医院感染现患率调查及危险因素分析

Prevalence and risk factors of healthcareassociated infection

摘要:

目的了解某院医院感染现状及危险因素，为更好地预防与控制医院感染及进一步完善医院感染管理计划与措施提供科学依据。方法采用横断面调查，床旁与病历调查相结合的方法，对2012年5月10日00∶00—24∶00该院所有住院患者进行医院感染现患率调查。结果应查住院患者2 700例，实查2 684例，实查率为99.41%。共发生医院感染67例，74例次，医院感染现患率为2.50%，例次现患率为2.76%；发生社区感染171例，182例次，社区感染现患率为6.37%，例次现患率为6.78%。医院感染现患率最高的科室是干细胞移植病房（25.00%，2/8),其次为血液科（7.77%,8/103）和整形科（6.82%,3/44）；医院感染部位以下呼吸道居首位（41.90%），其次为泌尿系统（10.81%）和手术切口（9.46%）。抗菌药物使用率为32.94%(884/2 684)，其中预防用药占76.24%，治疗+预防用药占3.28%，治疗用药占20.48%；抗菌药物单一用药占86.65%，二联用药占12.78%，三联及以上用药占0.57%。多因素logistic回归模型结果显示,单纯气管切开、留置导尿、经外周静脉穿刺中心静脉置管（PICC）、留置引流和肠内营养是医院感染的危险因素。结论医院感染现患率调查有助于了解医院感染发生情况；医院应加强重点科室的医院感染管理，尽量避免不必要的侵入性操作，规范、合理使用抗菌药物，以降低医院感染发生率。

Abstract:

ObjectiveTo realize the current situation and risk factors of healthcareassociated infection(HAI) in a hospital, so as to provide a scientific basis for improving management of HAI.MethodsA crosssectional survey on HAI prevalence was conducted by combination of bedside examination and medical record review, all hospitalized patients from 00∶00 to 24∶00 on May 10, 2012 were included in the survey.ResultsA total of 2 700 patients should be surveyed, 2 684 of whom (99.41%) were actually surveyed. 67 patients developed 74 times of HAI, HAI prevalence rate and case rate was 2.50% and 2.76% respectively; 171 patients developed 182 times of communityacquired infection (CAI),CAI prevalence rate and case rate was 6.37% and 6.78% respectively. The stem cell transplantation ward had the highest HAI prevalence (25.00%, 2/8), followed by hematology department(7.77%,8/103) and the department of plastic surgery (6.82%,3/44); lower respiratory tract was the main site of HAI (41.90%), followed by urinary system (10.81%) and surgical incision (9.46%). Antimicrobial usage rate was 32.94%(884/2 684), 76.24% of which were for prophylactic use, 3.28% for both prophylactic and therapeutic use, and 20.48% for therapeutic use;the usage rate of single,combination of 2,3 or more antimicrobial agents accounted for 86.65%,12.78%, and 0.57% respectively. Multivariate regression analysis revealed that risk factors of HAI were tracheotomy, indwelling urinary catheterization, peripherally inserted central catheterization, drainage, and enteral nutrition.ConclusionPrevalence survey of HAI helps to know the occurrence of HAI; hospital should strengthen the management of key departments,avoid unnecessary invasive operation, standardize the use of antimicrobial agents, and reduce the incidence of HAI.