重症监护病房近13年医院感染目标性监测分析

Targeted monitoring of healthcare-associated infection in intensive care unit in the past 13 years

目的通过开展重症监护病房(ICU)目标性监测,了解医院感染发生情况,为减少医院感染的发生提供科学依据。方法选取某院2010年5月—2022年12月ICU患者为研究对象,开展目标性监测,对患者医院感染率、器械相关感染发病率、医院感染病原菌分布情况、医院感染部位和手卫生依从率等进行统计学分析。结果ICU共收治患者8998例,医院感染率为10.35%,例次感染率为14.66%,调整例次感染率为3.72%。不同年份医院感染率比较,差异有统计学意义(P<0.001)。呼吸机、导尿管置管和中心静脉导管置管使用率分别为57.56%、95.92%、79.14%,呼吸机相关肺炎(VAP)、导尿管相关泌尿道感染(CAUTI)、血管导管相关血流感染(CLABSI)发病率分别为10.62‰、3.08‰、0.65‰。呼吸机使用率从2010年的37.12%上升到2022年的72.35%,VAP发病率从23.36‰下降至5.61‰。CAUTI和CLABSI发病率趋于较稳定水平。共检出病原菌1673株,排名前5位的病原菌依次为鲍曼不动杆菌(34.79%)、肺炎克雷伯菌(18.35%)、铜绿假单胞菌(10.58%)、嗜麦芽窄食单胞菌(2.81%)和大肠埃希菌(2.75%)。多重耐药菌(MDRO)检出率位于前3位的为耐碳青霉烯类鲍曼不动杆菌(CRAB,83.88%)、耐甲氧西林金黄色葡萄球菌(MRSA,56.37%)、耐碳青霉烯类肺炎克雷伯菌(CRKP,50.29%);MDRO医院感染率前3位分别为CRAB(6.39%)、CRKP(2.56%)、耐碳青霉烯类铜绿假单胞菌(CRPA,1.09%)。医院感染部位以呼吸系统(55.80%)为主,其次为泌尿系统(16.53%)、血液系统(16.38%)、消化系统(6.75%)等。ICU医务人员手卫生依从率从2010年5—12月的62.25%上升至2022年的87.86%。速干手消毒剂和洗手液消耗量从2013年的65.66 mL/日·床上升至2022年的95.49 mL/日·床。结论近13年ICU医院感染目标性监测结果有利于帮助医务人员掌握医院感染发生趋势,为制定有效防控措施提供有力的数据支撑,减少医院感染的发生。

Objective To understand the occurrence of healthcare-associated infection(HAI)in intensive care unit(ICU)through conducting targeted monitoring,and provide scientific basis for reducing the occurrence of HAI.Methods Patients in the ICU in a hospital from May 2010 to December 2022 were selected as research objects.Targeted monitoring was carried out.Incidence of HAI,incidence of device-associated infection,distribution of pathogens,sites of HAI,and compliance rate of hand hygiene were statistically analyzed.Results A total of 8998 patients were admitted to the ICU,with a HAI rate of 10.35%and a HAI case rate of 14.66%.The adjusted HAI case rate was 3.72%.Difference in HAI rates among different years was statistically significant(P<0.001).Utilization rates of ventilators,urinary catheters,and central venous catheters were 57.56%,95.92%,and 79.14%,respectively.Incidences of ventilator-associated pneumonia(VAP),catheter-associated urinary tract infection(CAUTI),and central line-associated bloodstream infection(CLABSI)were 10.62‰,3.08‰,and 0.65‰,respectively.Utilization rate of ventilators increased from 37.12%in 2010 to 72.35%in 2022,and the incidence of VAP dropped from 23.36‰to 5.61‰.Incidences of CAUTI and CLABSI tended to be relatively stable.A total of 1673 pathogenic bacteria strains were detected,and the top 5 pathogens were Acinetobacter baumannii(34.79%),Klebsiella pneumoniae(18.35%),Pseudomonas aeruginosa(10.58%),Stenotrophomonas maltophilia(2.81%)and Escherichia coli(2.75%).The top 3 detected multidrug-resistant organisms(MDROs)were carbapenem-resistant Acinetobac-ter baumannii(CRAB,83.88%),methicillin-resistant Staphylococcus aureus(MRSA,56.37%)and carbapenem-resistant Klebsiella pneumoniae(CRKP,50.29%).MDROs with the top 3 highest HAI rates were CRAB(6.39%),CRKP(2.56%)and carbapenem-resistant Pseudomonas aeruginosa(CRPA)(1.09%).The main site of HAI was respiratory system(55.80%),followed by urinary system(16.53%),blood system(16.38%),and digestive system(6.75%).Hand hygiene compliance rate of ICU health care workers increased from 62.25%in May-December 2010 to 87.86%in 2022.The consumption of alcohol-based hand rub and hand sanitizers increased from 65.66 mL/day/bed in 2013 to 95.49 mL/day/bed in 2022.Conclusion The targeted monitoring results of HAI in ICU in the past 13 years help health care workers understand the trend of HAI,provide powerful data support for formulating effective prevention and control measures,and reduce the occurrence of HAI.