大庆某综合医院的医院感染流行病学研究
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摘要
医院感染是指住院病人在医院内获得的感染,包括在住院期间发生的感染和在医院内获得出院后发生的感染,但不包括入院前已开始或者入院时已处于潜伏期的感染。医院工作人员在医院内获得的感染也属医院感染。广义上讲,任何人员在医院活动期间受到病原体袭击而引起的任何诊断明确的感染或疾病,均称为医院感染;狭义上讲,凡是住院患者在入院时不存在、也非已处于潜伏期的,而在住院期间遭受病原体袭击而引起的任何诊断明确的感染或疾病,无论受感染者在医院期间或是出院以后出现症状,均称为医院感染。
医院感染是目前各医疗机构所面临的突出公共卫生问题,医院感染发病率的高低直接影响综合性医院的医疗水平,目前也越来越受到各国医务人员和卫生行政人员的高度重视。
为了系统全面地分析医院感染控制的各个环节监测指标,准确了解综合性三级甲等医院医院感染现状,掌握医院感染的变化趋势以及危险因素,分析医院感染所造成的经济损失,探讨医院感染管理存在的问题及对策,制定有效的监控体系,达到降低医院感染的目的。
本研究围绕着病原菌、感染分布、感染环节、危险因素等方面,对大庆市某综合性三级甲等医院四年的医院感染病例监测资料进行了描述性研究、对在院病人医院感染现患率进行了横断面调查以及对患者因医院感染造成的直接经济损失进行了病例对照研究,旨在为预防和控制医院感染提供理论依据。
Nosocomial Infection is one of the important problems in the population health of the global hospitals, especially in the hospitalization people who are recuperating. It is also the important criteria to weight and value the level of hospital management and medical attendance. and its incidence which is an important indicator to evaluate the level of hospital management and medical attendance has drawn a wide attention among the medical profession all over the world . Nosocomial Infection was affected by several factors such as resources.and level , infection management of the hospital. The number of Outpatients and beds in the hospital is more than 170 man-time and 1066 respectively ,and the hospital can do heart ,kidney transplantation successfully and so on.
Epidemiologic study on Nosocomial Infection is about pathogenic bacteria ,the distribution and link of infection, risk factors and so on .It provides scientific and accurate monitoring date as the basis of estimation ,controlling and management of the nosocomial infection
Objective: To learn about nosocomial infection actuality in Daqing oilfield general hospital, master the dynamic variation tendency of nosocomial infection for 4 years and analyse the risk factors. This paper is to explore the Infection management of general hospital from the perspective of health economics, analyze the economic losses, caused by nosocomial infection, and discuss the problems and solutions of the nosocomial infection management. According to the disciplinarian of hospital infections occurred , we may make a use of the relating theory, methods and technical measures to constitute an effective monitoring system.
Methods:
1. Monitoring data: investigate retrospectively all the infection monitoring cases that patients discharged from hospital from July 2004 to July 2008, the result is a total of 149219 case- times. Sum up cases of nosocomial infection during 4 years, describe the nosocomial infection distribution of the time,space and population,analyse the changes in the trend of characteristics of pathogens, the prevalence of drug-resistant strains and so on.
2. Cross-sectional surveys: make the inventory survey of the in- patients’cases twice with a combination method of the beside survey and hospitalization survey.
3. the case-control survey: with the pair matching , compare the health resource consumption of the nosocomial infection with that of the none nosocomial infection hospitals to evaluate the nosocomial infection from the perspective of health economics .
Statistical Analysis : The data is input by the means of Epidate software to set up a database and analyzed with SPSS 13.0 software.
Results: The survey result in 4 years indicated that the total incidence of the nosoeomial Infection was stabilized ,the incidence were from 2.5% to 2.8%, its case- times incidence were from 2.8% to 3.0%,and incidence density were from 2.6% to4.3%.The top 5 Infection sites were upper respiratory tract (46.8%), lower respiratory tract (21.8%), gastrointestinal tract (11.7%), urinary tract(6.2%) and deep surgical incision (3.7%).The top 5 Infection departments were neurological rehabilitation (9.2%), hematological (7.6%), traditional Chinese medicine(5.5%) and renal medicine (5.3 %).The prevalence of the nosoeomial Infection is significant higher than the incidence. The main Infection site was respiratory tract and the main Infection departments were medical and surgical. the top 5 medical methods usage rate were immunosuppressive、urinary intubation、chemical radiotherapy、biomotor. Due to the nosoeomial infection, hospitalization time were extended by 10.4 days per case on average. In comparison with the control group, the extra expenditure is 9286.0±23784.5 yuan per case on average, which was mainly spent on drugs, laboratory, materials ,treatment and disposal fees.
