新生儿医院感染目标性监测  

Targeted monitoring on healthcare-associated infection in neonates

作　　者：宗亚玲 丁洁[1] 程龙慧[1] ZONG Ya-ling;DING Jie;CHENG Long-hui(Anhui Women and Child Health Care Hospital,Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽省妇幼保健院安徽医科大学附属妇幼保健院,安徽合肥230001

出　　处：《中国感染控制杂志》2018年第11期998-1002,共5页Chinese Journal of Infection Control

摘　　要：目的了解新生儿重症监护病房(NICU)和普通病房不同体重组新生儿的医院感染情况,发现医院感染的高危因素。方法采用前瞻性的调查方法,对2016年、2017年1—11月某院新生儿科住院新生儿进行目标性监测,比较NICU与普通病房不同体重组新生儿的医院感染率、器械使用率和器械相关感染率等。结果 2016—2017年11月共监测新生儿科病例3 872例,监测住院总日数42 427 d,感染例数56例,感染例次数62例,医院感染率1.45%,例次感染率1.60%。NICU医院感染率为5.28%,例次感染率为6.03%;普通病房医院感染率、例次感染率均为0.46%,NICU和普通病房感染构成比中居第一位的均为败血症,分别占43.75%、50.00%,其次均为下呼吸道感染,各占27.08%、21.43%。不同体重组医院感染率:NICU、普通病房各组比较,差异均有统计学意义(χ~2值分别为107.78、46.65,均P<0.0001),新生儿体重越低,医院感染率越高;新生儿呼吸机使用率和医院感染率呈正相关(r=0.973,P=0.027),器械使用率越高,医院感染率也越高。梅雨季节真菌败血症每千日感染率高于非梅雨季节(0.53‰vs 0.37‰)。送检标本70份,检出细菌和真菌共45株,检出病原菌均来源于下呼吸道和血液系统,其中下呼吸道以铜绿假单胞菌为主,血液系统以肺炎克雷伯菌和克柔假丝酵母菌为主。结论对新生儿医院感染进行目标性监测可以及时发现新生儿医院感染高危因素,分析感染发生的原因,制定出相应的预防和控制措施,降低医院感染率,保障新生儿的医疗安全。Objective To investigate the occurrence of healthcare -associated infection（HAI） in different weight groups of neonates in neonatal intensive care unit （NICU） and general neonatal wards, and find out the high risk factors for HAI.Methods Targeted monitoring on hospitalized neonates in the neonatal department of a hospital in 2016 and January-November 2017 was prospectively surveyed, HAI rate, device usage rate and device-associated infection rate in different weight groups of neonates in NICU and general neonatal wards were compared.Results From 2016 to November 2017, a total of 3 872 neonates were monitored, the total hospitalization days were 42 427 days, 56 patients had 62 cases of infection, HAI rate and HAI case rate were 1.45% and 1.60% respectively. HAI rate and HAI case rate in NICU were 5.28% and 6.03% respectively;HAI rate and HAI case rate in general neonatal wards were both 0.46%, constituent ratio of septicemia ranked first of infection in both NICU and general neonatal wards, accounting for 43.75% and 50.00% respectively, followed by lower respiratory tract（LRT） infection, accounting for 27.08% and 21.43% respectively. HAI rate of different weight groups of neonates in NICU and general wards were both significantly different（ χ^2 =107.78, 46.65,respectively, both P 〈0.0001）, the lower weight of the neonates, the higher HAI rate; ventilator usage rate in neonates was positively correlated with HAI（ r = 0.973, P =0.027）, the higher device usage rate, the higher HAI rate. Fungal septicemia rate per 1 000 days in rainy season was higher than that of non-rainy season （0.53‰ vs 0.37‰）. A total of 70 specimens were detected, 45 strains of bacteria and fungi were isolated, pathogens were all from LRT and blood system, Pseudomonas aeru-ginosa was the main pathogen from LRT, Klebsiella pneumoniae and Candida krusei were the main pathogens from blood system.Conclusion Targeted monitoring on neonatal HAI can timely find out high risk factors for neonatal HAI, analyze the cause

关 键 词：新生儿 医院感染 目标性监测 

分 类 号：R181.32[医药卫生—流行病学] R722[医药卫生—公共卫生与预防医学]