某医院手术病人医院感染监测研究
发布时间：2018-09-04 17:31
【摘要】：研究目的 研究手术病人医院感染的发病情况，并采用发病密度、危险因素指数等指标描述医院感染的发病强度；探索采用前瞻性巢式病例对照研究方法开展易感人群医院感染的方法学研究；研究手术病人医院感染危险因素，进行易感人群目标性监测。通过对手术病人医院感染情况进行目标性监测，，进一步掌握医院感染实际情况，为医院有关部门进行医院感染监测提供参考依据，进而使其采取有效措施控制医院感染现存问题，预防医院感染发生，同时为综合性医院应对突发公共卫生事件奠定坚实的基础。 研究方法 本研究采用前瞻性巢式病例对照研究的方法，收集某医院2013年1月1日至2013年12月31日所有住院时间超过48小时的手术病人的基本资料，由这部分手术病人组成研究队列，对其进行目标性监测，观察其至出院、发生医院感染或死亡，将发生医院感染的手术病人纳入病例组，未发生医院感染者纳入对照组，通过对病例组和对照组间差异的比较，研究医院感染与危险因素的相关性，估计医院感染与危险因素间的联系强度。 研究结果 1、本研究共调查手术病人3804例，发生医院感染者219例，即病例组219例，对照组3585例，医院感染发病率为5.8%，发病密度为6.7‰，漏报率为12.7%。 2、手术病人医院感染的主要类型为下呼吸道感染。 3、通过Logistic回归分析结果显示：男性手术病人医院感染发病强度高于女性手术病人；15-59岁年龄组医院感染发病强度最低，14岁及其以下年龄组手术病人发病强度次之，60岁及其以上年龄组医院感染发病强度最高；术前预防性使用抗菌药物可以有效降低医院感染发病强度；随着术前住院时间、手术持续时间延长，医院感染发病强度随之相应增加；择期手术病人医院感染发病强度小于急诊手术者；全麻手术病人医院感染发病强度高于其它麻醉方式的手术病人；侵入性操作、手术切口类型是手术病人医院感染独立的危险因素。 4、所有手术病人的平均危险因素指数为1.7。各外科科室中，胸外科的危险因素指数最高，妇产科的危险因素指数最低。 5、进行危险因素指数调整后，医院感染的发病密度排序与排序前有所变化，普外科标化后发病密度排序下降；妇产科标化后发病密度排序明显升高。 6、本研究显示外科预防性使用抗菌药物仍以术后预防用药为主，存在预防性用药时间不恰当的问题。 7、手术病人医院感染以G-菌为主，其次为G+菌，常见病原微生物有：大肠埃希菌、铜绿假单胞菌、鲍曼氏不动杆菌。 8、病例组医疗费用中位数为19897.1元，对照组医疗费用中位数为6584.6元，两组具有统计学意义，即病例组花费的医疗费用明显高于对照组。 研究结论 1、本研究结果显示，手术病人医院感染的主要类型为下呼吸道感染，因此，通过控制手术病人下呼吸道感染可以有效降低医院感染的发病强度。 2、本次研究显示，男性患者、60岁及其以上患者、术前未预防性使用抗菌药药物、术前住院时间大于3天、急诊、全麻、手术切口类型、手术持续时间大于2小时、侵入性操作是手术病人医院感染的独立危险因素。 3、使用发病密度、标化发病密度等指标描述医院感染发病情况，更具可比性、合理性、科学性。 4、本研究采用前瞻性巢式病例对照研究对手术病人医院感染发病情况进行前瞻性的观察研究，可以精确地估计医院感染的发病强度。
[Abstract]:research objective
To study the incidence of nosocomial infection in surgical patients, and to describe the incidence of nosocomial infection by disease density, risk factor index and other indicators; to explore a prospective nested case-control study to carry out a methodological study of nosocomial infection in susceptible population; to study the risk factors of nosocomial infection in surgical patients and to carry out a population susceptible to nosocomial infection. Standardized surveillance. Through target surveillance of nosocomial infections in surgical patients, the actual situation of nosocomial infections can be further mastered to provide reference for the relevant departments of hospitals to monitor nosocomial infections, and then make them take effective measures to control the existing problems of nosocomial infections, prevent the occurrence of nosocomial infections, and cope with sudden outbreaks for general hospitals. We will lay a solid foundation for public health events.
research method
In this study, a prospective nested case-control study was conducted to collect the basic data of all surgical patients who had been hospitalized for more than 48 hours from January 1, 2013 to December 31, 2013 in a hospital. Operative patients with nosocomial infection were included in the case group and those without nosocomial infection were included in the control group. The correlation between nosocomial infection and risk factors was studied by comparing the differences between the case group and the control group.
Research results
1. A total of 3804 surgical patients were investigated in this study. 219 cases of nosocomial infection occurred in this study, including 219 cases in case group and 3585 cases in control group.
2, the main type of nosocomial infection in surgical patients is lower respiratory tract infection.
3. Logistic regression analysis showed that the incidence of nosocomial infection in male patients was higher than that in female patients; the incidence of nosocomial infection in 15-59 years old group was the lowest, followed by those in 14 years old and under, and the incidence of nosocomial infection was the highest in 60 years old and above. Antibiotics can effectively reduce the incidence of nosocomial infection; with the preoperative hospital stay, prolonged operation duration, the incidence of nosocomial infection increased accordingly; selective surgery patients with nosocomial infection intensity is less than emergency surgery; general anesthesia surgery patients with nosocomial infection intensity is higher than other anesthesia surgery patients. Invasive operation and type of surgical incision are independent risk factors for hospital infection of surgical patients.
