多部门协作模式在多重耐药菌感染防控中的应用研究
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摘要
目的探讨多部门协作模式在多重耐药菌感染预防控制的应用效果。方法对2016年检出的256例多重耐药菌感染住院病人实施常规监管,对2017年检出的272例多重耐药菌感染住院病人实施多部门协作模式监管。比较多部门协作模式监管前后多重耐药菌医院感染发生及各项防控措施执行情况。结果实施多部门协作模式监管后,多重耐药菌医院感染发生率从2016年的1. 01%下降到2017年的0. 64%,多重耐药菌医院感染发生率差异有统计学意义(χ2=12. 250,P <0. 01)。干预前后24 h内开隔离医嘱执行率、床旁隔离标识执行率、床旁配备手消毒剂和物品专用执行率、手卫生依从性率差异均有统计学意义(χ2=25. 251,86. 333,70. 123,121. 877,148. 754,P <0. 01)。多重耐药菌感染部位构成呼吸道感染最常见,多重耐药菌检出的致病菌占比最多的为耐碳青霉烯类抗菌药物鲍曼不动杆菌。多重耐药菌病人微生物标本送检率从2016年的47. 66%上升到2017年的73. 53%,实施前后微生物送检率差异有统计学意义(χ2=37. 104,P <0. 01)。结论多部门协作模式监管可减少多重耐药菌医院感染发生,提高医务人员对多重耐药菌的防控意识。
Objective To explore the application effect of multi-sectoral collaboration model in the prevention and control of multi-drug resistant organisms( MDROs) infection. Methods The routine supervision of 256 inpatients with multi-drug resistant infections detected in 2016 was carried out,and the multi-sectoral collaboration model was monitored for 272 inpatients with multi-drug resistant infections detected in 2017. The occurrence of multi-drug resistant hospital infections and the implementation of various prevention and control measures were compared before and after the use of multi-sectoral collaboration model. Results After the implementation of multi-sectoral collaboration model,the incidence of MDROs infection decreased from 1. 01% in 2016 to0. 64% in 2017. The incidence of nosocomial infection in hospitals was statistically significant( χ2= 12. 250,P < 0. 01). There was statistical significant differences in the implementation rate of isolated medical order,the implementation rate of bedside isolation marks,the bedside equipped with hand disinfectant and article specific implementation rate,and the hand hygiene compliance rate within 24 hours before and after intervention( χ2= 25. 251,86. 333,70. 123,121. 877,148. 754,P < 0. 01). The infection sites of multi-drug resistant bacteria often result in respiratory infections,and the most common pathogens detected by multi-drug resistant bacteria are the carbapenem-resistant antibacterial drug Acinetobacter baumannii. The detection rate of microbial specimens from patients with multi-drug resistant bacteria increased from 47. 66% in 2016 to 73. 53% in 2017. The difference in microbiological examination rates before and after implementation was statistically significant( χ2= 37. 104,P <0. 01). Conclusion The application of multi-sectoral collaboration model can effectively decrease the incidence of multi-drug resistant hospital infections and improve the awareness of medical personnel on the prevention and control of multi-drug resistant bacteria.
Objective To explore the application effect of multi-sectoral collaboration model in the prevention and control of multi-drug resistant organisms( MDROs) infection. Methods The routine supervision of 256 inpatients with multi-drug resistant infections detected in 2016 was carried out,and the multi-sectoral collaboration model was monitored for 272 inpatients with multi-drug resistant infections detected in 2017. The occurrence of multi-drug resistant hospital infections and the implementation of various prevention and control measures were compared before and after the use of multi-sectoral collaboration model. Results After the implementation of multi-sectoral collaboration model,the incidence of MDROs infection decreased from 1. 01% in 2016 to0. 64% in 2017. The incidence of nosocomial infection in hospitals was statistically significant( χ2= 12. 250,P < 0. 01). There was statistical significant differences in the implementation rate of isolated medical order,the implementation rate of bedside isolation marks,the bedside equipped with hand disinfectant and article specific implementation rate,and the hand hygiene compliance rate within 24 hours before and after intervention( χ2= 25. 251,86. 333,70. 123,121. 877,148. 754,P < 0. 01). The infection sites of multi-drug resistant bacteria often result in respiratory infections,and the most common pathogens detected by multi-drug resistant bacteria are the carbapenem-resistant antibacterial drug Acinetobacter baumannii. The detection rate of microbial specimens from patients with multi-drug resistant bacteria increased from 47. 66% in 2016 to 73. 53% in 2017. The difference in microbiological examination rates before and after implementation was statistically significant( χ2= 37. 104,P <0. 01). Conclusion The application of multi-sectoral collaboration model can effectively decrease the incidence of multi-drug resistant hospital infections and improve the awareness of medical personnel on the prevention and control of multi-drug resistant bacteria.
