Gurskis Vaidotas, Asembergiene Jolanta, Kevalas Rimantas, Miciuleviciene Jolanta, Pavilonis Alvydas, Valinteliene Rolanda, Dagys Algirdas
Unit of Pediatric Intensive Care, Clinic of Children's Diseases, Hospital of Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania.
Medicina (Kaunas). 2009;45(3):203-13.
The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections.
This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures.
A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05)
The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.
本研究旨在确定医院感染最重要的风险因素，评估多模式干预后医院感染的发病率及风险变化，并评估医院感染所致的死亡率。
这是一项前瞻性监测研究。于2005年1月至2007年12月期间，在三个儿科重症监护病房收集数据。研究纳入了所有年龄在1个月至18岁之间、在各病房住院超过48小时的患者。患者被分为干预前（2006年）和干预后（2007年）两组。多模式干预包括对工作人员进行教育以及实施循证感染控制措施。
本研究共纳入755名儿童。确定了医院感染的主要风险因素：机械通气、中心静脉置管、颅内压监测装置和气管切开术。总体而言，与干预前组相比，干预后医院感染的发病率（每百名患者中15.6例对7.5例，P = 0.002）、发病密度（每1000患者日中19.1例对10.4例，P = 0.015）以及肺炎发病率（每百名患者中5.6例对1.9例，P = 0.016）均有所下降。呼吸机相关性肺炎的相对风险降低率、绝对风险降低率和需治疗人数具有统计学意义（分别为66.5%、3.7%、27；P = 0.016）。有无医院感染患者的生存时间无显著差异（无感染患者为83.67患者日，有感染患者为74.33患者日，P>0.05）。
医院感染最重要的风险因素为机械通气、中心静脉置管、颅内压监测装置和气管切开术。多模式干预后，医院感染发病率及呼吸机相关性肺炎风险降低具有统计学意义。未确定医院感染对死亡率有显著影响。
