2016-2019年某三甲中医医院骨科科室院内感染发生特点及影响因素分析

Analysis of the Influencing Factors and the Characteristics of Hospital Infection in Orthopedic Department of a Grade-A Tertiary TCM Hospital Between 2016 and 2019

目的:对2016—2019年某三甲中医医院骨科科室医院感染现状发生特点及影响因素进行分析,为控制和降低骨科科室院内感染的发生提供依据。方法:对2016—2019年骨科科室出院患者的全部病例结合《感染病例登记表》进行回顾性调查分析,对2016—2019年骨科的感染率、感染例次率、感染部位、病原学的分布以及影响因素进行统计和分析。结果:2016—2019年骨科科室院内感染发生率为1809/56097(3.22%),感染例次率为1926/56097(3.43%)。骨科科室院内感染率最高的依次为修复重建骨科22/185(11.89%)、软组织损伤肾科65/672(9.67%)和骨肿瘤科173/2473(7.00%)。患者院内感染部位最常见的为手术切口693/1926(35.98%),其次为上呼吸道387/1926(20.09%)与骨和关节315/1926(16.36%)。共检测病原菌2151株,检出革兰阴性菌(G^(-))68.62%(1476株/2151),革兰阳性菌(G^(+))31.38%(675株/2151),未检出真菌。革兰阴性菌(G^(-))最常见的为大肠埃希菌19.25%(414株/2151)、阴沟肠杆菌15.06%(324株/2151)、鲍曼不动杆菌12.55%(270株/2151)和肺炎克雷伯菌12.55%(270株/2151)。革兰阳性菌(G^(+))最常见的为金黄色葡萄球菌12.97%(279株/2151)、表皮葡萄球菌10.88%(234株/2151)和粪肠球菌5.02%(108株/2151)。单因素分析结果显示,年龄、合并基础疾病、进行手术、三类手术切口、住院天数、有侵袭性操作、抗菌药物应用种类以及抗菌药物是否合理应用等因素是骨科科室院内感染发生的影响因素;Logistic回归分析结果显示,年龄>60岁、合并基础疾病≥5种、进行手术、三类手术切口、住院天数≥15天、有侵袭性操作、抗菌药物应用≥2种以及未合理应用抗菌药物等因素为骨科科室院内感染发生的独立影响因素。结论:2016—2019年骨科科室院内感染率较高。医院应针对新建科室、主要感染部位、常见感染病原体以及常见独立危险因素采取有效的预防和控制措施,积极落实无菌操作、改善骨科手术技巧、合理应用抗菌药物,加强医护人员手卫生意识,加强中医特色理疗。

Objective:To analyze the characteristics of hospital infection in the orthopedic department of a Grade-A tertiary TCM hospital and the influencing factors between 2016 and 2019,so as to provide the reference for the prevention and reduction of the hospital infection in orthopedic department.Methods:The retrospective analysis was conducted on all the medical records of the orthopedic patients discharged from 2016 to 2019 on the foundation of infection case registration form,to count and analyze the infection rate,case-times of nosocomial infection rate,infection site,the distribution of pathogen and the influencing factors.Results:The incidence of hospital infection in orthopedic department between 2016 and 2019 was 1809/56097(3.22%),and case-times of nosocomial infection rate was 1926/56097(3.43%).The orthopedic departments with the highest infection rate were reconstructive orthopedics 22/185(11.89%),soft tissue injury orthopedic department 65/672(9.67%)and bone oncology 173/2473(7.00%).The common infection sites were surgical incision 693/1926(35.98%),the next upper respiratory tract 387/1926(20.09%),bone and joint 315/1926(16.36%).A total of 2151 strains of pathogens were detected,among them,Gram-negative bacteria(G^(-))held 68.62%(1476 strains/2151),Gram-positive bacteria(G^(+))31.38%(675 strains/2151),no fungus was detected.The most common G^(-)was escherichia coli 19.25%(414 strains/2151),enterobacter cloacae 15.06%(324 strains/2151),Acinetobacter baumanii 12.55%(270 strains/2151),and klebsiella pneumoniae 12.55%(270 strains/2151).The common G^(+)was staphylococcus aureus 12.97%(279 strains/2151),staphylococcus epidermidis 10.88%(234 strains/2151)and enterococcus faecalis 5.02%(108 strains/2151).The results of univariate analysis revealed that age,complicated with the underlying disease,the operations,class-three surgical incision,hospitalization days,invasive manipulation,types of antimicrobial agents used and whether it is reasonable to use antimicrobial agents are the influencing factors for the incidence of hospital infection in orthopedic departments;Logistic regression analysis displayed that age>60 years,complicated with the underlying disease≥five kinde,the surgeries,surgical incision,length of stay≥15days,invasive manipulation,types of antimicrobial agents used≥two types and improper use of antimicrobial agents are the independent influencing factors for the incidence of hospital infection in orthopedic departments.Conclusion:The infection rate was relatively high in the orthopedic departments between 2016 and 2019.the hospital should adopt the effective prevention and control measures targeted at the new-built department,the main infection sites,common infection pathogens and common independent risk factors,actively implement sterile operation,improve the technique of orthopedic department,rationally use antibiotics,enhance medical staffs'awareness of hand hygiene and TCM-featured physiotherapy.