中国医院感染监测工作的发展及变化趋势

Development and changing trend in monitoring of healthcareassociated infection in China

摘要:

目的总结三十年来我国医院感染监测活动所取得的成效，探索医院感染监测的变化趋势，寻找适合我国医院感染监测的新模式。方法抽取13个省（自治区、直辖市）及军队系统综合性医院194所，采用问卷调查的方式调查其医院感染监测工作开展情况。结果194所医院审核后数据可用医院为184所(94.85%)。二级、三级医院医院感染发病率分别为0.78%、1.58%，两组比较，差异有统计学意义（P＜0.01）。以2006年为界线分为两个阶段，2006年以前、2006—2016年开展各项监测的医院累计比率：环境卫生学监测分别为73.91%、100.00%，消毒效果监测分别为69.57%、97.28%，全面综合性监测分别为64.67%、98.91%，手术部位感染监测分别为13.04%、94.57%，ICU医院感染监测分别为4.89%、87.50%，新生儿医院感染监测分别为1.75%、60.82%，多重耐药菌监测分别为5.43%、95.65%，手卫生依从性监测分别为2.17%、93.48%，抗菌药物监测分别为15.22%、87.50%。三级医院医院感染暴发事件报告的比率为33.33%（37所），高于二级医院16.44%（12所），差异有统计学意义（P=0.01）。结论我国医院感染监测起步较晚，但发展较快。我国医院感染监测系统仍然存在缺陷，医院感染病例漏报率仍较高，医院感染暴发报告率低。

Abstract:

ObjectiveTo summarize the effectiveness in monitoring activities for healthcareassociated infection (HAI) in China in the past 30 years, explore the changing trend in HAI monitoring, find a new model for the monitoring of HAI in China. MethodsA total of 194 comprehensive hospitals and military hospitals in 13 provinces (autonomous regions, municipalities) were selected, questionnaire survey was adopted to investigate the situation of HAI monitoring. ResultsOf 194 hospitals, 184 (94.85%) had available data after being checked, incidence of HAI in secondary and tertiary hospitals were 0.78% and 1.58% respectively， difference was significant (P＜0.01）. Monitoring was divided into two stages, cumulative percentage of each monitoring activity before 2006 and during 20062016 were respectively as follows: environmental hygiene were 73.91% and 100.00%, disinfection efficacy 69.57% and 97.28%, overall comprehensive monitoring  64.67% and 98.91%, surgical site infection(SSI) 13.04% and 94.57%, ICU HAI  4.89% and 87.50%, neonatal HAI 1.75% and 60.82%, multidrugresistant organisms(MDROs) 5.43% and 95.65%, hand hygiene compliance  2.17% and 93.48%, antimicrobial agents 15.22% and 87.50%. The reporting rate of HAI  outbreak in tertiary hospitals was higher than secondary hospitals ( 33.33% ［n=37］ vs 16.44%［n=12］, P=0.01）. ConclusionThe monitoring of HAI in China starts late, but develops rapidly, defects still exist in HAI monitoring system, reporting rate of HAI cases is still high, reporting rate of HAI outbreak is low.