神经内科重症监护病房医院感染目标性监测及危险因素分析

Targeted surveillance and risk factors analysis of nosocomial infection in neurological intensive care unit

目的调查研究神经内科重症监护病房(NICU)的医院感染特点,探讨医院感染相关危险因素及预防控制措施。方法结合目标性监测和急性生理功能和慢性健康状况评分(APACHEⅡ)预警模型,对2015年10月-2018年9月入住北京市顺义区医院953例NICU患者临床资料和医院感染发生率进行统计分析,并与文献资料进行对比。结果总住院日13818d内发生医院感染76例,患者医院感染例次发生率为7.97%,日例次感染率为5.50‰,根据平均病情严重程度调整后日例次感染率为1.70‰。器械相关感染发生率处于较低水平,与美国国家医疗保健安全网(NHSN)综合ICUs的医院感染发生率接近,远低于国际医院感染控制联盟(INICC)的NICU医院感染发生率。院内感染以呼吸系统为主,脑出血患者医院感染率高于缺血性脑血管病患者。多因素Logistic回归分析结果显示,高龄(≥70岁)、住院日长(≥15d)、脑出血、行动不便、器械使用、病情严重程度评分(ASIS)≥4和APACHEⅡ≥20是医院感染的独立危险因素(P <0.05)。结论 NICU是医院感染发生的高危科室,存在多种独立危险因素。目标性监测、评分预警模型、院感管理平台和隔离病房等系列防控措施有助于降低医院感染发生率。

Objective To investigate the characteristics of nosocomial infection in neurological intensive care unit,and to explore the risk factors and preventive and control measures of nosocomial infection.Methods Combining the targeted surveillance and APACHEⅡscoring warning model,953 patients admitted to the NICU of the Hospital of Shunyi District Beijing from October 2015 to September 2018,were analyzed and compared the results with the literature data.Results 76 patients had nosocomial infection in a total of 13818 patient-days.The incidence of nosocomial infection was 7.97 per 100 patients and the 5.50 per 1000 patient-days.The adjusted nosocomial infection ratio for ASIS was 1.70 per 1000 patient-days.The device related nosocomial infection ratios were at a relatively low level,close to ICUs data from NHSN,USA,much lower than the NICU data from INICC.Respiratory system is the main site of nosocomial infection.The nosocomial infection ratio of patients with cerebral hemorrhage was much higher than the patients with ischemic cerebrovascular disease.Multivariate logistic regression analysis showed that elder age(≥70 years old),high-length of hospitalization(≥15 days),cerebral hemorrhage,mobility inconvenience,usage of devices,ASIS(≥4)and APACHEE II(≥20)were independent risk factors for nosocomial infection(P<0.05).Conclusion Is a high-risk department of nosocomial infection.There are many independent risk factors.A series of preventive and control measures,such as target monitoring,scoring and early warning model,nosocomial infection management platform and isolation ward,can help to reduce the incidence of nosocomial infection.