多重耐药菌医院感染监测及效果评价
|
摘要
目的了解PDCA循环法在多重耐药菌(MDROs)医院感染管理中的应用效果。方法回顾性分析2016-2017年医院发生MDROs感染患者的临床资料,并于2017年1月起运用PDCA循环法实施管理,对比干预前后MDROs医院感染情况。结果共分离出目标监测的MDROs 1 582株,其中医院感染的多重耐药菌166株,居前2位的是产ESBLs(+)大肠埃希菌(占42. 17%)和产ESBLs(+)肺炎克雷伯菌(占31. 33%);主要分布在ICU和神经外一病区;常见的感染部位为呼吸道和泌尿道;千日MDROs医院感染例次发生率由2016年的0. 30‰降至2017年0. 20‰。结论运用PDCA循环法可以降低MDROs医院感染风险。
Objective To understand the application of PDCA( Plan Do Check Action) cycle on multidrug-resistant organisms( MDROs) causing healthcare-associated infection( HAI). Methods From Jan 2016 to Dec 2017,the clinical data of MDROs-HAI were retrospectively analyzed. PDCA cycle was taken since Jan 2017,MDROs-HAI before and after intervention was compared. Results A total of 1 582 MDROs of target monitoring were isolated,of which 166 were MDROs-HAI,the top two MDROs were Escherichia coli( 42. 17%) and Klebsiella pneumoniae( 31. 33%),which both produced ESBLs. They were mainly distributed in the ICU and meural surgical. The main infection site of MDROs-HAI was respiratory tract,followed by urinary tract. The thousand day infectionrate of the MDROs-HAI decreased from 0. 30‰ in 2016 to 0. 20‰ in 2017. Conclusion The application of PDCA cycle can reduce the risk of MDROs-HAI.
Objective To understand the application of PDCA( Plan Do Check Action) cycle on multidrug-resistant organisms( MDROs) causing healthcare-associated infection( HAI). Methods From Jan 2016 to Dec 2017,the clinical data of MDROs-HAI were retrospectively analyzed. PDCA cycle was taken since Jan 2017,MDROs-HAI before and after intervention was compared. Results A total of 1 582 MDROs of target monitoring were isolated,of which 166 were MDROs-HAI,the top two MDROs were Escherichia coli( 42. 17%) and Klebsiella pneumoniae( 31. 33%),which both produced ESBLs. They were mainly distributed in the ICU and meural surgical. The main infection site of MDROs-HAI was respiratory tract,followed by urinary tract. The thousand day infectionrate of the MDROs-HAI decreased from 0. 30‰ in 2016 to 0. 20‰ in 2017. Conclusion The application of PDCA cycle can reduce the risk of MDROs-HAI.
引文
[1]黄勋,邓子德,倪语星,等.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):1-9.
[2]中华人民共和国卫生部.多重耐药菌医院感染预防与控制技术指南(试行)[S].2011.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[S].2011.
[4]Magiorakos AP,Srinivasan A,CareyRB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim stangard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[5]王洪梅,郭振清,孙迎娟,等.多药耐药菌目标性监测与感染防控对策[J].中华医院感染学杂志,2017,27(16):3810-3813.
[6]陈玉华,曾翠,龚瑞娥,等.某三级甲等综合医院多药耐药菌监测与预防控制研究[J].中华医院感染学杂志,2016,26(1):200-203.
[7]杨润秀,郭彦言,陈进玲,等.产超广谱β-内酰胺酶大肠埃希菌与肺炎克雷伯菌2013-2015年耐药谱动态分析[J].中华医院感染学杂志,2017,27(12):2656-2659.
[8]龙盛双,胡潇云,张啟鹏,等.多重耐药菌的科室分布及院内感染控制[J].中国消毒学杂志,2016,33(10):986-988.
[9]Agarwal S,Kakati B,Khanduri S,et al.Emergence of carbapenem resistant Non-Fermenting Gram-Negative bacilli isolated in an ICU of a tertiary care hospita[J].J Clin Diagn Res,2017,11(1):DC04-DC07.
