新建康复医院医院感染发病率及危险因素前瞻性研究

摘要

目的：了解新建康复医院医院感染的流行病学特点及其危险因素。方法采用前瞻性调查方法，监测2011年1月—2014年12月入住某新建康复医院的所有住院患者医院感染情况，收集相关资料并进行统计分析。结果共监测出院患者22126例，男性12023例，女性10103例，年龄4月～100岁。发生医院感染720例、738例次，医院感染发病率为3．25％，例次发病率为3．34％。脊髓康复科发病率最高（9．76％）；医院感染部位主要为下呼吸道（388例次，52．57％）；共检出病原菌186株，其中革兰阴性（G－）菌154株（占82．80％），革兰阳性（G＋）菌25株（占13．44％），真菌7株（占3．76％）。多因素 logistic 回归分析表明，瘫痪[OR（95％ CI）：1．77（1．24～2．53）]、住院时间≥60 d[OR（95％ CI）：4．62（3．28～5．10）]、年龄≤10岁[OR（95％ CI）：1．55（1．33～2．93）]、年龄≥60岁[OR（95％ CI ）：4．59（1．02～20．59）]、有慢性基础疾病[OR（95％ CI）：1．56（1．37～11．34）]、有侵入性操作[OR（95％ CI ）：3．33（1．21～6．86）]及昏迷[OR（95％ CI）：6．77（5．41～7．05）]是康复医院患者发生医院感染的主要危险因素。结论对新建康复医院进行调查，有助于了解其医院感染发病情况，医务人员可针对其主要危险因素采取相应的预防与控制措施。%Objective To investigate the epidemiological characteristics and risk factors for healthcare-associated infection(HAI)in a newly built rehabilitation hospital.Methods A prospective survey was adopted to monitor HAI among all patients admitted to a newly built rehabilitation hospital between January 2011 and December 2014, related data were collected and analyzed statistically.Results A total of 22 126 patients (male,n=12 023;female, n=10 103)were monitored,age were 4 months-100 years old.HAI rate was 3.25%(n=720),HAI case rate was 3.34% (n=738).Patients in department of spinal rehabilitation had the highest HAI rate (9.76%);the main HAI site was lower respiratory tract (n = 388,52.57%);a total of 186 pathogenic isolates were detected,154 (82.80%)were gram-negative bacteria,25 (13.44%)were gram-positive bacteria,and 7 (3.76%)were fungi. Multivariate logistic regression analysis showed that paralysis (OR,1 .77 [95% CI ,1 .24 - 2.53 ]),length of hospital stay ≥60 days(OR,4.62 [95% CI ,3.28 -5.10]),age ≤ 10 years old (OR,1 .55 [95% CI ,1 .33 -2.93]),age ≥60 years old (OR,4.59 [95% CI ,1 .02-20.59]),chronic underlying diseases(OR,1 .56 [95% CI , 1 .37-11 .34]),invasive procedure (OR,3.33 [95% CI ,1 .21 -6.86]),and coma(OR,6.77 [95% CI ,5.41 -7.05])were major risk factors for HAI in patients in the rehabilitation hospital.Conclusion Investigation on newly built rehabilitation hospital is helpful for realizing the occurrence status of HAI,health care workers can carry out the corresponding prevention and control measures.