Conclusion:
1. nosoeomial infection rates total tended to be stable ,The main infection sites followed by high to low were upper respiratory tract , lower respiratory tract, gastrointestinal tract, urinary tract and deep surgical incision. Groups of age below 3 years or above 55 years are high risk for the nosoeomial Infection.nosoeomial infection rates as a result of the different departments vary ,The Internal medicine, pediatrics and surgery are the key departments for surveillance.
2. The top5 factors those have close relationship with nosocomial infection were as follows: immunosuppressant, indwelling catheter., chemical radiothrapy, ventilator and venous incubation. The usage rate of antimicrobial agents higher than National Standard, the department of surgery had the higher use in it and There were phenomenons of long medicine and prophylaxis use antimicrobial agents.
3. The prevalence of the nosoeomial Infection is significant higher than the incidence. The infection sites and departments distribution in the cross-sectional survey are different from that in the case-control survey.
4. the nosoeomial Infection increases the health care costs and reduces the turnover rate of hospital beds deeply. Conscientiously make a progress on the the nosoeomial Infection control will access to both economic and social benefits.
医院感染是目前各医疗机构所面临的突出公共卫生问题,医院感染发病率的高低直接影响综合性医院的医疗水平,目前也越来越受到各国医务人员和卫生行政人员的高度重视。
为了系统全面地分析医院感染控制的各个环节监测指标,准确了解综合性三级甲等医院医院感染现状,掌握医院感染的变化趋势以及危险因素,分析医院感染所造成的经济损失,探讨医院感染管理存在的问题及对策,制定有效的监控体系,达到降低医院感染的目的。
本研究围绕着病原菌、感染分布、感染环节、危险因素等方面,对大庆市某综合性三级甲等医院四年的医院感染病例监测资料进行了描述性研究、对在院病人医院感染现患率进行了横断面调查以及对患者因医院感染造成的直接经济损失进行了病例对照研究,旨在为预防和控制医院感染提供理论依据。
Nosocomial Infection is one of the important problems in the population health of the global hospitals, especially in the hospitalization people who are recuperating. It is also the important criteria to weight and value the level of hospital management and medical attendance. and its incidence which is an important indicator to evaluate the level of hospital management and medical attendance has drawn a wide attention among the medical profession all over the world . Nosocomial Infection was affected by several factors such as resources.and level , infection management of the hospital. The number of Outpatients and beds in the hospital is more than 170 man-time and 1066 respectively ,and the hospital can do heart ,kidney transplantation successfully and so on.
Epidemiologic study on Nosocomial Infection is about pathogenic bacteria ,the distribution and link of infection, risk factors and so on .It provides scientific and accurate monitoring date as the basis of estimation ,controlling and management of the nosocomial infection
Objective: To learn about nosocomial infection actuality in Daqing oilfield general hospital, master the dynamic variation tendency of nosocomial infection for 4 years and analyse the risk factors. This paper is to explore the Infection management of general hospital from the perspective of health economics, analyze the economic losses, caused by nosocomial infection, and discuss the problems and solutions of the nosocomial infection management. According to the disciplinarian of hospital infections occurred , we may make a use of the relating theory, methods and technical measures to constitute an effective monitoring system.
Methods:
1. Monitoring data: investigate retrospectively all the infection monitoring cases that patients discharged from hospital from July 2004 to July 2008, the result is a total of 149219 case- times. Sum up cases of nosocomial infection during 4 years, describe the nosocomial infection distribution of the time,space and population,analyse the changes in the trend of characteristics of pathogens, the prevalence of drug-resistant strains and so on.
2. Cross-sectional surveys: make the inventory survey of the in- patients’cases twice with a combination method of the beside survey and hospitalization survey.
3. the case-control survey: with the pair matching , compare the health resource consumption of the nosocomial infection with that of the none nosocomial infection hospitals to evaluate the nosocomial infection from the perspective of health economics .
Statistical Analysis : The data is input by the means of Epidate software to set up a database and analyzed with SPSS 13.0 software.
Results: The survey result in 4 years indicated that the total incidence of the nosoeomial Infection was stabilized ,the incidence were from 2.5% to 2.8%, its case- times incidence were from 2.8% to 3.0%,and incidence density were from 2.6% to4.3%.The top 5 Infection sites were upper respiratory tract (46.8%), lower respiratory tract (21.8%), gastrointestinal tract (11.7%), urinary tract(6.2%) and deep surgical incision (3.7%).The top 5 Infection departments were neurological rehabilitation (9.2%), hematological (7.6%), traditional Chinese medicine(5.5%) and renal medicine (5.3 %).The prevalence of the nosoeomial Infection is significant higher than the incidence. The main Infection site was respiratory tract and the main Infection departments were medical and surgical. the top 5 medical methods usage rate were immunosuppressive、urinary intubation、chemical radiotherapy、biomotor. Due to the nosoeomial infection, hospitalization time were extended by 10.4 days per case on average. In comparison with the control group, the extra expenditure is 9286.0±23784.5 yuan per case on average, which was mainly spent on drugs, laboratory, materials ,treatment and disposal fees.