[10]Kunder R,Kunder C,Sun HY,et al.Pediatric plastic bronchitis:case report and retrospective comparative analysis of epidemiology and pathology[J].Case Rep Pulmonol,2013(2013):1-8.
[11]刘帆,刘逸文,郑勇,等.神经科重症监护病房医院感染多重耐药菌的综合干预效果[J].中国感染控制杂志,2016,15(2):117-119.
[12]李帅,任旭.评价医院多重耐药菌感染预防与隔离现状调查及质量改进[J].中国卫生标准管理,2015,6(29):195-196.
[13]Barnes SL,Morgan DJ,Harris AD,et al.Preventing the transmission of multidrug-resistant organisms:modeling the relative importance of hand hygiene and environmental cleaning interventions[J].Infect Control Hosp Epidemiol,2014,35(9):1156-1162.
[14]Hu H,Johani K,Gosbell IB,et al.Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms:combined results of conventional culture,pyrosequencing,scanning electron microscopy,and confocal laser microscopy[J].J Hosp Infect,2015,91(1):35-44.
[15]Ueda A,Saito T,Ueda M,et al.Introduction and PDCA-management of a liaision-clinical pathway with cancer patients after a curative operation[J].Gan To Kagaku Ryoho,2015,42(10):1197-1201.
[16]周海龙.基于PDCA循环的医院投诉管理[J].中国急救复苏与灾害医学杂志,2016,11(9):894-897.
[2]中华人民共和国卫生部.多重耐药菌医院感染预防与控制技术指南(试行)[S].2011.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[S].2011.
[4]Magiorakos AP,Srinivasan A,CareyRB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim stangard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[5]王洪梅,郭振清,孙迎娟,等.多药耐药菌目标性监测与感染防控对策[J].中华医院感染学杂志,2017,27(16):3810-3813.
[6]陈玉华,曾翠,龚瑞娥,等.某三级甲等综合医院多药耐药菌监测与预防控制研究[J].中华医院感染学杂志,2016,26(1):200-203.
[7]杨润秀,郭彦言,陈进玲,等.产超广谱β-内酰胺酶大肠埃希菌与肺炎克雷伯菌2013-2015年耐药谱动态分析[J].中华医院感染学杂志,2017,27(12):2656-2659.
[8]龙盛双,胡潇云,张啟鹏,等.多重耐药菌的科室分布及院内感染控制[J].中国消毒学杂志,2016,33(10):986-988.
[9]Agarwal S,Kakati B,Khanduri S,et al.Emergence of carbapenem resistant Non-Fermenting Gram-Negative bacilli isolated in an ICU of a tertiary care hospita[J].J Clin Diagn Res,2017,11(1):DC04-DC07.
[10]Kunder R,Kunder C,Sun HY,et al.Pediatric plastic bronchitis:case report and retrospective comparative analysis of epidemiology and pathology[J].Case Rep Pulmonol,2013(2013):1-8.
[11]刘帆,刘逸文,郑勇,等.神经科重症监护病房医院感染多重耐药菌的综合干预效果[J].中国感染控制杂志,2016,15(2):117-119.
[12]李帅,任旭.评价医院多重耐药菌感染预防与隔离现状调查及质量改进[J].中国卫生标准管理,2015,6(29):195-196.
[13]Barnes SL,Morgan DJ,Harris AD,et al.Preventing the transmission of multidrug-resistant organisms:modeling the relative importance of hand hygiene and environmental cleaning interventions[J].Infect Control Hosp Epidemiol,2014,35(9):1156-1162.
[14]Hu H,Johani K,Gosbell IB,et al.Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms:combined results of conventional culture,pyrosequencing,scanning electron microscopy,and confocal laser microscopy[J].J Hosp Infect,2015,91(1):35-44.
[15]Ueda A,Saito T,Ueda M,et al.Introduction and PDCA-management of a liaision-clinical pathway with cancer patients after a curative operation[J].Gan To Kagaku Ryoho,2015,42(10):1197-1201.
[16]周海龙.基于PDCA循环的医院投诉管理[J].中国急救复苏与灾害医学杂志,2016,11(9):894-897.