三级传染病医院的医院感染现患率调查及影响因素分析

刘　立; 张一琼; 李俊义; 刘春云; 杜映荣; 李惠敏; 李卫昆; 常丽仙

文章摘要

三级传染病医院的医院感染现患率调查及影响因素分析

Survey on prevalence and influencing factors of nosocomial infections in tertiary infectious hospital

DOI：10.3969/j.issn.1007-8134.2021.03.015

中文关键词: 医院感染现患率调查抗菌药物

英文关键词: nosocomial infection prevalence survey antibiotics

基金项目:昆明市卫生和计划生育委员会科技计划项目（2017-12-07-003）

作者	单位
刘　立	昆明市第三人民医院肝病科
张一琼	昆明市第三人民医院控制感染办公室
李俊义	昆明市第三人民医院肝病科
刘春云	昆明市第三人民医院肝病科
杜映荣	昆明市第三人民医院内一科
李惠敏	昆明市第三人民医院肝病科
李卫昆	昆明市第三人民医院肝病科
常丽仙	昆明市第三人民医院肝病科

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中文摘要:

目的　了解三级传染病医院的医院感染的实际情况，掌握三级传染病医院的医院感染流行病学特征，评价近年来医院感染持续质量改进的效果，为强化医院感染的预防与控制提供参考依据。方法　采用医院感染实时监控系统与床边调查相结合的方法，对2015年7月8日0—24时我院所有住院患者进行调查分析。结果　本次三级传染病医院的医院感染现患率调查应查853例、实查835例，实查率为98.00％，发生医院感染的有13人（15例次），医院感染现患率为1.56％，例次感染率为1.80%；肿瘤科和ICU的医院感染现患率较高，其次为肝病科；感染部位以呼吸道为主，占46.67%，其次依次是泌尿道26.67%、胃肠道13.33%、血液系统13.33%；抗菌药物的使用率为45.03％，其中治疗性使用抗菌药物占98.94％；抗菌药物以一联用药为主，占84.84％；使用抗菌药物前病原学送检率为68.35%；三级传染病医院医院感染的影响因素有抗菌药物使用、抗菌药物联用、合并基础疾病及免疫抑制剂的使用。结论　三级传染病医院应加强肿瘤科、ICU及肝病科等科室的感染预防与控制，严格抗菌药物和免疫抑制剂的使用和管理，提高抗菌药物使用前病原学的送检率，以降低医院感染的发生率。

英文摘要:

Objective　To understand the actual situation of nosocomial infections in tertiary infectious hospital, discuss the epidemiology characteristics of nosocomial infections, evaluate the achievements in continuous quality improvement of nosocomial infections in recent years, so as to provide evidence for enhancing the prevention and control of nosocomial infection. Methods　All the patients who were hospitalized from 0 to 24 hour on July 8, 2015 were investigated by the review of real-time monitoring system combined with bedside investigation. Results　For the prevalence of nosocomial infections in tertiary infectious hospital, totally 853 cases were expected to be investigated and 835 cases (98%) were actually investigated. The prevalence of nosocomial infections was 1.56% (13 cases of nosocomial infections) and the case infection rate was 1.80% (15 case-times of nosocomial infections). The prevalence of nosocomial infection was the highest in oncology department and ICU, followed by liver disease department. The infection positions were dominant in respiratory tract, accounting for 46.67%, followed by urinary tract (26.67%) and gastrointestinal tract (13.33%). The utilization rate of antibiotics was 45.03% and the therapeutic use of antibiotics accounted for 98.94%. The single use of antibiotics was dominant, accounting for 84.84%. The examination rate of bacterial culture before antibiotics use was 68.35%. The influencing factors for nosocomial infections in tertiary infection hospitals included the length of hospital stays, the use of antibiotics, the combination of different antibiotics, the combination of underlying diseases and the use of immunosuppressive agents. Conclusions　It is necessary to strengthen the prevention and control of nosocomial infections in oncology department, ICU and liver disease department, strictly use and manage the antimicrobial agents and immunosuppressive agents, increase the etiological examination rate prior to the use of antibiotics, so as to reduce the incidence of nosocomial infections.

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