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目的了解新生儿重症监护病房(NICU)医院感染规律,以便采取更有效的控制措施。方法采用目标性监测的方法,研究NICU医院感染发病率及部位分布,监测NICU呼吸机相关性肺炎及脐中心静脉插管相关性感染发病率及其病原菌分布情况,感染率结果采用平均住院日调整法(ALOS)进行调整。结果2008年6月1日至11月30日间,NICU共收治危重新生儿1 289人次,发生医院感染173例次,医院感染例次发病率为13.42%。呼吸机相关性肺炎感染率为4.22‰,ALOS调整感染率为0.33‰。脐/中心静脉插管血管相关性感染率为3.46‰,ALOS调整感染率为0.27‰。呼吸机相关性肺炎患儿培养出28株病原菌中,G-杆菌占71.43%,G+球菌占17.86%,真菌占10.71%。脐/中心静脉插管血管相关性感染患儿培养出13株病原菌中,G+球菌占61.54%,G-杆菌占23.08%,真菌和G+杆菌各占7.69%。结论NICU是医院感染监控的重点部门,目标性监测较全面监测更准确。提高医务人员手卫生依从性,严格执行无菌操作和消毒隔离制度,合理使用抗生素等对控制NICU医院感染至关重要。
Objective To understand the nosocomial infection patterns of neonatal intensive care unit (NICU) in order to take more effective control measures. Methods The objective surveillance method was used to study the incidence and distribution of nosocomial infections in NICU and to monitor the incidence of NICU-associated pneumonia and umbilicus veno-venous catheter-related infections and the distribution of pathogens in NICU. The infection rate was adjusted by average length of stay Law (ALOS) to adjust. Results Between June 1, 2008 and November 30, 2008, NICU admitted 1 289 critically ill newborns, 173 hospital nosocomial infections and 13.42% nosocomial infections. Ventilator-associated pneumonia infection rate was 4.22 ‰, ALOS adjusted infection rate was 0.33 ‰. Umbilical / central venous catheter-related vascular infection rate was 3.46 ‰, ALOS adjusted infection rate was 0.27 ‰. 28 strains of pathogens were cultured in ventilator-associated pneumonia, accounting for 71.43% of G-bacteria, 17.86% of G + bacteria and 10.71% of fungi. Of the 13 pathogenic bacteria isolated from umbilical / central venous cannula-associated vascular infections, G + bacteria accounted for 61.54%, G- bacteria accounted for 23.08% and fungi and G + bacteria accounted for 7.69% respectively. Conclusion NICU is the key department of hospital infection surveillance, and the target monitoring is more accurate than the comprehensive monitoring. Improving medical staff’s compliance with hand hygiene, strictly enforcing aseptic handling and disinfection and isolation, and rational use of antibiotics are of crucial importance in controlling NICU nosocomial infections.