| ObjectNosocomial infection has become a big problem in the field of global health, not only the serious influence of hospitalized patients with rehabilitation, extend the length of hospital stay, causing unnecessary economic losses, but also pose a threat to the medical staff occupational safety. How to control the nosocomial infection and improve the quality of medical treatment, ensure the medical new technology, new methods and medical work smoothly functioning, is all levels of hospital managers need to pay close attention to the reality of the problem. This study based on a comprehensive hospital from2010to2012the nosocomial infection monitoring of registration data, analysis the current situation of comprehensive hospital of hospital infection, and grasp the characteristics and development trend of hospital infection, nosocomial infection work results and there is still a problem, analysis the influence factors of hospital infection, main clinical departments of hospital medical staff at the same time, the questionnaire survey to understand their perception of nosocomial infection situation, found that there were problems, so that targeted to strengthen education and training, improve the management level of hospital infection. Finally put forward reasonable advice and Suggestions for hospital managers should do a better job of nosocomial infection prevention, control and management to provide the reference, thereby reducing the occurrence of hospital infection, avoid infection outbreak, rising to ensure the quality of medical treatment, medical safety guarantee, shorten the hospital stay time, reduce medical costs, reduce unnecessary waste of resources, and ultimately achieve good economic and social benefits.MethodAdopt the method of retrospective analysis and study of a hospital from2010to2012cases of nosocomial infection for the patients in comparative analysis, access to diagnosis of nosocomial infection in medical record home page of medical record information, records of the general conditions, demographic characteristics and inpatient nosocomial infection associated risk factors, mainly analyzes the hospitalized patients generally:gender, age, department, hospital stays, infection time and so on, for the study of classification, comparison and analysis to provide information. Nosocomial infection status:whether the hospital infection, infection of parts (upper respiratory tract infection, infection of lower respiratory tract infection, blood, etc), the infection department (medical, surgical system, other departments, etc.) and the use of antimicrobial agents, sorts and drug resistance of pathogens. Nosocomial infection risk factors:whether urinary tract intubation, breathing machine use, radiation therapy, chemotherapy, tracheotomy, etc. Using questionnaire to investigate the main department of clinical medical staff, understand their cognition of the nosocomial infection knowledge, mainly including the basic concept of hospital infection, nosocomial infection control and prevention, hand hygiene behavior and cognition of occupational exposure and self-protection. SWOT analysis, analysis of the current internal and external environment and conditions of nosocomial infection management strengths, weaknesses, opportunities and threats. Integrated use of statistical analysis method to analyze the related data, the rate of nosocomial infection rates, infected cases, basic situation questionnaire and form than as a descriptive statistical analysis, using the chi-square test methods such as hypothesis testing, for of time data does not obey normal distribution, using the nonparametric tests, P=0.05as the inspection level.ResultNosocomial infection generally, survey2010-2012discharged patients,174211,107954men and66257women, hospitalization infection occurs,4302,4620times, general hospital infection rate2.47%,infection cases rate was2.65%, infection non-response rates at1.91%, specimens were at a rate of34.7%.Nosocomial infection demographic characteristics, there are differences between the different gender patients with nosocomial infection rates, male patients in general nosocomial infection rate was2.54%, higher than that of femal epatients (x2=6.02, P=0.014). Is different between different age groups in patients with hospital infection rate, most infections in the aged60and above group, the highest infection rate, at3.85%(x2=673.69, P<0.001).Different age groups patients admitted to hospital after infection duration and number of days also have differences, the age of15and under average age group infection after admission, the fastest time was13.54days (x2=59.74, P=0.000), the longest in the aged60and above group, was9.59days (x2=147.92, P=0.000).Distribution of hospital infection, length of hospital stay in patients with different infection rate was statistically significant,30～,60～infection rates were9.32%,11.4%, significantly higher than other groups (x2=3845.96, P=0.000).There are differences between the infection rate in different seasons, the highest infection rates were the second and third quarter,2.54%and2.94%.Different infection department also has difference, followed by internal system (3.02%)in pediatrics, surgery system (2.4%). Internal medicine system in each department, high infection rates were blood internal medicine department (16.79%), geriatrics department (4.8%), nerve internal medicine (4.78%), surgical system, infection rates high (21.35%), respectively, the ICU, neurosurgery department (8.77%), pediatric surgery (3.21%), other departments in the rehabilitation department infection rate (6.83%), oncology is2.65%. Hospital infection site form than was followed by upper respiratory tract infection (33.16%), lower resPiratory