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目的探讨精神科封闭式管理模式与开放性管理模式医院感染的因素及特点,寻找有效的预防措施。方法采用回顾性调查研究方法对济宁市精神病防治院2014年1-12月出院的精神病患者9080例进行调查分析。结果封闭式病区出院病人5 964例,感染137例,感染率为2.30%;开放式病区出院病人3 116例,感染22例,感染率为0.71%,差异有统计学意义(χ~2=30.116,P<0.05)。封闭式病区感染的137例患者中,呼吸道感染114例,占感染人数的83.21%,其次为皮肤软组织感染,共18例,胃肠道感染5例。开放式病区感染的22例患者中,胃肠道感染15例,占感染人数的68.18%,呼吸道感染5例,皮肤软组织感染2例。封闭式病区和开放式病区在呼吸道感染、胃肠道感染以及皮肤软组织感染差异均有统计学意义(χ~2=48.517、14.718、5.258,P均<0.05)。封闭病区住院时间1~30d、31~90d、91~180d、180d以上患者感染率分别为1.25%、1.31%、4.36%、11.53%,开放病区住院1~30d、31~90d、91~180d、180d以上患者感染率分别为0.54%、0.78%、0.85%、2.40%,差异具有统计学意义(χ~2值分别为5.301、7.752、9.575、9.239,P均<0.05)。结论精神科封闭式病区与开放式病区患者医院感染的发生率、发生部位不同,应在两个不同管理模式的病区分别采取相应的医院感染防范措施,以降低医院感染的发生率。
Objective To explore the factors and characteristics of nosocomial infections in psychiatric closed management and open management and to find out effective preventive measures. Methods A retrospective investigation was carried out to investigate and analyze 9080 mental patients discharged from Jining Psychiatric Prevention and Treatment Hospital from January to December 2014. Results A total of 5 964 discharged patients in closed ward were infected with 137 cases, the infection rate was 2.30%. In the open ward area, 3 116 patients were discharged and 22 cases were infected, the infection rate was 0.71%, with significant difference (χ ~ 2 = 30.116, P <0.05). Of the 137 patients with closed ward infection, 114 were respiratory infections, accounting for 83.21% of the total number of infections, followed by skin and soft tissue infections, 18 in total and 5 in gastrointestinal infections. Of the 22 patients with open ward infection, 15 were gastrointestinal infections, accounting for 68.18% of the total number of infections, 5 were respiratory infections and 2 were skin and soft tissue infections. There were significant differences in respiratory tract infection, gastrointestinal tract infection and skin and soft tissue infection between closed ward and open ward (χ ~ 2 = 48.517, 14.718, 5.258, P <0.05). The infection rates of patients in closed ward for 1 ~ 30d, 31 ~ 90d, 91 ~ 180d and 180d were 1.25%, 1.31%, 4.36% and 11.53% The infection rates of patients over 180d and 180d were 0.54%, 0.78%, 0.85% and 2.40%, respectively. The differences were statistically significant (χ ~ 2 values were 5.301,7.752,9.575,9.239, P <0.05 respectively). Conclusions The prevalence and occurrence of nosocomial infections in patients with psychiatric closed and open ward are different, and corresponding nosocomial infection prevention measures should be taken in ward of two different management modes to reduce the incidence of nosocomial infection.