Conclusion:
1. nosoeomial infection rates total tended to be stable ,The main infection sites followed by high to low were upper respiratory tract , lower respiratory tract, gastrointestinal tract, urinary tract and deep surgical incision. Groups of age below 3 years or above 55 years are high risk for the nosoeomial Infection.nosoeomial infection rates as a result of the different departments vary ,The Internal medicine, pediatrics and surgery are the key departments for surveillance.
2. The top5 factors those have close relationship with nosocomial infection were as follows: immunosuppressant, indwelling catheter., chemical radiothrapy, ventilator and venous incubation. The usage rate of antimicrobial agents higher than National Standard, the department of surgery had the higher use in it and There were phenomenons of long medicine and prophylaxis use antimicrobial agents.
3. The prevalence of the nosoeomial Infection is significant higher than the incidence. The infection sites and departments distribution in the cross-sectional survey are different from that in the case-control survey.
4. the nosoeomial Infection increases the health care costs and reduces the turnover rate of hospital beds deeply. Conscientiously make a progress on the the nosoeomial Infection control will access to both economic and social benefits.
引文
[1]陈清,吴娴波,云雪霞,等.医院感染的流行病学进展[J].新医学,2006,37(7):430-433.
[2] Daschner F. Cost-effectiveness in hospital infection control-lessons for the 1990s[J]. J Hosp Infect, 1989, 13: 325-336.
[3]肖光夏.烧伤肠源性感染的系列研究.中华流行病学杂志,1993,14(特9):7.
[4]贺买宏.2375例住院患者医院感染[J].现代预防医学,2006,33(4):536～537.
[5]徐武夷,古东东,潘涛.10年医院感染的监测和控制[J].中华医院感染学杂志,2003,13(10):925-927.
[6]文细毛,任南,徐秀华,等.全国医院感染监控网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002,12(4):241-242.
[7]张晓兵,龚雅利,刘智勇,等.3170株临床分离病原菌耐药谱与耐药机制的研究[J].中华医院感染学杂志,2008,18(3):422～424.
[8]申正义.中国大陆细菌耐药性监测研究[J].中国感染控制杂志,2002,1 (1):1.
[9]何多多,张玉强,张颖,等.230例死亡病历医院感染的分析〔J〕.中华医院感染学杂志,2004,14(12):1353.
[10]徐秀华.临床医院感染学[M].第2版.长沙:湖南科学技术出版社,2005.61.
[11]吴安华,任南,文细毛,等.159所医院感染现患率调查结果与分析[J].中国感染控制杂志,2005,4(1):13～14.
[12]李六亿.全我国医院感染管理现状与管理对策[J].实用医学杂志,2002,18(1)2.
[13]任南,文细毛,吴安华,等.全国医院感染横断面调查结果的变化趋势研究[J].中华医院感染控制杂志,2007,6(1):18.
[14]马非,李东力.医院感染流行病学研究现状[J]..解放军预防医学杂志,2006,24(5):387.
[15]吴安华.医院感染损失的经济评价[J].中国感染控制杂志,2006,5(3):193.
[16]Askarian M,Gooran N R. National nosocomial infection surveil-lancesystem-based study in Iran: additional hospital stay at-tribuable to nosocomial infections[J]. Am J Infect Control,2003, 31(8): 465-468. [16] Green JW. Postoperative wound infection: A controlled study of the increased duration of hospital stay and direct cost of hospitalization.Ann Surg,1977,155∶264-269.
[17] Warren D K, Shukla S J, Olsen M A,et al.Outcome and at-tributable cost of ventilator-associated pneumonia among inten-sive care unit patients in a suburban medical center[J]. Crit CareMed, 2003, 31(5): 1312-1317.
[18]杨武,李武英,贺桂菊,等.医院感染经济损失的1∶1病例对照研究.中华医院感染学杂志,1998,8∶193-195.
[19]吴安华,任南,文细毛,等. 159所医院医院感染现患率调结果与分析[J].中国感染控制杂志,2005,4(1):12-16.
[20]周虹,安文洪,周艳.医院感染的流行病学分析[J].中华医院感染学杂志, 2002, 12(2): 102-103.
