Department of Internal Medicine-Infectious Diseases, H.U. Virgen de la Arrixaca, Murcia, Spain.
Clin Microbiol Infect. 2011 Jun;17(6):894-900. doi: 10.1111/j.1469-0691.2010.03391.x. Epub 2010 Dec 6.
The objectives of this study were to determine the risk factors associated with nosocomial infection (NI) in the intensive-care unit and to assess the influence of a hand-washing promotion programme on the NI rate. Over a 6-month study period (P1), a prospective study of NI cases was performed, and risk factors for NI were analysed. Data were compared with those corresponding to a second period (P2), during which a health workers' hand-washing promotion programme was carried out; alcohol-based solution was also placed at the patients' headboard. Eight hundred and six patients were included (395 patients in P1 and 411 in P2). The mean APACHE II score was 11.41; there were no statistically significant differences in epidemiological or clinical variables between P1 and P2, and there were no differences in risk factors for NI. The rate of infection in P1 was 26%, and that in P2 was 16% (p <0.05). The hand-washing rate was higher in P2 than in P1 (before patient care, 45% and 35%, respectively; after contact with the patient, 63% and 51%, respectively). In the multivariate analysis, only central venous catheterization (>5 days) and tracheostomy were statistically significant risk factors for NI; having been included in the study during P1 or P2 was not statistically associated with NI. In conclusion, there was a significant increase in hand-washing frequency in P2; the incidence of NI during P1 was significantly higher than during P2, but having been included in the study in P1 was not significantly associated with a higher rate of NI; only central venous catheterization (>5 days) and tracheostomy were significantly associated with NI.
本研究的目的是确定重症监护病房（ICU）内医院感染（NI）的相关危险因素，并评估手部卫生促进计划对 NI 发生率的影响。在为期 6 个月的研究期间（P1），对 NI 病例进行了前瞻性研究，并对 NI 的危险因素进行了分析。将数据与第二个时期（P2）进行比较，在此期间，对卫生工作者进行了手部卫生促进计划，并且在患者床头放置了酒精溶液。共纳入 806 例患者（P1 中 395 例，P2 中 411 例）。平均急性生理学和慢性健康状况评分系统 II （APACHE II）评分为 11.41；P1 和 P2 之间在流行病学或临床变量方面没有统计学差异，并且 NI 的危险因素也没有差异。P1 中的感染率为 26%，P2 中的感染率为 16%（p<0.05）。P2 中的洗手率高于 P1（接触患者前，分别为 45%和 35%；接触患者后，分别为 63%和 51%）。多变量分析显示，只有中心静脉导管留置（>5 天）和气管切开术是 NI 的统计学显著危险因素；在 P1 或 P2 期间被纳入研究与 NI 无统计学相关性。综上所述，P2 中洗手频率显著增加；P1 期间的 NI 发生率明显高于 P2，但在 P1 期间被纳入研究与更高的 NI 发生率无显著相关性；只有中心静脉导管留置（>5 天）和气管切开术与 NI 显著相关。
