2019—2020年重症监护病房医院感染情况调查分析

Investigation and analysis of nosocomial infection in intensive care unit from 2019 to 2020

目的了解重症监护病房(ICU)患者医院感染和感染病原菌情况,为制订医院感染防控措施提供参考。方法对2019—2020年日照市中医医院ICU患者临床资料进行回顾性调查,分析ICU患者医院感染、器械相关感染及病原菌分布情况。结果共监测ICU患者5 081例,医院感染例次发病率4.86%,2020年(5.48%)与2019年(4.35%)相比差异无统计学意义(χ^(2)=3.475,P=0.062)。共发生器械相关感染124例次,血管导管相关血流感染(CLABSI)、导尿管相关尿路感染(CAUTI)、呼吸机相关肺炎(VAP)发病率分别为0.54‰、1.99‰和3.95‰。2020年的VAP发病率低于2019年(χ^(2)=5.273,P=0.022),CAUTI发病率差异无统计学意义(χ^(2)=0.431,P=0.512)。共检出病原菌233株,其中革兰阴性菌163株,以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌多见;检出多重耐药菌54株,以碳青酶烯耐药菌多见。结论应以预防控制器械相关感染为重点,实施集束化策略,强化目标性监测和预见性护理,降低ICU医院感染发生率。

Objective To understand the situation of nosocomial infection and pathogenic bacteria in intensive care unit(ICU) patients, and to provide reference for the formulation of nosocomial infection prevention and control measures.Methods The clinical data of ICU patients in Rizhao Hospital of Traditional Chinese Medicine from 2019 to 2020 were investigated retrospectively, and the nosocomial infection, device-associated infection and the distribution of pathogens in ICU patients were analyzed.Results A total of 5 081 ICU patients were monitored, and the incidence of nosocomial infection was 4.86%.There was no significant difference between 2020(5.48%) and 2019(4.35%)(χ^(2)=3.475,P=0.062).A total of 124 cases of device-associated infection occurred, and the incidences of central line associated-bloodstream infection(CLABSI),catheter-associated urinary tract infection(CAUTI),and ventilator-associated pneumonia(VAP) were 0.54‰,1.99‰,and 3.95‰,respectively.The incidence of VAP in 2020 was lower than that in 2019(χ^(2)=5.273,P=0.022),and there was no significant difference in the incidence of CAUTI(χ^(2)=0.431,P=0.512).A total of 233 strains of pathogens were detected, including 163 strains of gram-negative bacteria, most of which were Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa;54 strains of multidrug-resistant organisms were detected, and carbapenem-resistant bacteria were the most common.Conclusion The prevention and control of device-associated infection should be the focus.The implementation of management bundles strategy, strengthening of targeted monitoring and predictive nursing should be conducted to reduce the incidence of nosocomial infection in ICU.