ICU与普通病房器械相关感染特点的比较研究

Characteristics of device-related infections in ICUs and common wards

  • 摘要: 目的 分析普通病房与重症监护病房(ICU)呼吸机、中央导管与尿管使用情况及器械相关感染特点,为更好地进行器械相关感染预防控制提供科学依据。方法 对2015年4月-2016年3月所有住院患者进行前瞻性监测,记录患者使用呼吸机、中心导管和尿管情况及发生呼吸机相关性肺炎(VAP)、中央导管相关性血流感染(CLABSI)与导尿管相关尿路感染(CAUTI)的病例资料,分析普通病房与ICU患者器械使用率与感染率以及不同科室的相关情况。结果 共调查70 898例患者,呼吸机、中央导管、尿管使用率分别为1.5%、15.5%和11.7%,VAP、CLABSI、CAUTI感染率分别为2.5‰、0.2‰和1.3‰; ICU呼吸机、中央导管与尿管使用率均显著高于普通病房(P<0.01),ICU内VAP、CLABSI感染率均显著高于普通病房(P<0.05),CAUTI感染率差异无统计学意义; 不同科室中,呼吸机使用率内科和ICU相对较高,VAP感染率ICU较高; 中央导管使用率妇科相对较低,CLABSI感染率ICU相对较高; 导尿管使用率儿科相对较低,CAUTI感染率内科、妇科、ICU相对较高。结论 普通病房患者使用侵入性器械数量庞大,CLABSI与CAUTI病例主要分布在普通病房,因此应关注普通病房器械相关感染的监测与预防控制。

     

    Abstract: OBJECTIVE To investigate the situation of use of ventilators, central catheters, and urinary catheters and explore the characteristics of device-related infections in common wards and intensive care units (ICUs) so as to provide scientific basis for prevention and control of the device-related infections. METHODS The prospective surveillance was conducted for all of the patients who were hospitalized from Apr 2015 to Mar 2016.The status of use of ventilators, central catheters, and urinary catheters was recorded, the clinical data of the patients with ventilator-associated pneumonia (VAP), central catheter-related bloodstream infection, or catheter-associated urinary tract infection (CAUTI) were observed.The utilization rates of devices and infection rates were observed and compared between the common wards and the ICUs. RESULTS A total of 70 898 patients were investigated; the utilization rates of ventilators, central catheters, and urinary catheters were 1.5%, 15.5%, and 11.7%, respectively.The incidence rates of VAP, central catheter-related bloodstream infections, and CAUTI were 2.5‰, 0.2‰, and 1.3‰, respectively.The utilization rates of ventilators, central catheters, and urinary catheters were significantly higher in the ICUs than in the common wards (P<0.01).The incidence rates of VAP and central catheter-related bloodstream infections were remarkably higher in the ICUs than in the common wards (P<0.05); there was no significant difference in the incidence rate of CAUTI.Among the different departments, the utilization rate of ventilators was relatively high in the internal medicine department and ICUs, the incidence rate of VAP was relatively high in the ICUs.The utilization rate of central catheters was relatively low in the gynecology department, the incidence of central catheter-related bloodstream infections was relatively high in the ICUs; the utilization rate of urinary catheters was relatively low in the pediatric department, and the incidence rate of CAUTI was relatively high in the internal medicine department, gynecology department, and ICUs. CONCLUSION There are a large number of invasive devices that are used in the common wards, the majority of the patients with central catheter-related bloodstream infections or CAUTI distribute in the common wards, therefore, it is necessary to focus on the surveillance and prevention of the device-related infections in the common wards.

     

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