精神科院内感染的临床特点与相关因素及预防措施的研究
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摘要
目的分析精神科院内感染的临床特点及相关因素,旨在为临床控制与预防措施提供参考依据。方法选取2014-2018年温州医科大学附属康宁医院精神科收治的患者200例作为研究对象,对其医院感染情况进行调查,分析引发医院感染的相关因素并提出控制预防措施,数据统计与分析采用SPSS17.0软件。结果选取的200例患者中有21例发生院内感染,感染率10.50%;感染部位主要以呼吸道感染为主(12例, 57.14%),其次为胃肠道感染(4例,19.05%)与泌尿道感染(3例,14.29%)。精神科患者出现医院感染的因素包括年龄、精神疾病类型、合并基础疾病、长期使用抗精神病药物、住院时间、住院季节及抗菌药物的使用,差异有统计学意义(P<0.05);影响精神科患者发生医院感染的危险因素主要是住院时间长(OR=2.316)、患精神分裂症(OR=2.039)、高龄(OR=1.528)及长期使用抗精神病药物(OR=1.610),差异有统计学意义(P<0.05)。结论精神科患者发生院内感染率较高,影响医院感染发生的主要因素为住院时间长、患精神分裂症、高龄及长期使用抗精神病药物,因此,为降低精神科患者在院内感染发生情况,临床应根据发病因素进行针对性干预,以促进患者快速康复。
Objective To analyze the clinical characteristics and related factors of nosocomial infection of patients with psychiatric disorder, and to provide reference for clinical control and preventive measures. Methods 200 patients admitted to the Department of Psychiatry of Kangning Hospital affiliated to Wenzhou Medical University from 2014 to 2018 were selected as study subjects.The hospital infections were recorded and the related factors were analyzed.SPSS17.0 software was used for data statistical analysis. Results 21 cases with nosocomial infections were reported with the overall infection rate of 10.50%.Respiratory infection(57.14%) was the most common one, followed by gastrointestinal infection(19.05%) and urinary tract infection(14.29%).Univariate analysis showed that age, type of mental illness, underlying disease, long-term use of antipsychotics, length of hospital stay, season of hospital stay, and use of antibiotics were closely related to nosocomial infections of patients with psychiatric disorder.Long hospital stay(OR=2.316), schizophrenia(OR=2.039), older age(OR=1.528), and long-term use of antipsychotic drugs(OR=1.610) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in psychiatric patients is high.The main factors affecting the occurrence of nosocomial infection are long hospital stay, schizophrenia, advanced age and long-term use of antipsychotic drugs.Therefore, in order to reduce the incidence of nosocomial infection in psychiatric patients, targeted interventions should be adopted based on the incidence factors.
Objective To analyze the clinical characteristics and related factors of nosocomial infection of patients with psychiatric disorder, and to provide reference for clinical control and preventive measures. Methods 200 patients admitted to the Department of Psychiatry of Kangning Hospital affiliated to Wenzhou Medical University from 2014 to 2018 were selected as study subjects.The hospital infections were recorded and the related factors were analyzed.SPSS17.0 software was used for data statistical analysis. Results 21 cases with nosocomial infections were reported with the overall infection rate of 10.50%.Respiratory infection(57.14%) was the most common one, followed by gastrointestinal infection(19.05%) and urinary tract infection(14.29%).Univariate analysis showed that age, type of mental illness, underlying disease, long-term use of antipsychotics, length of hospital stay, season of hospital stay, and use of antibiotics were closely related to nosocomial infections of patients with psychiatric disorder.Long hospital stay(OR=2.316), schizophrenia(OR=2.039), older age(OR=1.528), and long-term use of antipsychotic drugs(OR=1.610) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in psychiatric patients is high.The main factors affecting the occurrence of nosocomial infection are long hospital stay, schizophrenia, advanced age and long-term use of antipsychotic drugs.Therefore, in order to reduce the incidence of nosocomial infection in psychiatric patients, targeted interventions should be adopted based on the incidence factors.
引文
[1] Ammerlaan HS,Harbarth S,Buiting AG,et al.Secular trends in nosocomial bloodstream infections:antibiotic resistant bacteria increase the total burden of infection[J].Clin Infect Dis,2013,56(6):798-805.
[2] 李雅琴,苏雪萍,郭京艳.精神科老年患者医院感染分析及预防[J].中华医院感染学杂志,2014,24(24):6125-6126.
[3] Abdel-Wahab F,Ghoneim M,Khashaba M,et al.Nosocomial infection surveillance in an Egyptian neonatal intensive care unit[J].J Hosp Infect,2013,83(3):196-199.
[4] 张英杰,张丹,邹吉敏,等.精神病院患者医院感染调查分析[J].中华医院感染学杂志,2015,25(5):1073-1075.
[5] 中华医学会精神科分会.中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2011:75-83.
[6] 中华人民共和国卫生部.医院感染诊断标准[S].北京:中华人民共和国卫生部,2001.
[7] Nagao M.Amulticenteranalysis of epidemiology of the nosocomial bloodstream infections in Japanese university hospitals[J].Clin Microbiol Infect,2013,19(9):852-858.
[8] Geerlings S,Fonseca V,Castrodiaz D,et al.Genital and urinary tract infections in diabetes:impact of pharmacologically induced glucosuria[J].Diabetes Res Clin Pract,2014,103(3):373-381.
[9] Hagiya H,Murase T,Suzukim,et al.Chromobacterium violaceum nosocomial pneumonia in two Japanese patients at an intensive care unit[J].J Infect Chemother,2014,20(2):139-142.
[10] 赵俊雄,王卫平,林承凤,等.精神疾病患者医院感染调查[J].中华医院感染学杂志,2015,25(22):5191-5192.
