医院感染的高危因素研究

目的 分析某医院住院病人感染的发生情况及其危险因素，探讨控制医院感染的有效措施。 方法 回顾性分析2015-2016年某院13 027份出院病人的电子病历，结合临床医师相关报告和感染科室专职人员调查结果，统计该院医院感染发生率，并分析其影响因素。 结果 该院医院感染发生率为2.70%（352/13 207）。其2015年医院感染发生率为2.89%（182/6 299），2016年为2.53%（170/6 728），差异无统计学意义（P>0.05）。医院感染的好发科室主要为ICU、泌尿外科和神经内科；好发部位主要为上呼吸道、下呼吸道、泌尿道和胃肠道，手术切口感染亦占一定比例。除真菌外，主要分离出1 180株病原菌，感染次数较多的主要为革兰阴性菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等，其中革兰阴性菌822株（69.66%）。logistic回归分析显示，使用呼吸机、行气管切开术、留置导尿管和血液透析是发生医院感染的独立危险因素（P < 0.05~P < 0.01）。 结论 控制医院感染，应根据医院自身情况，分析高危因素，进而重点防控。感染控制措施主要为严格执行消毒制度、加强基础护理工作、合理使用抗菌药物、增强医生和病人手卫生的依从性意识等。

Study on the risk factors of hospital infection

Objective To analyze the occurrence and risk factors of infection in inpatients, and explore the effective measures to control hospital infection. Methods The electronic medical records of 13 027 discharged patients from January 2015 to December 2016 were retrospectively analyzed.Based on the results of relevant report of clinician and investigation of full-time staff in infection department, the incidence rate of infection and its influencing factors were analyzed. Results The incidence rate of infection was 2.70% (352/13 207).The incidence rates of infection in 2015 and 2016 were 2.89% and 2.93%, respectively, and the difference of which was not statistically significant (P>0.05).The main departments of infection were ICU, urology and neurology.The most common locations of infection were the upper respiratory tract, lower respiratory tract, urinary tract and gastrointestinal tract, and surgical incision infection also accounted for a certain proportion.In addition to fungi, 1 180 strains of pathogenic bacteria were isolated.The infection bacteria were mainly the gram negative bacteria, Escherichia coli, Klebsiella Pneumoniae, Pseudomonas aeruginosa and so on, and the gram negative bacteria accounted for 69.66% (822 strains).The results of logistic regression analysis showed that the ventilator use, tracheotomy, indwelling catheter and hemodialysis were the independent risk factors of hospital infection (P < 0.05 to P < 0.01). Conclusion To control hospital infection, the high-risk factors should be analyzed according to the hospital's situation, and then the prevention and control should be emphasized.The main measures of control infection include the strict implementing disinfection system, strengthening basic nursing work, rational use of antibiotics, and enhancing the hand hygiene compliance of doctors and patients.