某三甲医院肝胆胰外科医院感染现况调查及影响因素分析
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摘要
目的利用院内感染实时监控系统(NIS)对肝胆胰外科院内感染进行现况描述,分析相关危险因素,为采取针对性的预防措施提供依据。方法收集2014年1月1日至2016年12月31日由肝胆胰外科出院的12 385例患者资料,进行回顾性调查。结果 3年间总出院患者为12 385例,其中感染209例,总感染率为1.69%。主要致病菌前3位为肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌;感染部位前3位为手术部位、下呼吸道及腹(盆)腔内组织;易感因素前3位为腹腔穿刺(引流)、恶性肿瘤及慢性病。重点部位如呼吸机相关肺炎、中心静脉导管相关血流感染、导尿管相关尿路感染的千日感染率分别为22.22‰、18.86‰、0.33‰。多因素分析结果显示男性、手术、使用呼吸机及中心静脉导管均是肝胆胰外科患者发生院内感染的独立危险因素。结论肝胆胰外科患者发生院内感染与多种因素有关,应根据其特点采取积极合理的预防及治疗措施,降低院内感染发生率。
Objective To describe the hospital infection in the hepatobiliary and pancreatic surgery department using the hospital infection real time monitoring system(NIS)and to analyze the related risk factors to provide a basis for adopting the targeted preventive measures.Methods The data in 12 385 patients discharged from the hepatobiliary and pancreatic surgery department from January 1,2014 to December 31,2016 were collected and conducted the retrospective investigation.Results A total of 12 385 patients were discharged from this department during these 3 years,among them there were 209 cases of infection with the total infection rate of 1.69%.The top three pathogenic bacteria were Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii;the top three infection sites were the surgical site,lower respiratory tract and abdominal pelvic tissue;the top three susceptible factors were abdominal puncture(drainage),malignant tumor and chronic diseases.The thousand-day infection rates of key sites such as ventilator-associated pneumonia,central venous catheter-related blood flow infection and catheter-related urinary tract infection were 22.22‰,18.86‰and 0.33‰respectively.The multivariate analysis results showed that male,surgery,using ventilator and central venous catheter were the independent risk factors for the hospital infection occurrence in the patients of hepatobiliary and pancreatic surgery department.Conclusion The hospital infection occurrence in the hepatobiliary and pancreatic surgery department is related to many factors.It is necessary to adopt the active and reasonable prevention and treatment measures for reducing the hospital infection occurrence rate according to their characteristics.
Objective To describe the hospital infection in the hepatobiliary and pancreatic surgery department using the hospital infection real time monitoring system(NIS)and to analyze the related risk factors to provide a basis for adopting the targeted preventive measures.Methods The data in 12 385 patients discharged from the hepatobiliary and pancreatic surgery department from January 1,2014 to December 31,2016 were collected and conducted the retrospective investigation.Results A total of 12 385 patients were discharged from this department during these 3 years,among them there were 209 cases of infection with the total infection rate of 1.69%.The top three pathogenic bacteria were Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii;the top three infection sites were the surgical site,lower respiratory tract and abdominal pelvic tissue;the top three susceptible factors were abdominal puncture(drainage),malignant tumor and chronic diseases.The thousand-day infection rates of key sites such as ventilator-associated pneumonia,central venous catheter-related blood flow infection and catheter-related urinary tract infection were 22.22‰,18.86‰and 0.33‰respectively.The multivariate analysis results showed that male,surgery,using ventilator and central venous catheter were the independent risk factors for the hospital infection occurrence in the patients of hepatobiliary and pancreatic surgery department.Conclusion The hospital infection occurrence in the hepatobiliary and pancreatic surgery department is related to many factors.It is necessary to adopt the active and reasonable prevention and treatment measures for reducing the hospital infection occurrence rate according to their characteristics.
引文
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[7]蔡秀娟,杨家宏,吴成,等.1705株医院常见病原菌分布及其耐药性研究[J].重庆医学,2015,44(35):4977-4979.
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[11]陈光裕,周小月,郭建平.术后加速康复理念在肝胆胰外科手术中的应用效果观察[J].中国地方病防治杂志,2017,32(11):1229-1230.
[12]陈梅先,元云飞,陈盈,等.肝胆外科手术患者医院感染的相关因素分析[J].中华医院感染学杂志,2014,24(1):144-145,153.
[13]彭创,易为民,谭朝霞,等.加速康复外科理念在肝胆管结石手术治疗中应用的前瞻性随机对照研究[J].肝胆胰外科杂志,2016,28(3):177-180.
[14]李晓婕,黄绍华.临床常见细菌和ICU院内感染病原菌分布及耐药性的对比分析[J].重庆医学,2011,40(1):59-61.
[15]冉雪曼,沈军.集束化干预预防呼吸机相关性肺炎效果的Meta分析[J].重庆医学,2018,47(9):1225-1228,1232.
[16]何昊,吴勇,梁亮.颅脑外科手术患者手术部位感染的危险因素分析[J].重庆医学,2017,46(3):385-387.
[2]刘双双.肝胆外科院内感染及其相关危险因素调查研究[J].现代预防医学,2015,42(11):2083-2084,2087.
[3]陈伯宁,肖秀红,徐凤琴,等.82例肝胆外科住院病人医院感染调查分析[J].岭南现代临床外科,2011,11(3):177-179.
[4]MELZER M,WELCH C.Outcomes in UK patients with hospital-acquired bacteraemia and the risk of catheter-associated urinary tract infections[J].Postgrad Med J,2013,89(1052):329-334.
[5]张丽伟,冯诚怿,江淑芳,等.2015年某院住院患者医院感染现患率调查及影响因素分析[J].中华医院感染学杂志,2016,26(22):5107-5109.
[6]金雪妹.肝胆外科患者医院感染的因素分析与对策[J].中医药管理杂志,2015,23(4):98-99.
[7]蔡秀娟,杨家宏,吴成,等.1705株医院常见病原菌分布及其耐药性研究[J].重庆医学,2015,44(35):4977-4979.
[8]MURNI I K,DUKE T,KINNEY S,et al.Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country:an effectiveness study[J].Arch Dis Child,2015,100(5):454-459.
[9]王捷,孙健.肝胆外科中手术应激与脏器损伤[J].中国实用外科杂志,2015,35(1):40-42.
[10]朱会英,李艳春,向佩莹,等.肝胆外科手术部位感染目标性监测分析[J].中华医院感染学杂志,2012,22(21):4755-4757.
[11]陈光裕,周小月,郭建平.术后加速康复理念在肝胆胰外科手术中的应用效果观察[J].中国地方病防治杂志,2017,32(11):1229-1230.
[12]陈梅先,元云飞,陈盈,等.肝胆外科手术患者医院感染的相关因素分析[J].中华医院感染学杂志,2014,24(1):144-145,153.
[13]彭创,易为民,谭朝霞,等.加速康复外科理念在肝胆管结石手术治疗中应用的前瞻性随机对照研究[J].肝胆胰外科杂志,2016,28(3):177-180.
[14]李晓婕,黄绍华.临床常见细菌和ICU院内感染病原菌分布及耐药性的对比分析[J].重庆医学,2011,40(1):59-61.
[15]冉雪曼,沈军.集束化干预预防呼吸机相关性肺炎效果的Meta分析[J].重庆医学,2018,47(9):1225-1228,1232.
[16]何昊,吴勇,梁亮.颅脑外科手术患者手术部位感染的危险因素分析[J].重庆医学,2017,46(3):385-387.