引文
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[3]谢首佳,王美玉,潘建平.多学科协作在多重耐药菌医院感染防控中的实践与效果[J].中国感染控制杂志,2017,16(8):741-744.
[4]嵇晓红,刘春湘,陈嫣红.多学科协作模式在多重耐药菌医院感染控制中应用的效果观察[J].重庆医学,2013,42(19):2254-2256.
[5]祁羽鹏,鲁卫华,姜小敢,等. ICU患者抗菌药物使用情况和多药耐药菌产生的相关性分析[J].中华医院感染学杂志,2017,27(6):1228-1231.
[6]黄勋,邓子德,倪语星.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-8.
[7]徐敏,许川,谢红艳,等.精准化监管模式在多重耐药菌感染防控的应用研究[J].护理学杂志,2017,32(17):6-9.
[8]林秀娟,林红燕,钟韵.某三甲医院2014-2016年多重耐药菌感染趋势变迁[J].广东医学,2018,39(1):107-110.
[9]金龙,都鹏飞. 446例住院患者医院内多重耐药菌感染监测结果及分析[J].安徽医学,2015,36(7):797-800.
[10]于爱玲.综合干预措施对医院多重耐药菌感染的防控作用[J].山东医药,2016,56(5):104-105.
[11]谢红艳,赖晓全,谭莉. PDCA循环管理模式对武汉市某医院工作人员手卫生依从性的影响[J].医学与社会,2017,30(4):37-39.
[12] CHEN Y,ZHAO W,LIU H,et al. Occurrence of nosocomial methicillin resistant staphylococcus aureus as a marker for transmission in a surgical intensive care unit in China[J]. Am J Infect Control,2014,42(4):436-438.
[13]黄铄,蒋宏.患者参与促进医务人员提高手卫生依从性[J].中国感染控制杂志,2017,16(5):449-452.
[14] SIEGEL JD,RHINEHART E,JACKSON M,et al. 2007 Guideline for isolation precautions:preventing transmission of infectious agents in health care settings[J]. Am J Infect Control,2007,35(10S2):S65-S164.
[15]林金兰,李六亿.耐药菌医院感染的现状及研究进展[J].中国护理管理,2010,12(2):76-78.
[2]国家卫生和计划生育委员会.多重耐药菌医院感染预防与控制技术指南(试行)[Z]. 2011-01-17.
[3]谢首佳,王美玉,潘建平.多学科协作在多重耐药菌医院感染防控中的实践与效果[J].中国感染控制杂志,2017,16(8):741-744.
[4]嵇晓红,刘春湘,陈嫣红.多学科协作模式在多重耐药菌医院感染控制中应用的效果观察[J].重庆医学,2013,42(19):2254-2256.
[5]祁羽鹏,鲁卫华,姜小敢,等. ICU患者抗菌药物使用情况和多药耐药菌产生的相关性分析[J].中华医院感染学杂志,2017,27(6):1228-1231.
[6]黄勋,邓子德,倪语星.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-8.
[7]徐敏,许川,谢红艳,等.精准化监管模式在多重耐药菌感染防控的应用研究[J].护理学杂志,2017,32(17):6-9.
[8]林秀娟,林红燕,钟韵.某三甲医院2014-2016年多重耐药菌感染趋势变迁[J].广东医学,2018,39(1):107-110.
[9]金龙,都鹏飞. 446例住院患者医院内多重耐药菌感染监测结果及分析[J].安徽医学,2015,36(7):797-800.
[10]于爱玲.综合干预措施对医院多重耐药菌感染的防控作用[J].山东医药,2016,56(5):104-105.
[11]谢红艳,赖晓全,谭莉. PDCA循环管理模式对武汉市某医院工作人员手卫生依从性的影响[J].医学与社会,2017,30(4):37-39.
[12] CHEN Y,ZHAO W,LIU H,et al. Occurrence of nosocomial methicillin resistant staphylococcus aureus as a marker for transmission in a surgical intensive care unit in China[J]. Am J Infect Control,2014,42(4):436-438.
[13]黄铄,蒋宏.患者参与促进医务人员提高手卫生依从性[J].中国感染控制杂志,2017,16(5):449-452.
[14] SIEGEL JD,RHINEHART E,JACKSON M,et al. 2007 Guideline for isolation precautions:preventing transmission of infectious agents in health care settings[J]. Am J Infect Control,2007,35(10S2):S65-S164.
[15]林金兰,李六亿.耐药菌医院感染的现状及研究进展[J].中国护理管理,2010,12(2):76-78.