tract infection (29.31%), gastrointestinal tract infection (7.77%).Pathogenic bacteria distribution and drug resistance,2010-2012yearly check out most of the pathogenic bacteria was acinetobacter baumannii (16.46%), followed by staphylococcus aureus (12.55%), the third is the e. coli (12.13%), fungus is in the lead of candida albicans. Staphylococcus aureus for Rio nai azole alkane, vancomycin and their stead resistance are0, but resistance to other antibiotics were higher than65%, e. coli to produce super broad spectrum to decide-lactamase (ESBL) was57.2%, to the United States e.faecalis, imine south resistant rate of0, acinetobacter baumannii resistance is one of the most serious in all negative bacillus, for all of antimicrobial agents have certain resistance.Hospital infection associated risk factors, single factor analysis showed that arteriovenous intubation and tracheotomy, long-term lie in bed, surgery, chemotherapy, urinary tract intubation, use of immune suppressants, coma, nine factors such as cirrhosis of the liver is a risk factor, for the influence of hospital infection have significant difference (P<0.05).introducing the unconditioned multi-factor stepwise logistic regression model analysis, the results showed that intravenous cannula, long-term lie in bed, operation, immunosuppressants, coma and so on five factors are the risk factors of hospital infection.Medical staff in hospital infection basic concept of cognitive, definition of hospital infection, hospital infection outbreak and the hospital infection management norms of have no significant difference (P>0.05) cognition, including specification for hospital infection management awareness is generally low,5.3%doctor said clearly that the nurse was2.1%. Diagnostic criteria for hospital infection, the harm of hospital infection, hospital infection cognitive medical staff there are differences of the three key elements (P<0.05), the overall awareness is better than the doctor nurse, Different degree in medical staff in addition to the Perception of hospital infection harm no difference, all have differences in other ways(P<0.05).Different title doctor harm definition of hospital infection, hospital infection, hospital infection of susceptible people cognitive differences, different titles harm nurses on hospital infection, hospital infection transmission way cognitive differences, other nurses cognition have different title differences (P<0.05).Medical staff in the cognition of hospital infection prevention and control, for disinfection method, medical waste treatment did not differ between the cognitive, medical staff awareness is higher, the report system of hospital infection, hospital infection control and prevention, the basic measures of cognition, there are differences between the medical personnel(P<0.05),the doctor awareness is higher than the nurse.Different titles there are differences between the medical personnel in the cognition of infection prevention and control(P<0.05).Medical staff hand hygiene, medical staff in the correct way to wash your hands said clear cognition of48.7%,41.7%respectively, both no statistical difference, the doctor for hand washing is important means to prevent the transmission of pathogens clear cognition was30.7%, the number of nurses was16.1%, there are differences between the two.Different gender and academic staff in the correct way to wash your hands of cognitive differences, for hand washing is important means to prevent the transmission of pathogens of cognitive differences.Hand washing by medical personnel before handling patients have differences, the doctor has to wash their hands was29%, the nurse was54.2%, and after contact with patients and contacts of hand washing behavior has no difference between different patients, doctors were76%and23%respectively, the nurse were68.2%and21.9%respectively.Different titles to wash their hands of medical staff in Patients with different contact time behavior have difference.Perception of occupational exposure, the doctor50.2%said clear,5.3%of people don’t know, nurse is40.1%,13%don’t know, there are differences between the two. Different gender, different degree, the title of the medical staff there are differences in perception of occupational exposure. The doctor was stabbed with12.7%of people in work, nurse with27.1%, statistically significant. Among them,84.5%of doctors stabbed choice immediately report, to conduct, on its own15.5%nurses have64.1%reported immediately,35.9%will handle themselves, no choice, difference was statistically significant,75.6%of the doctors and nurses to attend hospital infection knowledge education training activities.Nosocomial infection management of SWOT analysis, Strength:hospital strength, with advanced technology. Nosocomial infection management system perfect, perfect organization system, effective information management system of hospital. Weakness:the hospital infection management personnel structure is not reasonable.The consciousness of medical personnel to prevent infection lack. The use of antimicrobial agents. Opportunity:to3armour hospital review as an opportunity to promote the medical quality constantly improve.Floor to carry out quality management circle, activities, strengthen the consciousness of medical staffs sense of control. Implementation of urban and rural residents health care system, be helpful for hospital infection management work smoothly.Threat:the difficulty of critical cases increased as potential risk factors for infection. Become the new challenges for hospital infection multi-resistant bacteria.The doctor-patient relationship nervous to hospital infection control is a wake-up call.ConclutionDischarged patients from2010to2012,174211people,in