重症监护室目标监测感染控制范围的建立及应用

Establishment and application of nosocomial infection control range for intensive care unit target monitoring

摘要:

目的：建立重症监护室（intensive care unit，ICU）的月医院感染发病率的控制范围，为医院感染的控制提供一种科学的方法。方法：依据统计学医学参考值范围的原理：正态分布下曲线面积的规律，数值落在（-∞，x+1.64s）的区域概率为95%，若有数据超出此值，则需要提醒临床科室注意；数值落在（-∞，x+2.33s）的区域概率为99%，若有数据超出此值，则表明质量失控。分别统计本院2011年1月至2012年6月呼吸ICU、神内ICU、中心ICU、神外ICU、心胸外ICU目标监测的资料，确立各ICU月医院感染发病率的预警限和控制限，于2012年7月至今对超出预警限的临床科室进行反馈，对超出控制限的临床科室进行反馈干预。结果：确立了各ICU月医院感染发病率的预警限和控制限，其中神外ICU月医院感染发病率的控制限是22.39%，2012年8月神外ICU的医院感染发病率超出控制限，分析反馈干预后，该ICU 9月至11月的医院感染发病率下降。结论：本文已确立ICU的月医院感染发病率的控制范围，可以此来判断ICU的医院感染的流行趋势，及时预警，作为各ICU比较的衡量标准，保证持续改进的质量控制过程，是一种值得推荐的科学方法。

Abstract:

Objective：To establish the control range of the monthly nosocomial infection incidence for intensive care unit（ICU） and to offer a scientific method for controlling nosocomial infection. Methods：Based on the statistical theory of medical reference range：value falls in the region of the warning limit is less than the probability of 95% for the area under the normal distribution curve. If the value exceeds the limit，attention should be paid by the clinical department. While the value falls in the region of the control limit is less than the probability of 99% for the area under the normal distribution curve. If the value exceeds the limit，it indicates out of control. Target monitoring data of respiratory ICU，neurology ICU，comprehensive ICU，neurosurgery ICU，cardiothoracic ICU from January 2011 to June 2012 were separately collected to establish the warning limit and control limit of the monthly nosocomial infection incidence. Nosocomial infection incidences of these ICUs since July 2012 were compared with the warning limit and control limit to find out the abnormal values. Feedback was returned to the units when the value exceeded the warning limit. Intervention was made when the value exceeded the control limit. Results：The warming limit and the control limit of monthly nosocomial infection incidence for dif－ferent ICU had been established. The control limit of monthly nosocomial infection incidence for neurosurgery ICU was 22.39%. Nosocomial infection incidence of neurosurgery ICU exceeded the control limit in August 2012. Nosocomial infection incidence of neuro－surgery ICU decreased the following three months after analysis，feedback and intervention. Conclusions：Establishing control range of the monthly nosocomial infection incidence is recommendable since it can warn the tendency of the nosocomial infection，assess the nosocomial infection incidence levels of different ICUs and ensure the continuous quality control.