting the effect of age,sex,and disease type.Stay in general ward resulted in 1.644 times higher risk of infection than in clean ward (P=0.030).The patients in control group had higher cumulative risk of infection than the patients in intervention group.Conclusions Individualized treatment should be considered for the hospital infections in case of hematologic malignancy according to the clinical features.Clean wards enabled by air sterilization station can significantly reduce the incidence of nosocomial infections,shorten the length of hospital stay,reduce medical cost,and improve the quality of medical care.