新型冠状病毒感染疫情期间某医院重症监护病房医院感染目标性监测

Targeted surveillance on nosocomial infection in the ICU patients during the COVID-19 epidemic

目的了解新冠病毒感染疫情期间医院重症监护病房(ICU)住院患者医院感染特征,为ICU医院感染管理提供循证依据。方法采取前瞻性调查法,对某医院ICU新冠病毒感染患者进行医院感染目标性监测。结果共监测该医院ICU住院患者90例,医院感染发病率14.44%,医院感染发生部位以下呼吸道为主。ICU患者呼吸机相关性肺炎(VAP)发病率21.93‰,导管相关尿路感染(CAUTI)发病率3.42‰,导管相关血流感染(CRBSI)发病率为0.00‰。检出率居前2位的病原菌是鲍曼不动杆菌和肺炎克雷伯菌,构成比分别为60.87%和13.04%。抗菌药物使用居前4位的是卡泊芬净(11.58%)、多黏菌素(10.53%)、替加环素(8.42%)和哌拉西林/他唑巴坦(8.42%)。结论该医院ICU在新冠病毒感染疫情期间,住院患者医院感染以下呼吸道感染为主,VAP发病率高。科学规范呼吸机管理,严格实施CAUTI和CRBSI集束化干预策略、加强手卫生质量管理和恰当应用抗菌药物治疗是减少ICU院内感染的关键。

Objective To understand the characteristics of nosocomial infection of inpatients in the intensive care unit(ICU)during the COVID-19 epidemic,and to provide an evidence-based basis for managing nosocomial infection in the ICU.Methods A prospective investigation method was adopted to carry out the targeted observation of nosocomial infection among patients with new coronary pneumonia in the ICU of a hospital.Results A total of 90 patients in the ICU of the hospital were monitored.The incidence rate of nosocomial infection was 14.44%.The main site of nosocomial infection was the lower respiratory tract.The incidence of ventilator-associated pneumonia(VAP),urinary catheter-associated urinary tract infection(CAUTI),catheter-related bloodstream infection(CRBSI)in ICU patients was 21.93‰,3.42‰,and 0.00‰,reseparately.The pathogenic bacteria with the highest detection rate were Acinetobacter baumannii and Klebsiella pneumonia,accounting for 60.87%and 13.04%respectively.Caspofungin(11.58%),colistin(10.53%),tigecycline,and piperacillin/tazobactam(8.42%)were the top three antibiotics used.Conclusion During the COVID-19 epidemic in the ICU of this hospital,inpatients were mainly infected with lower respiratory tract infections,and the incidence of VAP was high.It weighs important to scientifically standardize the management of ventilators,implementing the bundle intervention strategies of CAUTI and CRBSI strictly,and strengthening the quality and compliance of hand hygiene and appropriate use of antibacterial drugs are the core elements to reduce nosocomial infection in the ICU.