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目的分析无锡市某三级医院重症监护病房(ICU)住院患者医院感染危险因素,探讨有效控制措施,为制定医院感染预防与控制策略提供依据。方法按照随机抽样原则,在2012年1月-2014年12月无锡市某三级医院ICU目标性监测中,随机抽取100例诊断为医院感染的患者为感染组,100例未发生医院感染的患者为对照组,进行病例对照研究。采用Epi Data 2.0软件录入数据,建立数据库,采用SPSS 13.0软件进行统计学分析。两组资料进行t检验和χ2检验后,用多因素条件logistic回归模型分析医院感染危险因素,检验水准α=0.05。结果单因素分析结果显示,糖尿病、低蛋白血症、长期卧床、手术、免疫抑制剂使用、激素使用、器官移植、气管插管、住院时间、机械通气时间、中心静脉置管时间、导尿时间、置胃管时间共13项因素指标,组间差异有统计学意义(P<0.05),感染组高于对照组,是ICU医院感染的危险因素;多因素logistic回归分析显示住院时间≥7 d[OR=1.106,95%CI(1.025,1.096),P=0.001],糖尿病[OR=2.770,95%CI(1.068,7.186),P=0.036],手术[OR=7.524,95%CI(2.352,24.063),P=0.001],机械通气时间≥7 d[OR=1.222,95%CI(1.116,1.339),P<0.001],置胃管时间≥7 d[OR=1.110,95%CI(1.035,1.190),P=0.003]为医院感染的独立危险因素。结论住院时间≥7 d、糖尿病、手术、机械通气时间≥7 d和置胃管时间≥7 d是ICU医院感染的主要危险因素,对危险因素尽早干预,并实施有效的综合预防措施,对有效降低医院感染的发生率,保障医疗安全有重要意义。
Objective To analyze the risk factors of nosocomial infection in hospitalized patients in intensive care unit (ICU) of a tertiary hospital in Wuxi City, and to explore effective control measures to provide the basis for the development of nosocomial infection prevention and control strategies. Methods According to the principle of random sampling, 100 patients diagnosed as nosocomial infection were randomly selected from the ICU target surveillance of a tertiary hospital in Wuxi from January 2012 to December 2014, and 100 patients without nosocomial infection As a control group, a case-control study. Epi Data 2.0 software was used to input data and establish a database. SPSS 13.0 software was used for statistical analysis. Two groups of data t test and χ2 test, multivariate conditional logistic regression analysis of hospital risk factors for infection, test level α = 0.05. Results The results of univariate analysis showed that diabetes, hypoalbuminemia, prolonged bed rest, operation, immunosuppressant use, hormone use, organ transplantation, endotracheal intubation, hospital stay, mechanical ventilation time, central venous catheterization time, catheterization time (P <0.05). The infection group was higher than that of the control group, which was the risk factor for ICU nosocomial infection. Multivariate logistic regression analysis showed that the hospitalization time was ≥7 days (OR = 1.106, 95% CI 1.025, 1.096, P 0.001), diabetes mellitus [OR = 2.770,95% CI 1.068,7.186, P = 0.036] , 24.063, P = 0.001], duration of mechanical ventilation ≥7 days [OR = 1.222,95% CI 1.116,1.339, P <0.001] 1.035, 1.190), P = 0.003] were independent risk factors for nosocomial infections. Conclusions The hospitalization time of ≥7 days, diabetes, surgery, mechanical ventilation time≥7 days and gastric tube placement time≥7 days are the main risk factors of ICU hospital infection. Early intervention of risk factors and implementation of effective comprehensive preventive measures are effective for effective Reduce the incidence of nosocomial infections, to ensure medical safety is of great significance.