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本文回顾性地分析了1985年1月～1989年12月606例以非感染性疾病收留住院超过48小时的NICU住院新生儿,有69例发生医院内获得性细菌感染,总感染率为11.4％,其中出生体重<1500g 24例,感染率占18.9％,出生体重>1500g 45例,占9.4％,经统计学分析,x~2=12.14,P<0.001,两者有显著差异。院内感染部位主要为呼吸道感染和败血症,感染率分别为49.3％和37.7％,其他有皮肤、消化道等感染。败血症中血培养革兰氏阴性杆菌占23.1％,革兰氏阳性菌占15.4％。呼吸道感染气管分泌物培养革兰氏阴性杆菌占51.5％,革兰氏阳性菌占15.2％。认为NICU医院内获得性细菌感染的来源有:(1) 病人自身带菌,尤其是住院时间长或危重病儿;(2) 监护、支持、治疗设备及医务人员手的污染;(3) 损伤性的诊断和治疗手段,如气管插管、口咽吸引、脐动静脉插管、动静脉穿刺等;(4) 广谱和多种抗生素的联合应用改变了机体的“正常菌群”;并通过医务人员的手与病人接触,引起病人之间的病菌传播。医院内感染延长住院时间,提高死亡率。本文报告因医院内感染而死亡的占10.2％,明显地高于无医院内感染的死亡率,后者占3.7％,x~2=5.9,P<0.02,有显著差异。因此,应严格遵守无菌操作,仪器设备的无菌消毒,并强调医务人员勤洗手是降低医院内感染率的主要措施。
This retrospective analysis of January 1985 ~ December 1989 606 cases of non-infectious disease hospitalized more than 48 hours hospitalized NICU hospitalized newborns, 69 cases of hospital acquired bacterial infections, the total infection rate was 11.4% , Including birth weight <1500g in 24 cases, the infection rate was 18.9%, birth weight> 1500g 45 cases, accounting for 9.4%, by statistical analysis, x ~ 2 = 12.14, P <0.001, significant difference between the two. Nosocomial infections mainly respiratory tract infections and sepsis, the infection rates were 49.3% and 37.7%, the other skin, digestive tract and other infections. Gram-negative bacilli accounted for 23.1% of the blood in sepsis and Gram-positive bacteria accounted for 15.4%. Respiratory tract tracheal secretions culture Gram-negative bacilli accounted for 51.5%, Gram-positive bacteria accounted for 15.2%. The sources of acquired bacterial infections in NICU hospitals are considered to be: (1) patients carrying themselves, especially long-term hospital stays or critically ill children; (2) contamination of care, support, treatment equipment and medical staff; (3) Such as endotracheal intubation, umbilical arteriovenous cannulation, arteriovenous puncture, etc .; (4) the combination of broad-spectrum and multiple antibiotics has changed the “normal flora” of the body; and passed Medical staff’s hands and patient contact, causing the spread of germs between patients. Hospital infection prolongs hospital stay and increases mortality. This article reports 10.2% of deaths due to nosocomial infections, significantly higher than those without nosocomial infections, the latter accounting for 3.7%, x ~ 2 = 5.9, p <0.02, with significant differences. Therefore, we should strictly abide by aseptic techniques, aseptic disinfection of instruments and equipment, and emphasize that medical staff should wash their hands frequently to reduce the rate of infection in the hospital.