[21]马惠兰,黄相增,李惠,等.1992~2001年新一大二附院医院感染监测和控制情况分析[J].新疆医科大学学报, 2004, 27(5): 467-469.
[22]魏淑琴. 7591例住院患者院内感染调查与分析[J].临床护理杂志,2005,4(4):52-53.
[23]吴安华,任南,文细毛,等.全国感染监控1998-1999年监测资料分析[J]·中华医院感染杂志, 2000, 10(6): 401-403.
[24]张常然,刘霞,谭妙莲,等. 3年医院感染流行病学调查分析[J].中华医院感染学杂志,2008,18(5):626-628.
[25]de Lourdes Garcia-Garcia M, Jimenez-Corona A,Jimenez-Corona ME·Nosocomial infections in a com-munity hospital in Mexico[J]·Infect ControlHosp Epi-demiol , 2001, 22(6):386.
[26]Croce MA, Fabian TC, Waddle–Smith L·Identification of early predictors for post-traumaticpneumonia[J]·Am Surg, 2001, 67(2):105.
[27]吴安华,任南,文细毛,等.159所医院医院感染现患率调结果与分析[J].中国感染控制杂志,2005,4(1):12-16.
[28]任玲,周宏,茅一平,等.医院感染现患率调查资料分析[J]中华医院感染学杂志,2007,17(1):24-26.
[29]林小聪,詹永忠,谢扬,等.医院感染现患率调查与监控研[J].中华医院感染学杂志,2004,14(3):265-268.
[30]杨雪英,陈华,李志伟.综合医院医院感染现患率调查分[J].中华医院感染学杂志,2005,15(4):393-395.
[31]史文昕,史文晶,李静峰,等. 2049例医院感染调查分析[J]中华医院感染学杂志,2006,16(7):753-754.
[32]周霓,陈少虹,张桂琴,等. 15397例住院病例医院感染调查分析[J]疾病控制杂志杂志,2001,5(4):355-356.
[33]何菊英.20523例住院患者医院感染流行病学分析[J].中国医院感染控制杂志,2004,3(4):359.
[34] kurlat I , Corral G , Oliveira F , et al. Infection control strategies in a neonatal intensive care unit in Argentina [J]. J Hosp Infect , 1998,40(2):149.
[35] Rubins JB, Cheung S, Carson P, et al·Identification clinical risk factors for nosocomial pneumococcal bac-teremia[J]·Clin Infect Dis, 1999,29: 178-83·
[36]任南,文细毛,吴安华. 178所医院医院感染危险因素调查分析[J].中国医院感染控制杂志,2003,2(1): 6-9.
[37]杨宝忠,海平.医院感染危险因素研究[J]宁夏医学院学报,2005,27(1):33-36.
[38]吴斌,许能锋,杨柳青,等.小儿肾病综合征医院感染流行病学调查[J].中华医院感染学杂志,2000,10(3):171.
[39]陈正堂.临床肿瘤学概论[M].北京:中国协和医科大学出版社,1999.161.
[40]吴安华,任南,文细毛. 151家医院2003年度住院患者日抗菌药物使用率的调查分析[J].中华流行病学志,2005,26(6): 451-454.
[41]陈彩芳,黄建华,谭秀艳.抗菌药物应用现状调查及分析[J].中华医院感染杂志,2004, 14(6): 668-670.
[42]任南,徐秀华,吴安华,等.医院感染横断面研究报告[J].中华医院感染学杂志,2002,12(1):1-3.
[43]吴安华,任南,文细毛,等.151家医院2003年度住院患者日抗菌药物使用率的调查分析[J].中华流行病学杂志2005 ,26(6) :451-454.
[44]刘鹰,朱蓓蓓,吴芳,等.加强抗菌药物临床应用与管理[J]中华医院感染学杂志,2008,18(8):1145-1146.
[45]Vatopouls AC, Kalapothaki V, Legakis NJ·Risk factorfor nosocomial infections caused by Gram-negative bacilli [J]·J Hosp Infect, 1996,34:11.
[46]Asensio A, Oliver A, Gonzalez-Diego P, et al·Out-break of a multiresistant Klebsiella pneumoniae strain in a intensive care unit: Antibiotic use as a risk factor for colonization and infection [J]·Clin Infect Dis,2000,30:55.
[47] Zinner S,Wise R,Robert M J r.Maximizing antimicrobial effi2cacy inimizing antimicrobialresistance:a paradigm for t he new millennium[J].CID,2001, 33(Suppl 3):S105.
[48]申正义,孙自镛,王洪波.湖北地区临床细菌耐药性监测结果[J].中华医院感染学杂志,2002,12 (2) :91-93.