4. The average risk factor index of all surgical patients was 1.7. The risk factor index of thoracic surgery was the highest and that of Obstetrics and Gynecology was the lowest.
5. After adjusting the risk factor index, the order of incidence density of nosocomial infections changed before and after standardization, the order of incidence density decreased after standardization of general surgery, and the order of incidence density increased significantly after standardization of Obstetrics and gynecology.
6. Preventive use of antibiotics in surgery is still dominated by postoperative prophylactic use, and there is a problem of inappropriate prophylactic use of antibiotics.
7. The nosocomial infection of surgical patients was mainly caused by G-bacteria, followed by G+ bacteria. The common pathogenic microorganisms were Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii.
8. The median medical cost of the case group was 19897.1 yuan and that of the control group was 6584.6 yuan. There was significant difference between the two groups, that is, the medical cost of the case group was significantly higher than that of the control group.
research conclusion
1. The results of this study showed that the main type of nosocomial infection in surgical patients was lower respiratory tract infection. Therefore, controlling lower respiratory tract infection in surgical patients can effectively reduce the incidence of nosocomial infection.
2. This study showed that male patients, 60 years old and above, did not use prophylactic antibiotics before surgery, preoperative hospitalization time was more than 3 days, emergency, general anesthesia, type of surgical incision, operation duration was more than 2 hours, invasive operation was an independent risk factor for hospital infection of surgical patients.
3. It is more comparable, reasonable and scientific to describe the incidence of nosocomial infection by using disease density and standardized disease density.
4. A prospective nested case-control study was used to observe the incidence of nosocomial infection in surgical patients, and the incidence of nosocomial infection could be accurately estimated.
【学位授予单位】：广东药学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.3
本文编号：2222862
[Abstract]:research objective
To study the incidence of nosocomial infection in surgical patients, and to describe the incidence of nosocomial infection by disease density, risk factor index and other indicators; to explore a prospective nested case-control study to carry out a methodological study of nosocomial infection in susceptible population; to study the risk factors of nosocomial infection in surgical patients and to carry out a population susceptible to nosocomial infection. Standardized surveillance. Through target surveillance of nosocomial infections in surgical patients, the actual situation of nosocomial infections can be further mastered to provide reference for the relevant departments of hospitals to monitor nosocomial infections, and then make them take effective measures to control the existing problems of nosocomial infections, prevent the occurrence of nosocomial infections, and cope with sudden outbreaks for general hospitals. We will lay a solid foundation for public health events.
research method
In this study, a prospective nested case-control study was conducted to collect the basic data of all surgical patients who had been hospitalized for more than 48 hours from January 1, 2013 to December 31, 2013 in a hospital. Operative patients with nosocomial infection were included in the case group and those without nosocomial infection were included in the control group. The correlation between nosocomial infection and risk factors was studied by comparing the differences between the case group and the control group.
Research results
1. A total of 3804 surgical patients were investigated in this study. 219 cases of nosocomial infection occurred in this study, including 219 cases in case group and 3585 cases in control group.
2, the main type of nosocomial infection in surgical patients is lower respiratory tract infection.
3. Logistic regression analysis showed that the incidence of nosocomial infection in male patients was higher than that in female patients; the incidence of nosocomial infection in 15-59 years old group was the lowest, followed by those in 14 years old and under, and the incidence of nosocomial infection was the highest in 60 years old and above. Antibiotics can effectively reduce the incidence of nosocomial infection; with the preoperative hospital stay, prolonged operation duration, the incidence of nosocomial infection increased accordingly; selective surgery patients with nosocomial infection intensity is less than emergency surgery; general anesthesia surgery patients with nosocomial infection intensity is higher than other anesthesia surgery patients. Invasive operation and type of surgical incision are independent risk factors for hospital infection of surgical patients.
4. The average risk factor index of all surgical patients was 1.7. The risk factor index of thoracic surgery was the highest and that of Obstetrics and Gynecology was the lowest.
5. After adjusting the risk factor index, the order of incidence density of nosocomial infections changed before and after standardization, the order of incidence density decreased after standardization of general surgery, and the order of incidence density increased significantly after standardization of Obstetrics and gynecology.
6. Preventive use of antibiotics in surgery is still dominated by postoperative prophylactic use, and there is a problem of inappropriate prophylactic use of antibiotics.
7. The nosocomial infection of surgical patients was mainly caused by G-bacteria, followed by G+ bacteria. The common pathogenic microorganisms were Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii.
8. The median medical cost of the case group was 19897.1 yuan and that of the control group was 6584.6 yuan. There was significant difference between the two groups, that is, the medical cost of the case group was significantly higher than that of the control group.
research conclusion
1. The results of this study showed that the main type of nosocomial infection in surgical patients was lower respiratory tract infection. Therefore, controlling lower respiratory tract infection in surgical patients can effectively reduce the incidence of nosocomial infection.
2. This study showed that male patients, 60 years old and above, did not use prophylactic antibiotics before surgery, preoperative hospitalization time was more than 3 days, emergency, general anesthesia, type of surgical incision, operation duration was more than 2 hours, invasive operation was an independent risk factor for hospital infection of surgical patients.
3. It is more comparable, reasonable and scientific to describe the incidence of nosocomial infection by using disease density and standardized disease density.
4. A prospective nested case-control study was used to observe the incidence of nosocomial infection in surgical patients, and the incidence of nosocomial infection could be accurately estimated.
【学位授予单位】：广东药学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.3
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