hospital infection occurs during4302,4620times, general hospital infection rate2.47%, infection cases rate was2.65%,infection rate is on the rise.The non-response rates at1.91%, hospital infection declined year by year. Specimens of pathogenic microorganism inspection rate of34.70%, rising. There are differences between the different gender patients with hospital infection rates, infection rates are higher than women. Infection rate in patients with different age grouPs also have differences, the older the higher infection rate.The low age group patients admitted to hospital infection before and after the fastest time, high infection after the longest age patients. Different length of hospital stay of patients with infections, the longer the length of hospital stay, the higher infection rates. Infection rates in different seasons have differences, the second and the third quarter of the hospital infection rate is higher.Different departments of the hospital infection rate also have differences, internal system infection rate is highest, ICU is composed of the highest infection rates department (21.35%).Hospital infection site form than was followed by upper respiratory tract infection (33.16%), lower respiratory tract infection (29.31%), gastrointestinal tract infection (7.77%), patients with different gender, different age groups there are differences between the distribution of the infection.2010-2012samples detected by most of the pathogenic bacteria was followed by acinetobacter baumannii (16.46%), staphylococcus aureus (12.55%), e. coli (12.13%). Acinetobacter baumannii in all antimicrobial agents have certain resistance, staphylococcus aureus for Rio nai azole alkane, vancomycin and their stead resistance are0, e. coli to e.faecalis, imine south resistant rate to zero. The unconditioned multi-factor stepwise logistic regression model analysis, the results showed that intravenous cannula, long-term lie in bed, operation, immunosuppressants, coma and so on five factors for the risk factors of hospital infection. It suggests that we need to strengthen a high incidence of vulnerable groups, departments, key parts of the targeted monitoring, strict operation management, reduce the necessity of invasive operation, not as much as possible to control the hospital infection risk factors.Attaching importance to and increase the rate of pathogenic microorganisms specimen inspection, accurately grasping the drug resistance of pathogenic bacteria, scientific and rational use of antimicrobial agents, avoid double infection and the emergence of multi-resistant bacteria.Further improve the hospital infection three-level management structure and the related rules and regulations, establish long-term effective mechanism of hospital infection management, management personnel should often under clinical departments supervise and urge to guide, to carry out the infection prevention measures, system, constantly improve the system of execution.Give full play to the important role of information technology in hospital infection management, the use of standardization, standardization of electronic medical record system to achieve real-time monitoring of the patient condition, enhance the timeliness and accuracy of infection control, improve the work efficiency.Basic concept of medical staff to hosPital infection and hospital infection prevention and control of general awareness is not high, the doctor is better than a nurse. Rate of health care workers to wash their hands after contact with patients is significantly higher than contact with patients and contacts between different patients before washing rate.Female medical staff hand washing compliance is higher than male.Doctors cognition of occupational exposure and self-protection consciousness than the nurse, nurse the occupational risk bigger, is the number of sharp instrument wound than doctors.Different degree and the title of medical staff about hospital infection knowledge of cognitive differences, highly educated, high title of the medical staff clear advantage. Therefore, hospitals should develop the standardization of the hospital infection knowledge training activities regularly, and into the evaluation system, can through the form of lecture popularize basic knowledge of hospital infection, self-protection and hospital infection prevention and control measures, rational use of antimicrobial agents, such as content, strengthen the cognition of hospital infection among health care workers, perfect the relevant rules and regulations, strengthen medical staff occupational exposure monitoring and prevention work.Enhance the promotion of hand hygiene education, behavior intervention for health care providers, and let the medical staff to fully realize the importance of hand washing and necessity, improve the compliance of hand washing, hand hygiene to rise to the height of the hospital culture.Hospital infection management advantage began to emerge and play a role, but still own disadvantage, opportunities and threats coexist, In the future to strengthen hospital infection management talent team construction, to rationalize the management structure and at the same time to strengthen the medical staff education training, improve the responsibility consciousness and the ego to protect consciousness, strictly regulate the rational use of antibiotics.Fully grasp the third review and qc circle, this opportunity, effective control of weak links, continue improve the quality of medical treatment. Constantly improve, the use of advantages and opportunities, monitor, eliminate the disadvantages and threats, finally realizes the infection control work in the oPtimal situation. |
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