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 (χ2=0.735,P>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.%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2285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.
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