[49]李六亿,于丽华,巩军,等.抗菌药物应用现状调查及管理对策的探讨[J].中华医院感染学杂志,1999 ,9 (4) :193-195.
[50]贺买宏.2375例住院患者医院感染调查[J].现代预防医学,2006,33(4): 536-537.
[51]文细毛,任南,徐秀华,等.全国医院感染监测网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002 ,12 (4) :241-242.
[52]王江桥,巫雪平,李玉娟,等.连续3年医院感染现患率调查报告[J].中国感染控制杂志,2006,5(1) :19-22.
[53]赵和平,杨芸,张缭云,等.180例医院感染病例流行病学调查[J].中华医院感染学杂志,1998,8(2):95.
[54]滕维亚,狄惠芝.深部真菌感染研究进展[J].中华医院感染学杂志,1999,9(l),62.
[55] Rhomberg PR,fritsche TR,Ssder HS,et al.Antimicrobial susceptibility pattern comparisons among intensive care unit and general ward Gram-negative isolates from the Meropenem Yearly Susceptibility Test Information Collection Program (USA)[J].Diag Microbiol Infenct Dis,2006,56:57-62.
[56] Witte W. Antibiotic resistance in Gram-positive: epidemiological aspects[J]. J Antimicrob Chemother, 1999, 44 TopicA: 1-9.
[57]CDC.Update.Staphylococcus aureusreduced susceptibility to vancomycin-United States, 1997[J]. MMWR, 1997, 46: 813-815.
[58]肖永红,王进.2006-2007年Mohnarin ICU病原菌耐药性监测[J].中华医院感染学杂志,2008,18(9): 1223-1227.
[59]张苏明,朱莉莉,许平,等.医院感染病原菌构成和耐药谱变迁趋势分析[J].中国医院感染控制杂志,2002,1(1): 44-46.
[60] Beck-Sagie C, Jarvis WWR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980~1990 [J]. J infect Dis, 1993, 167: 1247-1251.
[61]吴娴波.医院感染流行病学研究[D].广州:第一军医大学,2007.
[62]吴安华,任南,文细毛,等. 193所医院感染现患率调查分析[J].中华医院感染学杂志,2002 ,12 (8) :561-562.
[63]李晓红,房彤.我省医院感染现患率调查[J].中华医院管理杂志,2002,18(8): 492-493.
[64] Vaque J, Rossello J, Arribas J L,et al.Prevalence of nosoco-mial infection in Spain: EPINE study1990-1997[J]. J HospInfect,1999,43:S105-S111.
[65] Gikas A, Pediaditis I, Roumbelakis G,et al.Repeated multi-center prevalence surveys of hospital-acquired infection inGreek hospital[J]. J Hosp Infect,1999,41(1):11-18.
[66]任南,文细毛,吴安华.全国医院感染横断面调查结果的变化趋势研究[J].中国医院感染控制杂志,2007,6(1):16-18.
[67] PenaC,PuzolM,ArdanuyC,etal.Epjdemiojogy and sueeessful control of a large outbreak due toKIebsiella Pneuoniae produeing extended-speetrurn beta-laetamases[J].Antimicrob Agents Chemother,1998,42(l):53一58.
[68] Askarian M,Gooran N R. National nosocomial infection surveil-lance system-based study in Iran: additional hospital stay at-tribuable to nosocomial infections[J]. Am J Infect Control,2003, 31(8): 465-468.
[69]Warren D K, Shukla S J, Olsen M A,et al.Outcome and at-tributable cost of ventilator-associated pneumonia among inten-sive care unit patients in a suburban medical center[J]. Crit Care ed, 2003, 31(5): 1312-1317.
[70]Yalcin A N. Socioeconomic burden of nosocomial infections[J].Indian J Med Sci, 2003, 57(10): 450-456.
[71]王培忠.老年患者医院感染的直接经济损失评价及危险因素研究[D].北京:中国协和医科大学研究生院,2006.
[72]吴风波,王福明,郑新华等.医院感染经济损失的病例对照研究.中华医院感染学杂志,1996,6(2):83,
[73]刘一新,孔萍,孙代艳.综合性医院医院感染经济损失病例对照研究[J].中华医院感染学杂志, 2002,12(9):660-661.
[74]杨学岭,赵敬东.医院感染经济损失的病例对照研究[J].中华医院感染学杂志,2003,13(10):922-924.
[75]张欣文,安毅.医院感染病例经济损失的调查分析[J].上海铁路大学学报(医学板)[J],1997,11(4):348-350.
[76]杨武,李武英,贺桂菊.医院感染经济损失的1:1病例对照研究[J].中华医院感染学杂志,1998,8(4):193-195.
