基于全球医院感染暴发数据库和CNKI数据库的ICU医院感染暴发案例分析

Healthcare-associated infection outbreak cases in intensive care unit:an analysis based on Outbreaks Database and CNKI database

目的了解国内外重症监护病房(ICU)医院感染暴发情况,为临床有针对性地预防和控制医院感染暴发提供依据。方法基于全球医院感染暴发数据库及CNKI数据库,对ICU医院感染暴发事件数据进行对比研究。结果全球医院感染暴发数据库1091起ICU医院感染暴发事件,涉及68个国家及地区,2000-2006年是暴发事件发布的高峰期。ICU医院感染暴发事件中明确感染源的事件590起(占54.08%),依次是患者(37.46%)、环境(22.88%)、污染的医疗设备(15.09%);明确感染途径的事件占63.98%,依次是接触传播(73.78%)、侵入操作(15.19%)、呼吸道传播(8.17%)及胃肠道摄入(2.86%);医院感染病原体为:细菌类(83.68%)、病毒类(8.16%)及真菌类(7.52%);暴发案例控制主要根据传播途径及感染来源采取相应的措施。国内侵入性操作引起的感染(38.37%)高于国外(15.17%),国内ICU医院感染暴发检出的首要病原体为鲍曼不动杆菌(32.56%),国外为耐甲氧西林金黄色葡萄球菌(12.20%)。结论医院感染暴发存在一定规律可循,应针对其暴发流行的特征,制定干预措施,有效预防、控制感染的暴发。

Objective To understand the outbreak of healthcare-associated infection(HAI)in intensive care units(ICUs)at home and abroad,and provide basis for clinical targeted prevention and control of HAI outbreak.Me thods Based on Worldwide Database for Nosocomial Outbreaks(Outbreak Database)and China National Knowle-dge Infrastructure(CNKI)database,data of HAI outbreak in ICUs were analyzed and compared.Results 1091 cases of ICU HAI in Outbreak Database involved 68 countries and regions,2000-2006 was the peak of publication of outbreak events,590 cases(54.08%)of HAI outbreaks in ICUs were identified route,transmission through patients,environment,and contaminated medical device accounted for 37.46%,22.88%and 15.09%respectively;63.98%of the events identified the route of infection,transmission through contact,invasive manipulation,respiratory transmission and gastrointestinal intake accounted for 73.78%,15.19%,8.17%,and 2.86%respectively;pathogens of HAI were bacteria(83.68%),viruses(8.16%)and fungi(7.52%);control of outbreak cases mainly through taking corresponding measures according to the route of transmission and source of infection.Infection caused by invasive manipulation in China was higher than that in foreign countries(38.37%vs 15.17%).The main pathogens causing HAI outbreak in ICUs in China and abroad were Acinetobacter baumannii(32.56%)and methicillin-resistant Staphylococcus aureus(12.20%)respectively.Conclusion HAI outbreak has certain regularity,intervention measures should be formulated according to the characteristics of the outbreak to effectively prevent and control the outbreak of infection.