连续3年某院新生儿科医院感染监测

Surveillance on healthcareassociated infection in a neonatal intensive care unit of a hospital for three consecutive years

摘要:

目的了解某院新生儿科医院感染情况，为更好地控制新生儿医院感染提供参考依据。方法采用前瞻性调查方法，对2011年1月—2013年12月某院新生儿科住院的所有新生儿进行目标性监测。结果共监测新生儿5 365例，发生医院感染128例，133例次，医院感染率为2.39%，例次感染率为2.48%。医院感染部位以眼结膜居首位，占33.08%，其次是上呼吸道、皮肤及软组织，分别占23.31%和17.29%。新生儿日感染率为3.32‰（128/38 528），血管导管使用率为1.75%（676/38 528），呼吸机使用率为1.09%（420/38 528）。不同体重组新生儿血管导管使用率、呼吸机使用率比较，差异均有统计学意义(χ2值分别为3 075.22、442.46,均P＜0.01）。体重≤1 000 g、1 001～1 500 g、1 501～2 500 g、＞2 500 g各组新生儿医院感染率分别为16.67%、12.26%、4.15%、1.06%。新生儿均未发生导管相关性血流感染，且其呼吸机相关性肺炎发病率仅为4.76‰（2/420）。共送检标本51份，检出病原菌27株，以革兰阳性菌为主（占55.56%）。结论低体重新生儿医院感染发病率较高；新生儿感染部位以眼部、上呼吸道、皮肤及软组织为主。

Abstract:

ObjectiveTo investigate healthcareassociated infection (HAI) in neonatal intensive care unit(NICU), and provide reference for controlling HAI in newborns. MethodsTargeted surveillance on HAI in all newborns in NICU of a hospital from January 2011 to December 2013 was performed by  prospective investigation method.  ResultsA total of  5 365 newborns were monitored, 128 newborns developed 133 times of HAI,HAI rate and HAI case rate was 2.39% and 2.48% respectively. The major infection sites were conjunctiva (33.08%), upper respiratory tract (23.31%) and  skin soft tissue (17.29%). The daily infection rate was 3.32‰(128/38 528), vascular catheter usage rate and respirator usage rate was 1.75%（676/38 528）and 1.09%（420/38 528）respectively. The difference in vascular catheter usage rate and respirator usage rate in newborns with different body weight had statistical difference (χ2=3 075.22; 442.46, both P＜0.01）. HAI in newborns with body weight of ≤1 000 g, 1 001-1 500 g, 1 501-2 500 g, and ＞2 500 g was 16.67%,12.26%,4.15% and 1.06% respectively. None newborns developed catheterrelated bloodstream infection(CRBSI), the incidence of ventilator-associated pneumonia (VAP) was only 4.76‰（2/420）. A total of 51 specimens were sent for detection, 27 pathogens were isolated, the major were grampositive bacteria（55.56%）.ConclusionThe incidence of HAI in newborns is high,  the main infection sites are eye, upper respiratory tract, and skin and soft tissue.