[77]易文华,张有成,张柔玲.医院感染经济损失病例对照研究[J].中华医院感染学杂志,2006,16(10):1140-1143.
[78]吴安华.医院感染经济学评价[J].中国感染控制杂志,2006,5(3):193-197.
[79] Astagneau P, Leroy S,et al. Cost of antimicrobial treatment of nosocomial I nfections based on a Frenchprevalence survey.J Hosp Infect, 1999,42:303-312.
[80]黄勋,龚瑞俄,徐秀华,等.心胸外科手术病人医院感染的危险因素分析及经济损失的初步评估[J].中华医院感染学杂志,1997,7(增刊)∶309-310.
[81]周清德,诸德发,高秀华,等.4种类型医院感染直接经济损失的配比病例对照研究[J].中华流行病学杂志,2001,22(2):309-310.。
[2] Daschner F. Cost-effectiveness in hospital infection control-lessons for the 1990s[J]. J Hosp Infect, 1989, 13: 325-336.
[3]肖光夏.烧伤肠源性感染的系列研究.中华流行病学杂志,1993,14(特9):7.
[4]贺买宏.2375例住院患者医院感染[J].现代预防医学,2006,33(4):536～537.
[5]徐武夷,古东东,潘涛.10年医院感染的监测和控制[J].中华医院感染学杂志,2003,13(10):925-927.
[6]文细毛,任南,徐秀华,等.全国医院感染监控网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002,12(4):241-242.
[7]张晓兵,龚雅利,刘智勇,等.3170株临床分离病原菌耐药谱与耐药机制的研究[J].中华医院感染学杂志,2008,18(3):422～424.
[8]申正义.中国大陆细菌耐药性监测研究[J].中国感染控制杂志,2002,1 (1):1.
[9]何多多,张玉强,张颖,等.230例死亡病历医院感染的分析〔J〕.中华医院感染学杂志,2004,14(12):1353.
[10]徐秀华.临床医院感染学[M].第2版.长沙:湖南科学技术出版社,2005.61.
[11]吴安华,任南,文细毛,等.159所医院感染现患率调查结果与分析[J].中国感染控制杂志,2005,4(1):13～14.
[12]李六亿.全我国医院感染管理现状与管理对策[J].实用医学杂志,2002,18(1)2.
[13]任南,文细毛,吴安华,等.全国医院感染横断面调查结果的变化趋势研究[J].中华医院感染控制杂志,2007,6(1):18.
[14]马非,李东力.医院感染流行病学研究现状[J]..解放军预防医学杂志,2006,24(5):387.
[15]吴安华.医院感染损失的经济评价[J].中国感染控制杂志,2006,5(3):193.
[16]Askarian M,Gooran N R. National nosocomial infection surveil-lancesystem-based study in Iran: additional hospital stay at-tribuable to nosocomial infections[J]. Am J Infect Control,2003, 31(8): 465-468. [16] Green JW. Postoperative wound infection: A controlled study of the increased duration of hospital stay and direct cost of hospitalization.Ann Surg,1977,155∶264-269.
[17] Warren D K, Shukla S J, Olsen M A,et al.Outcome and at-tributable cost of ventilator-associated pneumonia among inten-sive care unit patients in a suburban medical center[J]. Crit CareMed, 2003, 31(5): 1312-1317.
[18]杨武,李武英,贺桂菊,等.医院感染经济损失的1∶1病例对照研究.中华医院感染学杂志,1998,8∶193-195.
[19]吴安华,任南,文细毛,等. 159所医院医院感染现患率调结果与分析[J].中国感染控制杂志,2005,4(1):12-16.
[20]周虹,安文洪,周艳.医院感染的流行病学分析[J].中华医院感染学杂志, 2002, 12(2): 102-103.
[21]马惠兰,黄相增,李惠,等.1992~2001年新一大二附院医院感染监测和控制情况分析[J].新疆医科大学学报, 2004, 27(5): 467-469.
[22]魏淑琴. 7591例住院患者院内感染调查与分析[J].临床护理杂志,2005,4(4):52-53.
[23]吴安华,任南,文细毛,等.全国感染监控1998-1999年监测资料分析[J]·中华医院感染杂志, 2000, 10(6): 401-403.
[24]张常然,刘霞,谭妙莲,等. 3年医院感染流行病学调查分析[J].中华医院感染学杂志,2008,18(5):626-628.
[25]de Lourdes Garcia-Garcia M, Jimenez-Corona A,Jimenez-Corona ME·Nosocomial infections in a com-munity hospital in Mexico[J]·Infect ControlHosp Epi-demiol , 2001, 22(6):386.