[11] Lopez EL,Contrini MM,Glatstein E,et al.An epidemiologic surveillance of shigalike toxin producing Escherichia coli infection in a Argentinean children:risk factors and serum shigalike toxin 1 values[J].Pediatr Infect Dis J,2012,31(1):20-24.
[12] 胡秋秋,魏爱荣,肖晓玲,等.精神科病房医院感染现状分析及对策[J].湖北中医杂志,2015,37(2):79-80.
[13] Cooley N,Cowley MJ,Lin RC,et al.Influence of atrial fibrillation on microRNA expression profiles in left and right atriafrom patients with valvular heart disease[J].Physiol Genomics,2012,44(3):211-219.
[14] Goren Y,Meiri E,Hogan C,et al.Relation of reduced expression of MiR-150 in platelets to atrial fibrillation in patients with chronic systolic heart failure[J].Am J Cardiol,2014,113(6):976-981.[14] 潘秀娟,刘林晶,刘家洪,等.精神科住院患者医院感染相关危险因素分析及干预对策研究[J].中华医院感染学杂志,2017,27(5):1186-1188.
[16] Leonars M,Mcinerney S,Mcfarland J,et al.Comparison of cognitive and neuropsychiatric profiles in hospitalized elderly medical patients with delirium,dementia and comorbid delirium dementia[J].BMJ Open,2016,6(3):9212-9215.
[17] 蔡红艳,杨志彩,曹仁俊.精神科住院患者医院感染危险因素logistic回归分析[J].中华医院感染学杂志,2015,25(1):160-162.
[18] Lachner C,Martin C,John D,et al.Older adult psychiatric inpatients with non-cognitive disorders should be screened for vitamin B12 deficiency[J].J Nutr Health Aging,2014,18(2):209-212.
[19] 李水英,周茜,张秀英,等.1 621例急重性精神分裂症患者医院感染危险因素的调查分析[J].华西医学,2014,21(11):2073-2076.
[20] Farzianpour F,Bakhtiari A,Mohammadi M,et al.Analysis of nosocomial infections in selected teaching hospitals,Qazvin,Iran[J].Health,2014,6(2):2425-2432.
[2] 李雅琴,苏雪萍,郭京艳.精神科老年患者医院感染分析及预防[J].中华医院感染学杂志,2014,24(24):6125-6126.
[3] Abdel-Wahab F,Ghoneim M,Khashaba M,et al.Nosocomial infection surveillance in an Egyptian neonatal intensive care unit[J].J Hosp Infect,2013,83(3):196-199.
[4] 张英杰,张丹,邹吉敏,等.精神病院患者医院感染调查分析[J].中华医院感染学杂志,2015,25(5):1073-1075.
[5] 中华医学会精神科分会.中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2011:75-83.
[6] 中华人民共和国卫生部.医院感染诊断标准[S].北京:中华人民共和国卫生部,2001.
[7] Nagao M.Amulticenteranalysis of epidemiology of the nosocomial bloodstream infections in Japanese university hospitals[J].Clin Microbiol Infect,2013,19(9):852-858.
[8] Geerlings S,Fonseca V,Castrodiaz D,et al.Genital and urinary tract infections in diabetes:impact of pharmacologically induced glucosuria[J].Diabetes Res Clin Pract,2014,103(3):373-381.
[9] Hagiya H,Murase T,Suzukim,et al.Chromobacterium violaceum nosocomial pneumonia in two Japanese patients at an intensive care unit[J].J Infect Chemother,2014,20(2):139-142.
[10] 赵俊雄,王卫平,林承凤,等.精神疾病患者医院感染调查[J].中华医院感染学杂志,2015,25(22):5191-5192.
[11] Lopez EL,Contrini MM,Glatstein E,et al.An epidemiologic surveillance of shigalike toxin producing Escherichia coli infection in a Argentinean children:risk factors and serum shigalike toxin 1 values[J].Pediatr Infect Dis J,2012,31(1):20-24.
[12] 胡秋秋,魏爱荣,肖晓玲,等.精神科病房医院感染现状分析及对策[J].湖北中医杂志,2015,37(2):79-80.
[13] Cooley N,Cowley MJ,Lin RC,et al.Influence of atrial fibrillation on microRNA expression profiles in left and right atriafrom patients with valvular heart disease[J].Physiol Genomics,2012,44(3):211-219.
[14] Goren Y,Meiri E,Hogan C,et al.Relation of reduced expression of MiR-150 in platelets to atrial fibrillation in patients with chronic systolic heart failure[J].Am J Cardiol,2014,113(6):976-981.[14] 潘秀娟,刘林晶,刘家洪,等.精神科住院患者医院感染相关危险因素分析及干预对策研究[J].中华医院感染学杂志,2017,27(5):1186-1188.
[16] Leonars M,Mcinerney S,Mcfarland J,et al.Comparison of cognitive and neuropsychiatric profiles in hospitalized elderly medical patients with delirium,dementia and comorbid delirium dementia[J].BMJ Open,2016,6(3):9212-9215.
[17] 蔡红艳,杨志彩,曹仁俊.精神科住院患者医院感染危险因素logistic回归分析[J].中华医院感染学杂志,2015,25(1):160-162.
[18] Lachner C,Martin C,John D,et al.Older adult psychiatric inpatients with non-cognitive disorders should be screened for vitamin B12 deficiency[J].J Nutr Health Aging,2014,18(2):209-212.
[19] 李水英,周茜,张秀英,等.1 621例急重性精神分裂症患者医院感染危险因素的调查分析[J].华西医学,2014,21(11):2073-2076.
[20] Farzianpour F,Bakhtiari A,Mohammadi M,et al.Analysis of nosocomial infections in selected teaching hospitals,Qazvin,Iran[J].Health,2014,6(2):2425-2432.