神经外科重症监护病房医院感染目标性监测分析
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摘要
目的分析神经外科重症监护病房(ICU)医院感染目标性监测结果,了解其医院感染特点,为干预措施的制定提供参考。方法对2013年1月-12月期间每例入住神经外科ICU≥2 d的患者及转神经外科ICU 2 d内的患者,监测其医院感染发病情况、侵入性操作使用及感染情况和多重耐药菌筛查及耐药性情况。结果共纳入1 178例患者,住院总时间4 144 d,医院感染率为4.92%,患者日感染率为13.75‰,1月、7月-12月的医院感染发病率与其他几月比较明显偏高;呼吸机使用率为9.75%,呼吸机相关性肺炎发病率为14.85‰;中心静脉导管使用率为28.40%,中心静脉导管相关性血流感染发病率为0.85‰;导尿管使用率为97.90%,导尿管相关性尿路感染发病率为0.25‰。结论神经外科ICU医院感染发病呈现明显季节性,需要医院感染控制专(兼)职人员提高警惕,及时发出风险预警,强化医院感染风险管理。
Objective To analyze targeted surveillance results of nosocomial infection in Neurosurgical Intensive Care Unit(ICU) and investigate the characteristics of nosocomial infection, in order to provide reference for constituting the intervention measures. Methods We monitored the incidence of nosocomial infection, the application and catheterrelated infection of invasive operation, and the situation of multiple resistant bacteria screening and drug resistance characteristics of each patient who stayed more than two days in neurosurgical ICU during January to December 2013. Results There were a total of 1 178 patients, and the total ICU stay was 4 144 days. The nosocomial infection rate was 4.92%, and the day incidence of nosocomial infection was 13.75‰. The nosocomial infection rate was signifi cantly higher in January and between July and December compared with other months. Ventilator utilization rate was 9.75%; ventilatorassociated pneumonia incidence density was 14.85 per 1 000 catheter-days; central line utilization rate was 28.40%; central line-associated bloodstream infection incidence density was 0.85 per 1 000 catheter-days; urinary catheter utilization rate was 97.90%; and the incidence density of catheter-associated urinary tract infection was 0.25 per 1 000 catheter-days. Conclusion The nosocomial infection rate has an obvious seasonal characteristic in neurosurgical intensive care unit, so it is necessary to make sure that the hospital infection control full-time and part-time staff should be on alert, issue timely risk warning, and strengthen the risk management of hospital infection.
Objective To analyze targeted surveillance results of nosocomial infection in Neurosurgical Intensive Care Unit(ICU) and investigate the characteristics of nosocomial infection, in order to provide reference for constituting the intervention measures. Methods We monitored the incidence of nosocomial infection, the application and catheterrelated infection of invasive operation, and the situation of multiple resistant bacteria screening and drug resistance characteristics of each patient who stayed more than two days in neurosurgical ICU during January to December 2013. Results There were a total of 1 178 patients, and the total ICU stay was 4 144 days. The nosocomial infection rate was 4.92%, and the day incidence of nosocomial infection was 13.75‰. The nosocomial infection rate was signifi cantly higher in January and between July and December compared with other months. Ventilator utilization rate was 9.75%; ventilatorassociated pneumonia incidence density was 14.85 per 1 000 catheter-days; central line utilization rate was 28.40%; central line-associated bloodstream infection incidence density was 0.85 per 1 000 catheter-days; urinary catheter utilization rate was 97.90%; and the incidence density of catheter-associated urinary tract infection was 0.25 per 1 000 catheter-days. Conclusion The nosocomial infection rate has an obvious seasonal characteristic in neurosurgical intensive care unit, so it is necessary to make sure that the hospital infection control full-time and part-time staff should be on alert, issue timely risk warning, and strengthen the risk management of hospital infection.
引文
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[12]程国雄,姚谦明,何启,等.神经外科ICU医院内感染临床分析[J].实用医学杂志,2009,25(9):1468-1469.
