医院综合ICU环境表面清洁效果持续质量改进的研究与分析
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摘要
目的研究持续质量改进措施对综合ICU环境表面清洁效果的改善情况。方法设定2016年10月-2016年12月为持续质量改进前,2017年1月-2017年9月为持续质量改进阶段。制定质量改进措施并实施,对综合ICU环境表面进行采样并鉴定细菌菌种。按季度统计综合ICU住院患者医院感染率、下呼吸道感染率、泌尿道感染率和血流相关感染率。结果持续质量改进前环境表面采样合格率为58. 49%,持续质量改进阶段环境表面采样合格率为76. 92%,两组数据比较差异有统计学意义(χ2=19. 36,P <0. 01)。环境表面细菌菌种鉴定主要为金黄色葡萄球菌、鲍曼不动杆菌和白假丝酵母菌。经持续质量改进后,检出菌菌株数均显著下降。综合ICU住院患者医院感染率、下呼吸道感染率、泌尿道感染率和血流相关感染率在持续质量改进阶段也呈下降趋势。结论持续质量改进措施可以有效提高综合ICU环境清洁效果,减少环境表面致病菌,降低住院患者医院感染率。
Objective To study and analyze the influence of continuous quality improvement on environmental surface cleaning in general ICU. Methods Oct 2016 to Dec2016 was set as the pre-stage of continuous quality improvement,and Jan 2017 to Sep 2017 was the stage of continuous quality improvement. The continuous quality improvement program was formulated and implemented,bacterial colonies were identified after sampling the environmental surface of the general ICU.The nosocomial infection rate,lower respiratory tract infection rate,urinary tract infection rate and blood flow related infection rate of inpatients in integrated ICU were calculated quarterly. Results The qualified rate of environmental surface sampling was 58. 49% at the pre-stage of continuous quality improvement and 76. 92% at the stage of continuous quality improvement. The difference between the two groups was statistically significant( χ2= 19. 36,P < 0. 01). The identification of bacterial strains on the surface of the environment was mainly Staphylococcus aureus,Acinetobacter baumanii and Candida albicans. After continuous quality improvement,the number of bacterial strains detected decreased significantly. The nosocomial infection rate,lower respiratory tract infection rate,urinary tract infection rate and blood flow related infection rate were also decreasing in the continuous quality improvement stage of ICU inpatients. Conclusion Continuous quality improvement measures can effectively improve the environmental cleaning effect of general ICU,decrease environmental surface pathogens,and reduce the nosocomial infection rate of inpatients.
Objective To study and analyze the influence of continuous quality improvement on environmental surface cleaning in general ICU. Methods Oct 2016 to Dec2016 was set as the pre-stage of continuous quality improvement,and Jan 2017 to Sep 2017 was the stage of continuous quality improvement. The continuous quality improvement program was formulated and implemented,bacterial colonies were identified after sampling the environmental surface of the general ICU.The nosocomial infection rate,lower respiratory tract infection rate,urinary tract infection rate and blood flow related infection rate of inpatients in integrated ICU were calculated quarterly. Results The qualified rate of environmental surface sampling was 58. 49% at the pre-stage of continuous quality improvement and 76. 92% at the stage of continuous quality improvement. The difference between the two groups was statistically significant( χ2= 19. 36,P < 0. 01). The identification of bacterial strains on the surface of the environment was mainly Staphylococcus aureus,Acinetobacter baumanii and Candida albicans. After continuous quality improvement,the number of bacterial strains detected decreased significantly. The nosocomial infection rate,lower respiratory tract infection rate,urinary tract infection rate and blood flow related infection rate were also decreasing in the continuous quality improvement stage of ICU inpatients. Conclusion Continuous quality improvement measures can effectively improve the environmental cleaning effect of general ICU,decrease environmental surface pathogens,and reduce the nosocomial infection rate of inpatients.
引文
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[13]徐敏,许川,王振玲,等.不同清洁消毒方法对ICU物体表面多重耐药菌定植率的影响[J].护理研究,2016,30(8):977-979.
[14]刘晓杰,孙利群,王艳秋,等.医院环境表面病原菌分布调查[J].中华医院感染学杂志,2013,23(18):4454-4455.
[2]Lei J,Han S,Wu W,et al.Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit[J].Am J Infect Control,2016,44(11):1280-1284.
[3]孔懿,姜亦虹,张亚英,等.医院内物体表面清洗消毒方法的正确选择[J].中国消毒学杂志,2015,32(6):587-591.
[4]中华人民共和国卫生部.消毒技术规范[S].2002.
[5]谷继荣.环境及物体表面消毒在预防和控制医院感染中的作用[J].中国感染控制杂志,2012,11(3):231-235.
[6]宛传丹,周金保,邹学军,等.ICU环境细菌学监测结果与医院感染病原菌耐药谱同源性分析[J].现代预防医学,2016,43(17):3235-3240.
[7]中华人民共和国卫生计生委.医疗机构环境表面清洁与消毒管理规范[S].2016.
[8]Evans G.Cleaning disinfecting hospital environment becoming a top priority in infection prevention[J].Hosp Infect Control,2013,40(6):61-64.
[9]Knelson LP,Ramadanovic GK,Chen LF,et al.Self-monitoring by Environmental Services May Not Accurately Measure Thoroughness of Hospital Room Cleaning[J].Infect Control Hosp Epidemiol,2017,38(11):1371-1373.
[10]陈芳,赵斌秀,沈瑾,等.呼吸机管路污染状况和清洗消毒方法研究进展[J].中国消毒学杂志,2014,31(8):858-862.
[11]薛菊兰,王向荣.呼吸机洗消安全管理方法及成效[J].中国消毒学杂志,2012,29(12):1122-1123.
[12]李惠芬,李松琴,张苏明,等.环境清洁消毒标准化干预措施预防重症监护室多重耐药菌感染应用研究[J].中国消毒学杂志,2016,33(6):594-596.
[13]徐敏,许川,王振玲,等.不同清洁消毒方法对ICU物体表面多重耐药菌定植率的影响[J].护理研究,2016,30(8):977-979.
[14]刘晓杰,孙利群,王艳秋,等.医院环境表面病原菌分布调查[J].中华医院感染学杂志,2013,23(18):4454-4455.