目的了解医院感染现患情况及其相关危险因素,为制定医院感染的预防与控制措施提供依据。方法采用逐床查阅病例和床旁调查相结合的方法,调查2014年11月26日某三级甲等军队医院0:00—24:00所有住院患者的医院感染、病原体检出及抗菌药物使用等情况。结果共调查住院患者1 657例,发生医院感染66例、71例次,医院感染现患率为3.98%,例次现患率为4.28%。医院感染现患率位于前4位的科室为神经外科(24.49%)、血液科(19.05%)、干部病房(13.73%)和烧伤外科(10.91%)。医院感染部位位于前5位的依次为下呼吸道(40.85%)、泌尿道(23.94%)、上呼吸道(12.68%)、手术部位(9.86%)、胃肠道(5.63%)。66例医院感染病例中,共有39例患者送培养标本,送检率为59.09%,共培养病原体48株,其中居首位的为大肠埃希菌(10株,占20.84%),其次为金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌(各7株,各占14.58%)。全院抗菌药物使用率为34.40%,治疗及治疗+预防用药标本送检率为59.28%。年龄(<2岁或>60岁)、使用呼吸机、气管切开、使用泌尿道插管、动静脉插管、血液透析及手术是医院感染的危险因素,差异均有统计学意义(均P<0.05)。结论应加强对医院感染高发的重点科室、重点部位的监测,依据病原学检测结果合理使用抗菌药物,提高病原学送检率,依据医院感染的危险因素采取有效的预防与控制措施。 Objective To understand the prevalence and related risk factors of nosocomial infections in order to provide basis for the development of nosocomial infection prevention and control measures. Methods A combination of case-by-case and bedside investigation was used to investigate the nosocomial infection, pathogen detection and antibacterial use of all hospitalized patients at a certain level A military hospital from 0: 00-24: 00 on November 26, And so on. Results A total of 1 657 hospitalized patients were investigated. Among them, 66 cases were hospital infection, 71 cases were hospitalized. The prevalence rate of hospital infection was 3.98% and the prevalence rate was 4.28%. The prevalence rate of nosocomial infection in the top four departments was neurosurgery (24.49%), hematology (19.05%), cadre ward (13.73%) and burn surgery (10.91%). The most common infection sites were lower respiratory tract (40.85%), urinary tract (23.94%), upper respiratory tract (12.68%), surgical site (9.86%) and gastrointestinal tract (5.63%). Among the 66 cases of nosocomial infections, 39 cases were sent for culture, with the detection rate of 59.09% and the co-culture of 48 pathogens, of which Escherichia coli was the top one (10 strains, accounting for 20.84%), followed by gold Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa (7 strains each, accounting for 14.58% each). The hospital antibacterial drug use rate was 34.40%, treatment and treatment + prophylactic drug delivery rate was 59.28%. Age (<2 years or> 60 years), ventilator, tracheostomy, urinary catheterization, arteriovenous catheterization, hemodialysis and surgery were risk factors for nosocomial infection with significant differences (P <0.05). Conclusion It is necessary to strengthen the monitoring of key departments and key sites with high incidence of nosocomial infections. The rational use of antimicrobial agents should be based on the results of etiological tests to improve the rate of etiological examination and to take effective preventive and control measures based on the risk factors of nosocomial infections.