湘雅医院15年间医院感染现患率调查  

Survey on prevalence of healthcare-associated infection in Xiangya Hospital in 15 years

作　　者：曾翠[1] 任南[1] 黄勋[1] 冯丽[1] 龚瑞娥[1] 文细毛[1] 刘珍如[1] 吴红曼[1] 李春辉[1] 吕一欣[1] 王曼平[1] 易霞云[1] 付陈超[1] 熊辛睿[1] 周鹏程[1] 陈玉华[1] 张莹[1] 徐秀华[1] 吴安华[1] 

机构地区：[1]中南大学湘雅医院,湖南长沙410008

出　　处：《中国感染控制杂志》2016年第6期367-373,共7页Chinese Journal of Infection Control

基　　金：湖南省卫生计生委课题(B2016107)

摘　　要：目的：了解湘雅医院感染的实际情况及变化趋势，为有效预防与控制医院感染提供依据。方法采用床旁调查与病历调查相结合的横断面调查方法，调查该院2000—2014年（2006年未进行）某一日所有住院患者的医院感染现患率、横断面抗菌药物使用率及细菌培养送检率。结果2000—2014年医院感染现患率从6．30％降低至3．91％，差异有统计学意义（χ2＝35．14，P ＜0．001）；社区感染现患率为15．61％～15．76％，各年度比较，差异无统计学意义。医院感染现患率最高的科室为综合重症监护病房（ICU）；医院感染与社区感染均以下呼吸道感染居首位；泌尿道置管率呈下降趋势，动静脉置管率呈上升趋势，差异均有统计学意义（χ2值分别为5．21、96．24，均P ＜0．001）。2008—2014年治疗性使用抗菌药物患者病原体送检率为36．37％～44．51％，医院感染病例病原体送检率为34．00％～44．99％，医院感染病原体检出率为41．57％～68．48％，均呈增长趋势，差异均有统计学意义（χ2值分别为22．78、10．03、26．49，均 P ＜0．001）。感染病原体以革兰阴性（G－）菌为主；抗菌药物横断面使用率与联合用药率均呈下降趋势，差异均有统计学意义（P ＜0．05）。结论该院医院感染防控与抗菌药物管理取得初步成效，医院感染现患率与抗菌药物横断面使用率均明显下降，感染病原体以 G－菌为主，感染部位以下呼吸道居首位。Objective To investigate the prevalence rate of healthcare-associated infection（HAI）in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 （except 2006）were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant （χ2 = 35.14,P〈0.001 ）;prevalence rates of community-associated infection（CAI）were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit （ICU）had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant（χ2 = 5.21,96.24,respectively,both P 〈0.001）.In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI＆amp;nbsp;were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant （χ2 = 22.78,10.03,26.49,respectively,all P 〈 0.001 ）.Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined （P 〈 0.05 ）.Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.

关 键 词：医院感染 现患率 病原菌 感染部位 抗菌药物 

分 类 号：R181.32[医药卫生—流行病学]