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目的了解重症监护病房导(ICU)管相关性医院感染的现状及主要影响因素。方法对2012—2015年ICU留置导管患者进行目标性监测,分析4年内ICU留置导管相关性医院感染现状及其影响因素。结果 ICU 3种导管相关性医院感染共230例,其感染率呈逐年上升趋势,总的感染率以呼吸机相关性肺炎113例(49.13%)最高,其次是留置导尿管相关性泌尿道感染94例(40.87%)及深静脉置管相关血液感染23例(10.0%)。基础疾病分类中,位于前4位病种分别是肺部疾病(35.29%)、脑出血(15.29%)、脑梗死(13.73%),呼吸衰竭(12.94%)。病原菌分布主要以革兰阴性杆菌为主,占68.25%;其次是革兰阳性球菌,占20.43%和真菌,占11.30%。多元logistic回归分析提示住院天数、重症患者、糖尿病史、机体免疫力低下、深静脉置管、昏迷、气管插管因素均是ICU发生3种导管相关性医院感染的主要危险因素。结论 ICU病房院内感染是亟待解决的难题,严格执行无菌操作,改善患者全身状况,增强抵抗力,加强ICU病房医院感染监管,是降低该人群导管相关感染的关键。
Objective To understand the current situation and main influential factors of nosocomial infection related to ICU tube in intensive care unit. Objective To monitor the status of ICU indwelling catheter-related nosocomial infections in hospital from 2012 to 2015 and its influencing factors. Results There were 230 hospital-acquired nosocomial infections in ICU. The infection rate showed an upward trend year by year. The total infection rate was 113 (49.13%) with ventilator-associated pneumonia, followed by indwelling catheter-associated urinary tract infection 94 cases (40.87%) and deep vein catheter-related blood infection in 23 cases (10.0%). In the classification of basic diseases, the top 4 diseases were lung disease (35.29%), cerebral hemorrhage (15.29%), cerebral infarction (13.73%) and respiratory failure (12.94%) respectively. The main pathogens were Gram-negative bacilli, accounting for 68.25%; followed by Gram-positive cocci, accounting for 20.43% and fungi accounting for 11.30%. Multivariate logistic regression analysis showed that hospitalization days, critically ill patients, diabetes mellitus, low body immunity, deep venous catheterization, coma and tracheal intubation were the main risk factors for 3 kinds of catheter-related nosocomial infections in ICU. Conclusion The nosocomial infection in ICU wards is an urgent problem to be solved. To strictly enforce aseptic procedures, to improve the general condition of the patients, to enhance the resistance and to strengthen the supervision of ICU ward in hospital is the key to reduce the catheter-related infections in this population.