目的 分析某综合医院住院患者医院感染发生的现况及危险因素,为医院感染预防与控制提供数据支撑。方法 参考全国医院感染监控管理培训基地2022年医院感染现患率调查方案,采用查阅病历和床旁调查相结合的横断面调查方法,对2022年10月20日当天某综合医院所有住院患者医院感染现患情况、微生物检出情况、抗菌药物使用情况及危险因素等进行调查与分析。结果 共调查住院患者2 310例,发生医院感染76例,医院感染现患率为3.29%。现患率最高的科室为重症监护室(12.50%)。医院感染部位分布以下呼吸道感染(占53.16%)为主。住院病人抗菌药物使用率为30.43%,使用抗菌药物治疗前的病原学送检率为82.49%。病原菌以革兰阴性(G-)菌为主,占75.47%。多因素logistic回归分析显示,住院天数≥28 d(OR=3.781,95%CI: 1.761~8.117)、留置导尿管(OR=2.407,95%CI: 1.262~4.589)是医院感染的危险因素。结论 该院住院患者医院感染现患率处于全国中等水平,重点科室的下呼吸道感染及侵入性操作等仍是医院感染防控的重点。
Abstract
Objective To analyze the current situation and risk factors of healthcare-associated infection (HAI) in patients of a general hospital,so as to provide reference for the prevention and control measures of HAI. Methods Referring to the 2022 hospital infection prevalence survey plan of the National Hospital Infection Monitoring and Management Training Base,a cross-sectional survey method combining medical records and bedside surveys was adopted.The prevalence of HAI,microbial detection,antibiotic use and risk factors of all hospitalized patients in a general hospital on October 20,2022 were investigated and analyzed. Results A total of 2 310 inpatients were investigated,and 76 cases of HAI occurred.The prevalence rate of HAI was 3.29%.The department with the highest incidence rate is the intensive care unit (ICU) (12.50%).HAI was mainly caused by lower respiratory tract infection,accounting for 53.16%.The utilization rate of antibiotics in hospitalized patients was 30.43%,and the pathogenic inspection rate before the use of therapeutic antibiotics was 82.49%.The main pathogens were Gram-negative (G-),accounting for 75.47%.Multivariate logistic regression analysis showed that hospitalization days ≥28 days (OR=3.781,95%CI: 1.761~8.117),and indwelling catheter (OR=2.407,95%CI: 1.262~4.589) were the risk factors of HAI. Conclusion The prevalence rate of HAI in the hospital is at the medium level in China, and the infection of the lower respiratory tract and invasive operations in key departments are still the focus of infection prevention and control in the hospital.
关键词
现患率 /
现况调查 /
医院感染 /
危险因素
Key words
Prevalence /
Survey /
Healthcare-associated infection /
Risk factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] World Health Organization (WHO).Report on the burden of endemic healthcare-associated infection worldwide[EB/OL].(2013-04-23)[2022-11-18].http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf.
[2] Allegranzi B,Bagheri Nejad S,Combescure C,et al.Burden of endemic healthcare-associated infection in developing countries: systematic review and meta-analysis[J].Lancet,2011,377(9761):228-241.
[3] 张磊,唐婷,杨滢,等.云南省203家医疗机构医院感染横断面调查分析[J].中国消毒学杂志,2022,39(6):452-455+460.
[4] 樊雯婧,蒙定武,楼冬洁,等.2014—2018年海南地区各级医院住院患者医院感染现患率[J].中国感染控制杂志,2021,20(4):333-339.
[5] 肖佳庆,林玲,任慧,等.2018年黑龙江省74所医院医院感染现患率调查[J].中华医院感染学杂志,2020,30(10):1569-1573.
[6] 曾萍,朱春梅,程娜,等.江西省某综合医院医院感染现患率调查分析[J].安徽预防医学杂志,2022,28(3):206-211.
[7] 王美霞,米宏霏,高晓东,等.某三级综合医院医院感染横断面调查及预测模型构建[J].公共卫生与预防医学,2021,32(5):56-60.
[8] 任南,文细毛,吴安华.2014年全国医院感染横断面调查报告[J].中国感染控制杂志,2016,15(2):83-87.
[9] 张慧慧,白鹏,游丽娟,等.两种方法调查医院感染现患率的结果比较与分析[J].检验医学与临床,2021,18(23):3495-3497.
[10] 彭美玲,周健,江淑芳,等.某三级甲等综合医院医院感染现患率调查与危险因素分析[J].中华医院感染学杂志,2015,25(17):3944-3946.
[11] 杨剑税,闵琦芬,龚晓文,等. 江苏某三级医院2013—2022年医院感染现患率调查[J]. 江苏预防医学,2023,34(2):192-194+225.
[12] Papazian L,Klompas M,Luyt CE.Ventilator-associated pneumonia in adults: a narrative review[J].Intensive Care Med,2020,46(5):888-906.
[13] 袁成,牛凯旋,徐阳,等.老年重症患者呼吸机相关肺炎的研究进展[J].牡丹江医学院学报,2022,43(4):141-144.
[14] 胡付品,郭燕,朱德妹,等.2021年CHINET中国细菌耐药监测[J].中国感染与化疗杂志,2022,22(5):521-530.
[15] 国家卫生健康委医政医管局.关于印发《遏制微生物耐药国家行动计划(2022—2025年)》的通知[EB/OL].(2022-10-28) [2022-11-18].http://www.nhc.gov.cn/yzygj/s7659/202210/2875ad7e2b2e46a2a672240ed9ee750f.shtml.
[16] 国家卫生计生委办公室,国家中医药管理局办公室,总后卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015年版)》的通知[EB/OL].(2022-08-27) [2022-11-18].http://www.nhc.gov.cn/yzygj/s3593/201508/c18e1014de6c45ed9f6f9d592b43db42.shtml.
[17] 李倩,平宝华,李宝珍.2013年医院感染现患率调查及危险因素分析[J].中国感染控制杂志,2014,13(8):467-471.
[18] 国家卫生健康委医政医管局.2021年国家医疗质量安全改进目标[J].中国卫生质量管理,2021,28(4):15.
基金
院中青年科研启动基金(J2021-2-15)
PDF(764 KB)