[13]刘华,罗蓓蓓.ICU医院感染多重耐药菌类型、耐药性及感染相关因素研究[J].实用医院临床杂志,2009,6(3):140-142.
[14]李文郎,唐恒锋,王文杰,等.神经外科ICU与普通神经外科医院感染病原菌及耐药性对比研究[J].中国医药导刊,2011,13(11):1957-1958,1939.
[15]向丽佳,宋晓英,郑晓红,等.综合重症监护病房医院感染目标性监测分析[J].华西医学,2014,29(3):432-435.
[16]文细毛,任南,吴安华,等.全国医院感染监控网细菌耐药情况及变化趋势[J].中国感染控制杂志,2009,8(6):389-396,408.
[17]刘利君,罗鑫,郑动,等.我院2012年医院感染病原菌分布及耐药性分析[J].中国药房,2013,24(30):2832-2835.
[18]钱丽华,童瑞琦,谢家政,等.神经外科患者医院感染调查分析[J].中华医院感染学杂志,2012,22(9):1803-1804.
[19]张淑平,谭慕杨.风险管理在医院感染管理中的应用与效果分析[J].华西医学,2012,27(1):129-131.
[2]中华人民共和国卫生部.WS/T 312-2009医院感染监测规范[S].2009.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]朱爱萍,朱彦,王新民,等.多重耐药菌感染监测与预防控制措施[J].医药论坛杂志,2010,31(20):175-176.
[5]王宏沛,孟灵,王鸿玮,等.多重耐药菌监测与易感因素的临床研究[J].兰州大学学报·医学版,2005,31(2):55-56.
[6]孙晓,张平,华卫红,等.多重耐药菌医院感染相关因素与控制[J].现代医药卫生,2009,25(16):2535-2536.
[7]McDonald LC,Banerjee SN,Jarvis WR.Seasonal variation of acinetobacter infections:1987-1996[J].Clin Infect Dis,1999,29(5):1133-1137.
[8]王枢群,张邦燮.医院感染学[M].重庆:科学技术文献出版社重庆分社,1990:50-83.
[9]蒋国钦.ICU病人鲍曼不动杆菌定植的流行病学特征及危险因素探讨[D].苏州:苏州大学,2011.
[10]Fournier PE,Richet H.The epidemiology and control of Acinetobacter baumannii in health care facilities[J].Clin Infect Dis,2006,42(5):692-699.
[11]章华萍,张玉琴,郑丹,等.综合性ICU医院感染目标性监测分析[J].中华医院感染学杂志,2011,21(1):49-51.
[12]程国雄,姚谦明,何启,等.神经外科ICU医院内感染临床分析[J].实用医学杂志,2009,25(9):1468-1469.
[13]刘华,罗蓓蓓.ICU医院感染多重耐药菌类型、耐药性及感染相关因素研究[J].实用医院临床杂志,2009,6(3):140-142.
[14]李文郎,唐恒锋,王文杰,等.神经外科ICU与普通神经外科医院感染病原菌及耐药性对比研究[J].中国医药导刊,2011,13(11):1957-1958,1939.
[15]向丽佳,宋晓英,郑晓红,等.综合重症监护病房医院感染目标性监测分析[J].华西医学,2014,29(3):432-435.
[16]文细毛,任南,吴安华,等.全国医院感染监控网细菌耐药情况及变化趋势[J].中国感染控制杂志,2009,8(6):389-396,408.
[17]刘利君,罗鑫,郑动,等.我院2012年医院感染病原菌分布及耐药性分析[J].中国药房,2013,24(30):2832-2835.
[18]钱丽华,童瑞琦,谢家政,等.神经外科患者医院感染调查分析[J].中华医院感染学杂志,2012,22(9):1803-1804.
[19]张淑平,谭慕杨.风险管理在医院感染管理中的应用与效果分析[J].华西医学,2012,27(1):129-131.