新型冠状病毒肺炎疫情下非定点医院重症监护病房的医院感染管理

Hospital infection management of intensive care unit in non-designated hospital during coronavirus disease 2019 epidemic

目的 观察新型冠状病毒肺炎(简称新冠肺炎)疫情期间医院感染管理措施的应用效果.方法 选择2019年全年(1月1日至12月31日)和2020年1月21日至3月15日在北京大学国际医院重症监护病房(ICU)住院的患者作为研究对象.以2019年全年(1月1日至12月31日)收治的1267例次患者为对照,并与2019年第一季度(1月1日至3月31日)收治的273例次及2020年1月21日至3月15日收治的57例次患者进行比较.2020年1月21日至3月15日本院实行疫情期间感染控制措施,包括严把入口关;在科患者予单间病房,均检测体温和血常规,新入科患者安置在隔离病区,与原有患者相隔至少1个以上房间,减少探视;工作人员实行弹性工作制,减少聚集;严格病区消毒和个人防护等.观察疫情前后ICU器械相关感染及手卫生依从性的变化.结果 疫情期间本院未收治新冠肺炎确诊及疑似病例.2020年1月21日至3月15日疫情期间本院ICU每日在科患者数(例:7.22±2.02比13.05±3.26、14.92±3.43)和每日新入住患者数〔例:0(0,2)比3(1,5)、3(1,5)〕均较2019年全年和2019年第一季度明显减少(均P<0.05),中心静脉导管使用率较2019年全年和2019年第一季度明显降低〔19.40%(77/397)比39.86%(1898/4762)、44.08%(592/1343),均P<0.05〕,导尿管使用率较2019年全年和2019年第一季度明显升高〔99.50%(395/397)比93.37%(1254/1343)、96.56%(4598/4762),P<0.05〕.2019年全年、2019年第一季度、2020年疫情期间中心静脉导管相关血流感染(CLABSI)千日发生率〔1.05(2/1898)、0(0/592)、0(0/77)例/千导管日〕、呼吸机使用率〔53.09%(2528/4762)、56.14%(754/1343)、54.41%(216/397)〕、呼吸机相关性肺炎(VAP)千日发生率〔5.14(13/2528)、3.98(3/754)、0(0/216)例/千通气日〕、导尿管相关泌尿系感染(GAUTI)千日发生率〔1.09(5/4598)、1.59(2/1254)、5.06(2/395)例/千导管日〕比较差异均无统计学意义(均P>0.05).2019年全年和2020年1月21日至3月15日疫情期间手卫生依从率比较差异亦无统计学意义〔91.26%(2505/2745)比90.91%(400/440),P>0.05〕.结论 疫情期间采取的一系列措施,在有效防控新冠肺炎的同时保证了常规医院感染管理工作的质量.

Objective To observe the application efet of measures for hospital infection management during coronavirus disease 2019(COVID-19)epidemic in a non-designated hospital.Methods Inpatients in intensive care unit(ICU)of Peking University International Hospital from January 1 to Deember 31,2019 and from January 21 to March 15,2020 were selected as research objects.The 1267 case times admitted in the whole year of 2019(from January 1 to December 31)were taken as control to compare with 273 case times in the first quarter of 2019(from January 1 to March 31)and 57 case times from January 21 to March 15,2020 admitted into the hospital.During epidemie period(January 21 to March 15,2020),the hospital implemented infection control measures,including strict control of the entrance;the patients already had stayed in the hospital were in a single ward,and the temperalure and blood routine were measured.The new patients were placed in isolated district,at least one room away from the original patients,and the visit was not allowed or much less;the flexible working system of the medical staff was carried out,and their aggregation was reduced as much as possible;the disinfection of the ward district and personal protection were strictly enforced,etc.The changes of device-associated infection and hand hygiene compliance in ICU before and after the epidemic were observed.Results During the epidemic period,no confirmed or suspected cases of COVID-19 were admilted into the hospital.During epidemic period from January 21 to March 15,2020,the number of patients every day in ICU(cases:7.22±2.02 vs.13.05±3.26,14.92±3.43)and the number of new patients everyday stay in ICU[cases:0(0,2)vs.3(1.5).3(1.5)]were all decreased significantly compared with those in 2019 whole year and the first quarter of 2019(all P<0.05),the utilization rate of central venous catheter was signifcantly lower than that of 2019 whole year and that of the first quarter of 2019[19.40%(77/397)vs.39.86%(1898/4762),44.08%(592/1343),all P<0.05],and the rale of using urine catheter was significantly higher than that applied in 2019 whole year and that in the first quarter of 2019[99.50%(395/397)vs.93.37%(1254/1343).96.56%(4598/4762).both P<0.05].In 2019 whole year,the first quarter of 2019 and epidemic period of 2020,there were no significant differences in the ineidence of central venous catheter-related bloodstream infection[CLABSI:1.05(2/1898),0(0/592),0(0/77)cases per 1000 catheter-days],ventilator utilization rale[53.09%(2528/4762),56.14%(754/1343).54.41%(216/397)].venilator-associated pneumonia(VAP)ineidence.[5.14(13/2528),3.98(3/754),0(0/216)cases per 1000 ventilation-days],and ceatheter-related urinary tract ifetion ineidence[CAUTI:1.09(5/4598),1.59(2/1254),5.06(2/395)eases per 1000 catheter-days,all P>0.05].There was no significant difference in the compliance rate of hand hygiene between 2019 whole year and epidemic period January 21 to March 15,2020[91.26%(2505/2745)vs.90.91%(400/440).P>0.05],Conclusion A series of measures taken during the epidemic period of COVID-19 has ffectively prevented and controlled COVID-19 transmission into the hospital and simultaneously ensured the quality of rouline management of hospital infection.