Effects of Integrated Intervention for the Prevention and Control of Nosocomial Infection in Neonatal Intensive Care Unit

doi:10.3877/cma.j.issn.1673-5250.2014.03.014

Objective

To investigate effects of implementation of integrated intervention measures such as the active screening of multidrug-resistant bacteria, monitoring of hand hygiene compliance and antibiotic application on prevention and control of nosocomial infection in neonatal intensive care unit(NICU).

Methods

From May 2011 to April 2013, a total of 10 577 infants were included in this study, and divided into pre-intervention group(n=4 122, hospitalization date from May 1st, 2011 to April 30th, 2012)and post-intervention group(n=6 455, hospitalization date from May 1st, 2012 to April 30th, 2013) according to their hospitalization date. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Guangdong Women and Children Hospital of Guangzhou Medical College.Informed consent was obtained from each participants' parents.

Results

There had significant differences in infection rates (6.23% vs. 5.31%) and case infection rates(7.52% vs. 6.35%) of NICU between two groups(χ²=3.99, 5.42; P<0.05). There were no significant differences between two groups on infections of gastrointestinal tract, blood and lower respiratory tract(P>0.05). But there had significant difference on skin and soft-tissue between two groups(χ²=4.46, P<0.05). Escherichia coli(29.52%) and Klebsiella pneumoniae (25.71%) were two of the most common bacteria in nosocomial infection patients in pre-intervention group.Klebsiella pneumoniae(36.50%) in post-intervention group was obviously higher than that of pre-intervention group(χ²=3.92, P<0.05).

Conclusions

Implementation of integrated intervention measures such as active screening of multi-drug resistant bacteria, monitoring of hand hygiene compliance and antibiotic application have an effect on reducing the incidence rate of nosocomial infections in NICU.

Key words: Infant, newborn, Cross infection, Intervention studies

表1 两组患儿院内感染发生率比较[n(%)]

Table 1 Comparison of incidence rates of nosocomial infection between two groups[n(%)]

组别	n	例数感染率	例次感染率
干预前组	4 122	257(6.23)	310(7.52)
干预后组	6 455	343(5.31)	410(6.35)
χ²		3.99	5.42
P		<0.05	<0.05

表1 两组患儿院内感染发生率比较[n(%)]

Table 1 Comparison of incidence rates of nosocomial infection between two groups[n(%)]

组别	n	例数感染率	例次感染率
干预前组	4 122	257(6.23)	310(7.52)
干预后组	6 455	343(5.31)	410(6.35)
χ²		3.99	5.42
P		<0.05	<0.05

表2 两组患儿院内感染部位分布比较[n(%)]

Table 2 Comparison of incidence rates of infection sites in NICU between two groups[n(%)]

组别	n	血液系统	上呼吸道	下呼吸道	胃肠道	泌尿道	皮肤软组织	手术切口	其他
干预前组	4 122	90(29.03)	5(1.61)	61(19.68)	97(31.29)	6(1.94)	18(5.81)	5(1.61)	28 (9.03)
干预后组	6 455	125(30.49)	10(2.44)	95(23.17)	108(26.34)	8(1.95)	11(2.68)	7(1.71)	46(11.22)
χ²		0.18	0.59	1.27	2.12	0.00	4.46	0.01	0.92
P		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05	>0.05

表2 两组患儿院内感染部位分布比较[n(%)]

Table 2 Comparison of incidence rates of infection sites in NICU between two groups[n(%)]

组别	n	血液系统	上呼吸道	下呼吸道	胃肠道	泌尿道	皮肤软组织	手术切口	其他
干预前组	4 122	90(29.03)	5(1.61)	61(19.68)	97(31.29)	6(1.94)	18(5.81)	5(1.61)	28 (9.03)
干预后组	6 455	125(30.49)	10(2.44)	95(23.17)	108(26.34)	8(1.95)	11(2.68)	7(1.71)	46(11.22)
χ²		0.18	0.59	1.27	2.12	0.00	4.46	0.01	0.92
P		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05	>0.05

表3 两组院内感染病原菌构成比较[n(%)]

Table 3 Comparison of incidence rates of infection bacteria in NICU between two groups[n(%)]

