闭环管理模式在MDROs感控中的应用与效果评价
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摘要
目的评价闭环管理模式在多药耐药菌(MDROs)感染控制中的应用。方法借助信息化技术手段设计并应用MDROs闭环管理模式,比较2016年1-6月(闭环管理模式执行前)和2016年7-12月(闭环管理模式执行后)全院及重症监护室(ICU)MDROs预防控制效果。观察闭环管理实施后MDROs患者隔离防控措施落实情况。结果全院MDROs总感染率从闭环管理模式执行前的0.14%(74/52 538)降至0.08%(49/60 065),差异有统计学意义(P=0.003),MRSA感染率有所下降(P=0.005)。ICU MDROs感染率也有所下降,总感染率从闭环管理模式执行前的17.45%(26/149)降至7.26%(13/179),差异有统计学意义(P=0.005)。闭环管理实施后,核查发现MDROs患者隔离防控措施得到了有效落实。结论闭环管理模式在MDROs感控中的应用能改善MDROs控制效果。
OBJECTIVE To evaluate the application of closed loop management mode in multidrug resistant organisms(MDROs)infection control.METHODS Closed loop infection control management mode was designed with the assistance of information technology methods and applied,and the efficacy of MDROs prevention and control in the whole hospital and intensive care units(ICU)was compared between Jan.-Jun.2016(before implementation of closed loop management mode)and Jul.-Dec.2016(after implementation of closed loop management mode).The implementation of isolation and control measures for MDROs patients after application of closed loop management was observed.RESULTS The overall MDROs infection rate in the whole hospital declined from0.14%(74/52538)to 0.08%(49/60065),and the difference was significant(P=0.003).The infection rate of MRSA also declined significantly(P=0.005).The infection rate in ICU declined from 17.45%to 7.26%,and the difference was significant(P=0.005).After the closed-loop management was implemented,the check results showed that the measures of isolation and control of MDROs patients were effectively implemented.CONCLUSION Application of closed loop management mode in MDROs infection control can improve the effect of MDROs control.
OBJECTIVE To evaluate the application of closed loop management mode in multidrug resistant organisms(MDROs)infection control.METHODS Closed loop infection control management mode was designed with the assistance of information technology methods and applied,and the efficacy of MDROs prevention and control in the whole hospital and intensive care units(ICU)was compared between Jan.-Jun.2016(before implementation of closed loop management mode)and Jul.-Dec.2016(after implementation of closed loop management mode).The implementation of isolation and control measures for MDROs patients after application of closed loop management was observed.RESULTS The overall MDROs infection rate in the whole hospital declined from0.14%(74/52538)to 0.08%(49/60065),and the difference was significant(P=0.003).The infection rate of MRSA also declined significantly(P=0.005).The infection rate in ICU declined from 17.45%to 7.26%,and the difference was significant(P=0.005).After the closed-loop management was implemented,the check results showed that the measures of isolation and control of MDROs patients were effectively implemented.CONCLUSION Application of closed loop management mode in MDROs infection control can improve the effect of MDROs control.
引文
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[12]佟青,张一兵,白璐.医院感染多系统网络信息化交互性管理的实践与实效[J].中华医院感染学杂志,2013,23(23):5759-5761.
[2]Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae,Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities[M].Geneva:World Health Organization,2017:28.
[3]Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level[M].Geneva:World Health Organization,2016:19.
[4]Coba V,Jaehne AK,Suarez A,et al.The incidence and significance of bacteremia in out of hospital cardiac arrest[J].Resuscitation,2014,85(2):196-202.
[5]Heal CF,Buettner PG,Drobetz H.Risk factors for surgical site infection after dermatological surgery[J].Int J Dermatol,2012,51(7):796-803.
[6]张映红,黎萍,盛文俊,等.“闭环式管理”运用于护理病历质控方法及效果探讨[J].中外医疗,2010,29(19):119.
[7]李强,丁勇,蔡秀军.ATTENDING负责制和医疗质量管理[J].中国医院,2001,5(4):19-21.
[8]Leonhardt KK,Yakusheva O,Phelan D,et al.Clinical effectiveness and cost benefit of universal versus targeted methicillin-resistant Staphylococcus aureus screening upon admission in hospitals[J].Infect Control Hosp Epidemiol,2011,32(8):797-803.
[9]Atchley KD,Pappas JM,Kennedy AT,et al.Use of administrative data for surgical site infection surveillance after congenital cardiac surgery results in inaccurate reporting of surgical site infection rates[J].Ann Thorac Surg,2014,97(2):651-657.
[10]Tacconelli E,Cataldo MA,Dancer SJ,et al.ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients[J].Clin Microbiol Infect,2014,1:1-55.
[11]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.
[12]佟青,张一兵,白璐.医院感染多系统网络信息化交互性管理的实践与实效[J].中华医院感染学杂志,2013,23(23):5759-5761.