加强医院感染防控能力建设，提升医院感染管理水平

摘要

目的：通过医院感染预防与控制能力建设项目的实施，加强我国医院感染的预防与控制能力，加大医院感染防控措施的落实力度，提升医院感染管理工作水平。方法整个项目包括呼吸机相关肺炎（VAP）、中央静脉插管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）、手术部位感染（SSI）、新生儿病房和新生儿重症监护室（NICU）、血液透析中心（室）、多重耐药菌（MDRO）医院感染防控7个子项目，通过召开项目启动会、基线调查、统一培训，参与项目的医院按照统一的要求、方法与内容进行调查。2013年10月项目正式实施；2013年10月—2014年3月：进行医院感染流行病学及防控措施实施情况的调查；2014年4—9月：实施各项干预防控措施，并监测干预措施的依从性。结果全国共有52所医院参与该项目，49所医院上报数据。重症监护病房（ICU）器械插管相关感染，VAP、CLABSI 和 CAUTI 发病率分别为8．89‰、1．32‰和2．02‰；综合 ICU VAP、CLABSI 和CAUTI 发病率分别为9．6‰、1．4‰和2．2‰。干预前后 ICU VAP、CAUTI 发病率比较，差异均有统计学意义（均P ＜0．05）。ICU 手卫生依从率为76．73％（29361／38267），通过采取干预措施，总依从性和各类医务人员的手卫生依从性均有提升，干预前后比较，差异均有统计学意义（均 P ＜0．05）。结论该项目加大了医院感染各项防控措施的落实力度，降低了相关医院感染发病率，提升了医院感染预防与控制能力，是一种值得推广的模式。%Objective Through the implementation of competence building project of healthcare-associated infec-tion(HAI)prevention and control,strengthen the competence for HAI prevention and control in China,promote the implementation of HAI prevention and control measures,and improve HAI management level.Methods The whole project included 7 sub-programmes for prevention and control of HAI :ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI),catheter-associated urinary tract infection (CAUTI),sur-gical site infection (SSI),neonatal ward and neonatal intensive care unit (NICU),hemodialysis center,and multi-drug-resistant organism (MDRO).Through the convening,baseline survey,and unified training,the participated hospitals started the project in accordance with the requirements,methods and contents.The project was initiated from October 2013;from October 2013 to March 2014,the investigation on HAI epidemiology,and implementation of prevention and control measures were carried out;from April to September 2014,various prevention and control intervention measures were conducted,and compliance to intervention measures were monitored .Results A total of 52 hospitals participated in the project,49 hospitals reported the data.Of device-associated infection (DAI)in ICUs,incidences of VAP,CLABSI ,and CAUTI per 1 000 device-days were 8.89‰,1 .32‰ and 2.02‰ respec-tively,in general ICUs were 9.6‰,1 .4‰,and 2.2‰ respectively.Incidences of VAP and CAUTI between before and after intervention were both significantly different(both P <0.05).Hand hygiene compliance rate in ICUs was 76.33%(29 361/38 267).Through taking intervention measures,overall compliance to intervention measures and hand hygiene among health care workers all improved significantly,the differences between before and after inter-vention were all significantly different(all P <0.05).Conclusion The project effectively improved the implementa-tion of prevention and control measures for HAI,reduced the incidence of HAI,and is worthy to be popularized.