湘雅医院15年间医院感染现患率调查

［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。

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

ObjectiveTo investigate the prevalence rate of healthcare associated infection（HAI） in Xiangya Hospital，and provide reference for preventing and controlling HAI.MethodsThe cross sectional surveys on prevalence 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.ResultsThe 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 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）.ConclusionPrevention 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.