176所医院连续6年ICU医院感染目标性监测分析

摘要

目的 了解某省二级及以上医院重症监护病房(ICU)医院感染发生情况,为医院感染管理提供依据.方法 医院感染管理质量控制中心(HAIQCC)于2010年7月1日-2015年6月30日组织全省二级及以上医院开展ICU医院感染目标性监测.结果 共监测176所医院的ICU,连续6年ICU医院感染发病率为7.23％,医院感染例次发病率9.72％;连续6年ICU医院感染发病率呈逐年下降趋势(P<0.001).综合医院ICU的调整例次日发病率(4.30‰)高于专科医院ICU(3.53‰).外科ICU和综合ICU医院感染发病率较高,调整例次日发病率分别为4.79‰和4.21‰.ICU医院感染以下呼吸道、泌尿道、血流感染为主,分别占68.64％、14.45％和10.09％.中心静脉导管、呼吸机、导尿管使用率分别为49.86％、39.16 ％、81.95％,三管相关感染例次日发病率分别为1.74‰、13.77‰、2.08‰. 连续6年三管相关感染例次日发病率逐年降低(P<0.001).呼吸机、中心静脉导管、导尿管在不同科别ICU中的使用率与其相关感染发病率均无相关性(均P>0.05).共检出病原菌36 223株,前6位病原菌依次为鲍曼不动杆菌(22.77％)、肺炎克雷伯菌(11.96％)、铜绿假单胞菌(11.94％)、金黄色葡萄球菌(8.08％)、白假丝酵母菌(5.63％)、大肠埃希菌(5.55％).连续6年耐碳青霉烯类肺炎克雷伯菌的检出率呈上升趋势(P<0.05).结论 持续开展ICU 医院感染目标性监测,定期分析医院感染的高危因素,及时采取干预措施,可有效降低 ICU 医院感染发病率.%Objective To understand the occurrence of healthcare-associated infection(HAI) in intensive care units (ICUs) in secondary and above hospitals in a province, and provide basis for HAI management.Methods HAI management quality control center in a province performed targeted monitoring on HAI in ICUs in secondary and above hospitals in a province from July 1, 2010 to June 30, 2015.Results ICUs in 176 hospitals were monitored, the incidence of HAI in ICUs for 6 consecutive years was 7.23％, case incidence of HAI was 9.72％;incidence of HAI showed a decreased trend in 6 years(P<0.001).The adjusted rate of HAI per 1 000 patient days in the general hospital ICUs was higher than that of special hospital ICUs (4.30‰ vs 3.53‰).Incidence of HAI in surgical ICUs and general ICUs were both relatively higher, adjusted rates of HAI per 1 000 patient days were 4.79‰ and 4.21‰ respectively.Respiratory tract, urinary tract, and bloodstream infection were major HAI in ICUs, accounting for 68.64％, 14.45％, and 10.09％ respectively, the utilization rates of central venous catheter, ventilator, and urinary catheter were 49.86％, 39.16％, and 81.95％ respectively, incidence of three catheter-associated infection were 1.74‰, 13.77‰, and 2.08‰ respectively, incidence of three catheter-associated infection decreased year by year (P<0.001).The utilization rates of ventilator, central venous catheter, and urinary catheter in different ICUs were not correlated with the incidence of infection(all P>0.05).A total of 36 223 strains of pathogens were isolated, the top 6 isolated pathogens were Acinetobacter baumannii(22.77％), Klebsiella pneumoniae (11.96％), Pseudomonas aeruginosa(11.94％), Staphylococcus aureus (8.08％), Candida albicans (5.63％), and Escherichia coli(5.55％).The isolation rates of carbapenem-resistant Klebsiella pneumoniae showed a increased tendency for 6 years(P<0.05).Conclusion Continuous targeted monitoring on HAI in ICUs, regular analysis on risk factors for HAI, and timely implementation of intervention measures can effectively decrease the incidence of HAI.