CAJ | 학술논문

目的：了解某教学医院新建呼吸内科重症监护病房（RICU）住院患者医院感染状况，为新建 ICU 医院感染的预防与控制提供依据。方法采取前瞻性目标性监测方法，对2014年1—12月入住某院 RICU 的患者进行医院感染目标性监测，并对监测结果进行统计分析。结果共监测住院患者561例，发生医院感染43例、44例次，医院感染发病率为7．66％，例次发病率为7．84％，例次日发病率为6．26‰，调整例次日发病率为1．79‰。医院感染部位以泌尿道为主（20例，占45．46％），其中呼吸机相关肺炎（VAP）、血管导管相关血流感染（CRBSI）、导尿管相关泌尿道感染（CAUTI）分别为13、2和18例，发病率分别为2．73‰、1．57‰和3．78‰。上半年（1—6月）患者医院感染日发病率与下半年（7—12月）比较，差异有统计学意义（4．59‰ VS 7．89‰；u ＝－1．75，P ＝0．04）。共分离病原菌47株，以革兰阴性菌为主（26株，占55．32％）。结论 ICU 医院感染以器械相关感染为主，应加强对侵入性操作的评估和严格管理；在 ICU 进行目标性监测，可及时发现医院感染控制的薄弱环节，有利于针对性制定防控措施，降低 ICU 医院感染发病率。
목적：료해모교학의원신건호흡내과중증감호병방（RICU）주원환자의원감염상황，위신건 ICU 의원감염적예방여공제제공의거。방법채취전첨성목표성감측방법，대2014년1—12월입주모원 RICU 적환자진행의원감염목표성감측，병대감측결과진행통계분석。결과공감측주원환자561례，발생의원감염43례、44례차，의원감염발병솔위7．66％，례차발병솔위7．84％，례차일발병솔위6．26‰，조정례차일발병솔위1．79‰。의원감염부위이비뇨도위주（20례，점45．46％），기중호흡궤상관폐염（VAP）、혈관도관상관혈류감염（CRBSI）、도뇨관상관비뇨도감염（CAUTI）분별위13、2화18례，발병솔분별위2．73‰、1．57‰화3．78‰。상반년（1—6월）환자의원감염일발병솔여하반년（7—12월）비교，차이유통계학의의（4．59‰ VS 7．89‰；u ＝－1．75，P ＝0．04）。공분리병원균47주，이혁란음성균위주（26주，점55．32％）。결론 ICU 의원감염이기계상관감염위주，응가강대침입성조작적평고화엄격관리；재 ICU 진행목표성감측，가급시발현의원감염공제적박약배절，유리우침대성제정방공조시，강저 ICU 의원감염발병솔。
Objective To investigate the incidence of healthcare-associated infection (HAI)in patients in a respiratory in-tensive care unit (RICU)of a teaching hospital,and provide reference for HAI prevention and control.Methods All pa-tients admitted to this RICU from January to December 2014 were surveyed with prospective targeted monitoring method, surveyed data were analyzed statistically.Results A total of 561 patients were surveyed,43 patients developed 44 times HAI,HAI rate and HAI case rate were 7.66% and 7.84% respectively,incidence of HAI and adjusted incidence of HAI per 1 000 patient-days were 6.26‰ and 1.79‰ respectively.The main infection site was urinary tract (45.46%,n=20). Incidence of ventilator-associated pneumonia (VAP ),catheter-related bloodstream infection (CRBSI),and catheter-associat-ed urinary tract infection (CAUTI)per 1 000 catheter-days were 2.73‰(n=13),1.57‰(n=2),and 3.78‰(n=18)re-spectively.Incidence of HAI per 1 000 patient-days between the first and second half year of 2014 was significantly differ-ent(4.59‰ vs 7.89‰;u=-1.75,P =0.04).A total of 47 pathogenic strains were isolated,the main pathogens were gram-negative bacteria(n=26,55.32%).Conclusion The major HAI in RICU is device-associated infection,it is necessary to strengthen the management of invasive procedures;targeted monitoring can find the weak links of infection control prac-tice and helpful for taking effective prevention and control measures to reduce the incidence of HAI in ICU.