外科重症监护室导管相关性医院感染5年监测资料分析

Catheterassociated nosocomial infection in surgical intensive care unit :a 5 year data analysis

摘要:

目的了解外科重症监护室（SICU）导管相关性医院感染发生状况及其原因，以采取相应措施降低其发病率。方法采用前瞻性监测方法，对SICU 2005—2009年间615例留置导管患者的相关医院感染发生状况、年龄、住院天数、侵入性操作实施、病原菌等进行综合分析。结果615例留置导管患者发生导管相关性医院感染197例（32.03%），其中仅使用1种、同时使用2种及3种导管者感染发生率分别为2.60%、12.85%、56.40%，3组比较，差异有统计学意义（χ2=151.55，P<0.001）。导管相关性医院感染率以呼吸机相关性肺炎最高，为15.51‰；留置导尿相关性泌尿系统感染、深静脉插管相关血流感染千导管日感染率分别为13.70‰、5.79‰。导管相关医院感染发生前导管平均使用时间：呼吸机（12.22±11.29）d，导尿管（13.09±13.29）d，血管导管（20.64±18.39）d。引起SICU导管相关性医院感染的居首位的病原菌：呼吸机为不动杆菌属细菌（18.80%），导尿管为其他假丝酵母菌（36.46%），血管导管为不动杆菌属细菌（18.75%）。结论SICU患者导管使用数量多，住院时间长，导管留置时间长者易发生医院感染。加强消毒隔离，缩短导管使用时间，严格落实洗手制度，合理应用抗菌药物是防止耐药菌产生，控制和降低医院感染的关键。

Abstract:

ObjectiveTo realize the status and causes of catheterassociated nosocomial infection (CANI) in surgical intensive care unit (SICU) , so as to decrease the incidence by taking proper measures.MethodsSix hundred and fifteen patients with catheters  in SICU between  2005 and 2009 were  monitored prospectively,  including the occurrence of CANI, patients’ age, length of hospital stay, invasive procedures, and pathogens.ResultsOne hundred and ninetyseven of 615 patients (32.03%) developed CANI,  and CANI rate was 2.60%,12.85% and 56.40% in patients with 1 kind , 2  or 3 kinds of catheters simultaneously respectively, there were significant difference among three groups (χ2=151.55,P<0.001). The rate of ventilatorassociated pneumonia (VAP), catheterassociated urinary tract infection (CAUTI) , and  central venous catheter (CVC)associated bloodstream infection (CVCBSI) per 1 000 catheter days was 15.51, 13.70 and 5.79 respectively. The average catheter  utilization days before the occurrence of CANI were as follows:  ventilator (12.22±11.29) days, urinary catheter (13.09±13.29) days , CVC (20.64±18.39) days respectively. The major pathogen in  VAP , CAUTI and  CVCBSI  was Acinetobacter spp.(18.80%), Candida albicans (36.46%) and Acinetobacter spp.(18.75%) respectively.ConclusionPatients with more catheters , long hospital stay and long duration of catheters are prone to develop nosocomial infection . The key to the prevention of emerging of drugresistant strain and decrease in NI are strengthening of  disinfection and isolation, shortening  the time of catheter  retaining, implementing hand hygiene, and using antimicrobial drug rationally.