[26]Croce MA, Fabian TC, Waddle–Smith L·Identification of early predictors for post-traumaticpneumonia[J]·Am Surg, 2001, 67(2):105.
[27]吴安华,任南,文细毛,等.159所医院医院感染现患率调结果与分析[J].中国感染控制杂志,2005,4(1):12-16.
[28]任玲,周宏,茅一平,等.医院感染现患率调查资料分析[J]中华医院感染学杂志,2007,17(1):24-26.
[29]林小聪,詹永忠,谢扬,等.医院感染现患率调查与监控研[J].中华医院感染学杂志,2004,14(3):265-268.
[30]杨雪英,陈华,李志伟.综合医院医院感染现患率调查分[J].中华医院感染学杂志,2005,15(4):393-395.
[31]史文昕,史文晶,李静峰,等. 2049例医院感染调查分析[J]中华医院感染学杂志,2006,16(7):753-754.
[32]周霓,陈少虹,张桂琴,等. 15397例住院病例医院感染调查分析[J]疾病控制杂志杂志,2001,5(4):355-356.
[33]何菊英.20523例住院患者医院感染流行病学分析[J].中国医院感染控制杂志,2004,3(4):359.
[34] kurlat I , Corral G , Oliveira F , et al. Infection control strategies in a neonatal intensive care unit in Argentina [J]. J Hosp Infect , 1998,40(2):149.
[35] Rubins JB, Cheung S, Carson P, et al·Identification clinical risk factors for nosocomial pneumococcal bac-teremia[J]·Clin Infect Dis, 1999,29: 178-83·
[36]任南,文细毛,吴安华. 178所医院医院感染危险因素调查分析[J].中国医院感染控制杂志,2003,2(1): 6-9.
[37]杨宝忠,海平.医院感染危险因素研究[J]宁夏医学院学报,2005,27(1):33-36.
[38]吴斌,许能锋,杨柳青,等.小儿肾病综合征医院感染流行病学调查[J].中华医院感染学杂志,2000,10(3):171.
[39]陈正堂.临床肿瘤学概论[M].北京:中国协和医科大学出版社,1999.161.
[40]吴安华,任南,文细毛. 151家医院2003年度住院患者日抗菌药物使用率的调查分析[J].中华流行病学志,2005,26(6): 451-454.
[41]陈彩芳,黄建华,谭秀艳.抗菌药物应用现状调查及分析[J].中华医院感染杂志,2004, 14(6): 668-670.
[42]任南,徐秀华,吴安华,等.医院感染横断面研究报告[J].中华医院感染学杂志,2002,12(1):1-3.
[43]吴安华,任南,文细毛,等.151家医院2003年度住院患者日抗菌药物使用率的调查分析[J].中华流行病学杂志2005 ,26(6) :451-454.
[44]刘鹰,朱蓓蓓,吴芳,等.加强抗菌药物临床应用与管理[J]中华医院感染学杂志,2008,18(8):1145-1146.
[45]Vatopouls AC, Kalapothaki V, Legakis NJ·Risk factorfor nosocomial infections caused by Gram-negative bacilli [J]·J Hosp Infect, 1996,34:11.
[46]Asensio A, Oliver A, Gonzalez-Diego P, et al·Out-break of a multiresistant Klebsiella pneumoniae strain in a intensive care unit: Antibiotic use as a risk factor for colonization and infection [J]·Clin Infect Dis,2000,30:55.
[47] Zinner S,Wise R,Robert M J r.Maximizing antimicrobial effi2cacy inimizing antimicrobialresistance:a paradigm for t he new millennium[J].CID,2001, 33(Suppl 3):S105.
[48]申正义,孙自镛,王洪波.湖北地区临床细菌耐药性监测结果[J].中华医院感染学杂志,2002,12 (2) :91-93.
[49]李六亿,于丽华,巩军,等.抗菌药物应用现状调查及管理对策的探讨[J].中华医院感染学杂志,1999 ,9 (4) :193-195.
[50]贺买宏.2375例住院患者医院感染调查[J].现代预防医学,2006,33(4): 536-537.
[51]文细毛,任南,徐秀华,等.全国医院感染监测网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002 ,12 (4) :241-242.
[52]王江桥,巫雪平,李玉娟,等.连续3年医院感染现患率调查报告[J].中国感染控制杂志,2006,5(1) :19-22.
[53]赵和平,杨芸,张缭云,等.180例医院感染病例流行病学调查[J].中华医院感染学杂志,1998,8(2):95.
[54]滕维亚,狄惠芝.深部真菌感染研究进展[J].中华医院感染学杂志,1999,9(l),62.
