【摘要】：研究目的 研究手術(shù)病人醫(yī)院感染的發(fā)病情況，并采用發(fā)病密度、危險因素指數(shù)等指標(biāo)描述醫(yī)院感染的發(fā)病強(qiáng)度；探索采用前瞻性巢式病例對照研究方法開展易感人群醫(yī)院感染的方法學(xué)研究；研究手術(shù)病人醫(yī)院感染危險因素，進(jìn)行易感人群目標(biāo)性監(jiān)測。通過對手術(shù)病人醫(yī)院感染情況進(jìn)行目標(biāo)性監(jiān)測，，進(jìn)一步掌握醫(yī)院感染實際情況，為醫(yī)院有關(guān)部門進(jìn)行醫(yī)院感染監(jiān)測提供參考依據(jù)，進(jìn)而使其采取有效措施控制醫(yī)院感染現(xiàn)存問題，預(yù)防醫(yī)院感染發(fā)生，同時為綜合性醫(yī)院應(yīng)對突發(fā)公共衛(wèi)生事件奠定堅實的基礎(chǔ)。 研究方法 本研究采用前瞻性巢式病例對照研究的方法，收集某醫(yī)院2013年1月1日至2013年12月31日所有住院時間超過48小時的手術(shù)病人的基本資料，由這部分手術(shù)病人組成研究隊列，對其進(jìn)行目標(biāo)性監(jiān)測，觀察其至出院、發(fā)生醫(yī)院感染或死亡，將發(fā)生醫(yī)院感染的手術(shù)病人納入病例組，未發(fā)生醫(yī)院感染者納入對照組，通過對病例組和對照組間差異的比較，研究醫(yī)院感染與危險因素的相關(guān)性，估計醫(yī)院感染與危險因素間的聯(lián)系強(qiáng)度。 研究結(jié)果 1、本研究共調(diào)查手術(shù)病人3804例，發(fā)生醫(yī)院感染者219例，即病例組219例，對照組3585例，醫(yī)院感染發(fā)病率為5.8%，發(fā)病密度為6.7‰，漏報率為12.7%。 2、手術(shù)病人醫(yī)院感染的主要類型為下呼吸道感染。 3、通過Logistic回歸分析結(jié)果顯示：男性手術(shù)病人醫(yī)院感染發(fā)病強(qiáng)度高于女性手術(shù)病人；15-59歲年齡組醫(yī)院感染發(fā)病強(qiáng)度最低，14歲及其以下年齡組手術(shù)病人發(fā)病強(qiáng)度次之，60歲及其以上年齡組醫(yī)院感染發(fā)病強(qiáng)度最高；術(shù)前預(yù)防性使用抗菌藥物可以有效降低醫(yī)院感染發(fā)病強(qiáng)度；隨著術(shù)前住院時間、手術(shù)持續(xù)時間延長，醫(yī)院感染發(fā)病強(qiáng)度隨之相應(yīng)增加；擇期手術(shù)病人醫(yī)院感染發(fā)病強(qiáng)度小于急診手術(shù)者；全麻手術(shù)病人醫(yī)院感染發(fā)病強(qiáng)度高于其它麻醉方式的手術(shù)病人；侵入性操作、手術(shù)切口類型是手術(shù)病人醫(yī)院感染獨立的危險因素。 4、所有手術(shù)病人的平均危險因素指數(shù)為1.7。各外科科室中，胸外科的危險因素指數(shù)最高，婦產(chǎn)科的危險因素指數(shù)最低。 5、進(jìn)行危險因素指數(shù)調(diào)整后，醫(yī)院感染的發(fā)病密度排序與排序前有所變化，普外科標(biāo)化后發(fā)病密度排序下降；婦產(chǎn)科標(biāo)化后發(fā)病密度排序明顯升高。 6、本研究顯示外科預(yù)防性使用抗菌藥物仍以術(shù)后預(yù)防用藥為主，存在預(yù)防性用藥時間不恰當(dāng)?shù)膯栴}。 7、手術(shù)病人醫(yī)院感染以G-菌為主，其次為G+菌，常見病原微生物有：大腸埃希菌、銅綠假單胞菌、鮑曼氏不動桿菌。 8、病例組醫(yī)療費用中位數(shù)為19897.1元，對照組醫(yī)療費用中位數(shù)為6584.6元，兩組具有統(tǒng)計學(xué)意義，即病例組花費的醫(yī)療費用明顯高于對照組。 研究結(jié)論 1、本研究結(jié)果顯示，手術(shù)病人醫(yī)院感染的主要類型為下呼吸道感染，因此，通過控制手術(shù)病人下呼吸道感染可以有效降低醫(yī)院感染的發(fā)病強(qiáng)度。 2、本次研究顯示，男性患者、60歲及其以上患者、術(shù)前未預(yù)防性使用抗菌藥藥物、術(shù)前住院時間大于3天、急診、全麻、手術(shù)切口類型、手術(shù)持續(xù)時間大于2小時、侵入性操作是手術(shù)病人醫(yī)院感染的獨立危險因素。 3、使用發(fā)病密度、標(biāo)化發(fā)病密度等指標(biāo)描述醫(yī)院感染發(fā)病情況，更具可比性、合理性、科學(xué)性。 4、本研究采用前瞻性巢式病例對照研究對手術(shù)病人醫(yī)院感染發(fā)病情況進(jìn)行前瞻性的觀察研究，可以精確地估計醫(yī)院感染的發(fā)病強(qiáng)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.
【學(xué)位授予單位】：廣東藥學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.3

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