组别	n	肺炎克雷伯杆菌	大肠埃希菌	鲍氏不动杆菌	铜绿假单胞菌	酵母样真菌	白色念珠菌	阴沟肠杆菌	金黄色葡萄球菌	其他细菌	其他真菌
干预前组	4 122	27(25.71)	31(29.52)	10(9.52)	9(8.57)	10 (9.52)	5(4.76)	5(4.76)	1(0.95)	6 (5.71)	1(0.95)
干预后组	6 455	96(36.50)	50(19.01)	14(5.32)	8(3.04)	30(11.41)	16(6.08)	4(1.52)	5(1.90)	28(10.65)	12(4.56)
χ²		3.92	4.83	2.17	5.21	0.27	0.24	3.30	0.42	2.18	2.87
P		<0.05	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表3 两组院内感染病原菌构成比较[n(%)]

Table 3 Comparison of incidence rates of infection bacteria in NICU between two groups[n(%)]

组别	n	肺炎克雷伯杆菌	大肠埃希菌	鲍氏不动杆菌	铜绿假单胞菌	酵母样真菌	白色念珠菌	阴沟肠杆菌	金黄色葡萄球菌	其他细菌	其他真菌
干预前组	4 122	27(25.71)	31(29.52)	10(9.52)	9(8.57)	10 (9.52)	5(4.76)	5(4.76)	1(0.95)	6 (5.71)	1(0.95)
干预后组	6 455	96(36.50)	50(19.01)	14(5.32)	8(3.04)	30(11.41)	16(6.08)	4(1.52)	5(1.90)	28(10.65)	12(4.56)
χ²		3.92	4.83	2.17	5.21	0.27	0.24	3.30	0.42	2.18	2.87
P		<0.05	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表4 干预后组产ESBL菌及MRSA主动筛查结果[n(%)]

Table 4 Results of detection rates and isolation rates of ESBL and MRSA[n(%)]

项目	筛查人数	阳性率	隔离率
产ESBL菌	742	318(42.86)	286(89.93)
MRSA	581	41 (7.06)	38(92.68)
合计	1 323	359(27.14)	324(90.25)

表4 干预后组产ESBL菌及MRSA主动筛查结果[n(%)]

Table 4 Results of detection rates and isolation rates of ESBL and MRSA[n(%)]

项目	筛查人数	阳性率	隔离率
产ESBL菌	742	318(42.86)	286(89.93)
MRSA	581	41 (7.06)	38(92.68)
合计	1 323	359(27.14)	324(90.25)

表5 两组医护人员手卫生依从性监测结果比较[n(%)]

Table 5 Comparison of hand hygiene compliance rates between two groups[n(%)]

组别	调查人数(n)	手卫生依从率
干预前组	738	519(70.32)
干预后组	1 146	964(84.10)
χ²		50.980
P		<0.001

表5 两组医护人员手卫生依从性监测结果比较[n(%)]

Table 5 Comparison of hand hygiene compliance rates between two groups[n(%)]

组别	调查人数(n)	手卫生依从率
干预前组	738	519(70.32)
干预后组	1 146	964(84.10)
χ²		50.980
P		<0.001

表6 两组抗菌药物使用监控结果比较[n(%)]

Table 6 Comparison of usage of antibiotics between two groups[n(%)]

组别	n	抗菌药物使用率	微生物送检率	抗菌药物费用占医疗费用比例(元)	特殊类型抗菌药物使用的药师会诊率
干预前组	4 122	2 790(67.69)	2 513(60.97)	2 235.86/15 635.41(14.30)	0 (0.00)
干预后组	6 455	3 785(58.64)	5 415(83.88)	1 933.11/16 368.42(11.81)	6 397(99.10)
χ²		87.580	440.140	43.76	－
P		<0.001	<0.001	<0.05	<0.001

表6 两组抗菌药物使用监控结果比较[n(%)]

Table 6 Comparison of usage of antibiotics between two groups[n(%)]

组别	n	抗菌药物使用率	微生物送检率	抗菌药物费用占医疗费用比例(元)	特殊类型抗菌药物使用的药师会诊率
干预前组	4 122	2 790(67.69)	2 513(60.97)	2 235.86/15 635.41(14.30)	0 (0.00)
干预后组	6 455	3 785(58.64)	5 415(83.88)	1 933.11/16 368.42(11.81)	6 397(99.10)
χ²		87.580	440.140	43.76	－
P		<0.001	<0.001	<0.05	<0.001

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