[55] Rhomberg PR,fritsche TR,Ssder HS,et al.Antimicrobial susceptibility pattern comparisons among intensive care unit and general ward Gram-negative isolates from the Meropenem Yearly Susceptibility Test Information Collection Program (USA)[J].Diag Microbiol Infenct Dis,2006,56:57-62.
[56] Witte W. Antibiotic resistance in Gram-positive: epidemiological aspects[J]. J Antimicrob Chemother, 1999, 44 TopicA: 1-9.
[57]CDC.Update.Staphylococcus aureusreduced susceptibility to vancomycin-United States, 1997[J]. MMWR, 1997, 46: 813-815.
[58]肖永红,王进.2006-2007年Mohnarin ICU病原菌耐药性监测[J].中华医院感染学杂志,2008,18(9): 1223-1227.
[59]张苏明,朱莉莉,许平,等.医院感染病原菌构成和耐药谱变迁趋势分析[J].中国医院感染控制杂志,2002,1(1): 44-46.
[60] Beck-Sagie C, Jarvis WWR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980~1990 [J]. J infect Dis, 1993, 167: 1247-1251.
[61]吴娴波.医院感染流行病学研究[D].广州:第一军医大学,2007.
[62]吴安华,任南,文细毛,等. 193所医院感染现患率调查分析[J].中华医院感染学杂志,2002 ,12 (8) :561-562.
[63]李晓红,房彤.我省医院感染现患率调查[J].中华医院管理杂志,2002,18(8): 492-493.
[64] Vaque J, Rossello J, Arribas J L,et al.Prevalence of nosoco-mial infection in Spain: EPINE study1990-1997[J]. J HospInfect,1999,43:S105-S111.
[65] Gikas A, Pediaditis I, Roumbelakis G,et al.Repeated multi-center prevalence surveys of hospital-acquired infection inGreek hospital[J]. J Hosp Infect,1999,41(1):11-18.
[66]任南,文细毛,吴安华.全国医院感染横断面调查结果的变化趋势研究[J].中国医院感染控制杂志,2007,6(1):16-18.
[67] PenaC,PuzolM,ArdanuyC,etal.Epjdemiojogy and sueeessful control of a large outbreak due toKIebsiella Pneuoniae produeing extended-speetrurn beta-laetamases[J].Antimicrob Agents Chemother,1998,42(l):53一58.
[68] Askarian M,Gooran N R. National nosocomial infection surveil-lance system-based study in Iran: additional hospital stay at-tribuable to nosocomial infections[J]. Am J Infect Control,2003, 31(8): 465-468.
[69]Warren D K, Shukla S J, Olsen M A,et al.Outcome and at-tributable cost of ventilator-associated pneumonia among inten-sive care unit patients in a suburban medical center[J]. Crit Care ed, 2003, 31(5): 1312-1317.
[70]Yalcin A N. Socioeconomic burden of nosocomial infections[J].Indian J Med Sci, 2003, 57(10): 450-456.
[71]王培忠.老年患者医院感染的直接经济损失评价及危险因素研究[D].北京:中国协和医科大学研究生院,2006.
[72]吴风波,王福明,郑新华等.医院感染经济损失的病例对照研究.中华医院感染学杂志,1996,6(2):83,
[73]刘一新,孔萍,孙代艳.综合性医院医院感染经济损失病例对照研究[J].中华医院感染学杂志, 2002,12(9):660-661.
[74]杨学岭,赵敬东.医院感染经济损失的病例对照研究[J].中华医院感染学杂志,2003,13(10):922-924.
[75]张欣文,安毅.医院感染病例经济损失的调查分析[J].上海铁路大学学报(医学板)[J],1997,11(4):348-350.
[76]杨武,李武英,贺桂菊.医院感染经济损失的1:1病例对照研究[J].中华医院感染学杂志,1998,8(4):193-195.
[77]易文华,张有成,张柔玲.医院感染经济损失病例对照研究[J].中华医院感染学杂志,2006,16(10):1140-1143.
[78]吴安华.医院感染经济学评价[J].中国感染控制杂志,2006,5(3):193-197.
[79] Astagneau P, Leroy S,et al. Cost of antimicrobial treatment of nosocomial I nfections based on a Frenchprevalence survey.J Hosp Infect, 1999,42:303-312.
[80]黄勋,龚瑞俄,徐秀华,等.心胸外科手术病人医院感染的危险因素分析及经济损失的初步评估[J].中华医院感染学杂志,1997,7(增刊)∶309-310.
[81]周清德,诸德发,高秀华,等.4种类型医院感染直接经济损失的配比病例对照研究[J].中华流行病学杂志,2001,22(2):309-310.。