天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (2): 206-210.doi: 10.11958/20171006

• 流行病学调查 • 上一篇    下一篇

2014—2016年天津市胸科医院感染现患率调查结果分析

吴雪1,2， 张书婧3， 李冠华2， 卢金玲2， 田立芝2， 魏殿军1△   

  1. 1天津医科大学第二医院 （邮编300211）； 2天津市胸科医院； 3天津市疾病预防控制中心
  • 收稿日期:2017-10-09 修回日期:2018-01-08 出版日期:2018-02-15 发布日期:2018-02-15
  • 通讯作者: 李冠华 E-mail:ligh1123@eyou.com

Analysis on prevalence survey of healthcare-associated infections in Tianjin Chest Hospital from 2014 to 2016

WU Xue1,2, ZHANG Shu-jing3, LI Guan-hua2, LU Jin-ling2, TIAN Li-zhi2, WEI Dian-jun1△   

  • Received:2017-10-09 Revised:2018-01-08 Published:2018-02-15 Online:2018-02-15

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摘要： 摘要： 目的 了解天津市胸科医院 2014—2016 年医院感染现状及变化趋势， 为制定预防和控制医院感染的有效措施提供科学依据。方法 采用床旁调查和查阅病历相结合的方法， 自 2014—2016 年起每年选取一日作为调查日， 进行医院感染横断面调查。采集患者手术切口等级、 感染类型、 感染部位、 感染病原体及其药敏情况、 抗菌药物及其使用目的、 联合用药情况、 治疗用药前是否送细菌培养、 送细菌培养时机是否合理等临床数据并汇总， 对数据进行统计学分析。结果 2014—2016 年共调查住院患者 2 285 例， 发生医院感染 55 例， 医院感染总现患率 2.41%。3 年医院感染现患率分别为 2.62%、 2.63%、 2.05%， 差异无统计学意义 （χ2 =0.750， P＞0.05）。2014—2016 年医院感染现患率最高的科室分别为心外科 （13.79%）、 心外科 （7.48%）、 内分泌科 （7.41%）。医院感染部位以下呼吸道感染为主（61.11%~78.95%）， 其次为上呼吸道、 泌尿道、 血液感染等， 多为散发。2014—2016 年医院感染送检率分别为 77.78%、 85.71%、 88.89%， 差异无统计学意义 （χ2 =0.735， P＞0.05）。2014—2016 年分离出病原体 45 株， 革兰阴性菌为主要致病菌， 3 年共分离出 32 株 （71.11%）； 分离出革兰阳性菌 6 株 （13.33%）； 分离出真菌 7 株 （15.56%）； 主要致病菌为肺炎克雷伯菌 （10 株）、 铜绿假单胞菌 （8 株） 和鲍曼不动杆菌 （5 株）。2014—2016 年抗菌药物使用率分别为 28.40%、 29.17%、 23.74%， 差异有统计学意义 （χ2 =7.175， P＜0.05）。3 年用药目的多为治疗用药， 占 83.39%； 预防用药占 14.17%； 治疗+预防用药占 2.44%， 差异有统计学意义 （χ2 =29.151， P＜0.05）。治疗用药送检率分别为 77.02%、 74.42%、 75.77%， 差异无统计学意义 （χ2 =0.306， P＞0.05）。结论 被调查医院感染现患率维持在稳定水平， 应加强对重点科室、 重点部位及主要致病菌的监测与防控， 科学制定预防和控制医院感染的有效措施， 以减少医院感染的发生。

关键词: 交叉感染, 横断面研究, 抗菌药物, 现患率

Abstract: Abstract: Objective To investigate the infection state and tendency in Tianjin Chest Hospital from 2014 to 2016, and provide scientific basis for making strategy to prevent and control nosocomial infection. Methods With bedside investigation and medical case review, one day every year was selected as the day of investigation to survey the healthcare- associated infections in our hospital during 2014-2016. Data of operative incision, infection condition, the usage of anti- bacterial agents and bacteria detection were collected and organized for further study. Results A total of 2 285 patients were investigated during 2014 to 2016, in which nosocomial infection was found in 55 cases. The total prevalence of healthcare-associated infections was 2.41%. The prevalence rates of healthcare-associated infections in each year were 2.62%, 2.63% and 2.05% respectively, and no significant differences between them (χ2 =0.750, P＞0.05). In the three years, the highest prevalence rates were found in Department of Cardiac Surgery (13.79%), Department of Cardiac Surgery (7.48%) and Department of Endocrine (7.41%) respectively. The lower respiratory tract infection was the main infection site of nosocomial infection (61.11%- 78.95%), followed by upper respiratory tract infection, urinary tract infection and blood infection. In 2014-2016, pathogenic detection rates for specimens were 77.78%, 85.71% and 88.89% from patients with nosocomial infection ( 2 =0.735 0.05). Forty-five strains of pathogen were isolated from 2014 to 2016. The main pathogen was the gram-negative bacteria, and 32 strains were isolated during the three years, which accounted for 71.11%. Six strains of gram-positive bacteria were isolated, which accounted for 13.33%. Seven strains of fungus were isolated, which accounted for 15.56%. The predominant pathogens were Klebsiella pneumonia (10 isolates), Pseudomonas aeruginosa (8 isolates) and Acinetobacter baumannii (5 isolates). The antibiotic utilization rates were 28.40%, 29.17% and 23.74% respectively from 2014 to 2016 (χ2 =7.175， P＜0.05). In the three years, most of antibiotics were used therapeutically, accounting for 83.39%, 14.17% received for prophylactic use, and 2.44% received for both prophylactic use and treatment (χ2 =29.151， P＜0.05). The rates of bacteria detection in patients who received therapeutic use were 77.02%, 74.42% and 75.77% respectively (χ2 =0.306， P＞0.05). Conclusion The prevalence of healthcare-associated infection of Tianjin Chest Hospital is maintained at a stable level. The monitoring and prevention of key departments, sites and predominant pathogens should be strengthen, and effective measures for preventing and controlling nosocomial infection should be formulated scientifically, so as to reduce the incidence of nosocomial infection.

Key words: cross infection, cross-sectional studies, anti-bacterial agents, prevalence survey