主动干预在综合ICU多药耐药菌感染预防控制中的作用  

Effect of active intervention on control of multidrug-resistant bacteria infections in general ICU

作　　者：叶旭琴[1] 俞桂珍[1] 王惠姣[2] 祝娟英 傅园花 

机构地区：[1]金华市人民医院感染管理科,浙江金华321000 [2]金华市人民医院检验科,浙江金华321000 [3]金华市人民医院重症监护病房,浙江金华321000

出　　处：《中华医院感染学杂志》2015年第11期2487-2488,2494,共3页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(Y2110239;2011-2014)

摘　　要：目的探讨主动干预对控制医院综合重症监护病房(ICU)患者多药耐药菌(MDROs)感染的作用,降低综合ICU患者多药耐药菌感染率。方法选择医院2012年3月-2014年2月入住ICU>48h的662例患者为研究对象,按照实施主动干预前后分干预组346例和对照组316例,对照组患者采用多药耐药菌常规预防治疗措施,干预组采用入院患者主动筛查及循证治疗,通过观察干预前后综合ICU标本送检和多药耐药菌检出率变化。结果实施主动干预措施后,干预组患者标本送检1 988例次,明显高于对照组的1 434例次,两组比较差异有统计学意义(P<0.05);干预组患者多药耐药菌检出率11.37%,较对照组的15.97%明显下降,差异有统计学意义(P<0.05);耐甲氧西林凝固酶阴性葡萄球菌检出率干预组为23.92%、对照组为51.40%,未分离出革兰阴性多药耐药菌。结论主动干预措施能有效降低基层医院综合ICU多药耐药菌检出率,明显提高基层医院综合ICU环境的清洁度,保证医务人员和患者共处环境的安全。OBJECTIVE To explore the effect of active intervention on control of the multidrug‐resistant organisms （MDROs） infections in the general intensive care unit （ICU ） so as to reduce the incidence of the MDROs infections in the ICU patients .METHODS From Mar 2012 to Feb 2014 , a total of 662 patients who were hospitalized the ICU for more than 48 hours were recruited as the study objects and were divided into the intervention group with 346 cases and the control group with 316 cases according to the implementation of the active intervention ;the control group was treated with conventional prevention measures for the MDROs ,while the intervention group was treated with active screening and evidence‐based therapy . The changes of the submission rate of specimens and the detection rates of MDROs in the general ICU were observed before and after the intervention .RESULTS After the implementation of the active interventions ,the specimens of 1 988 case‐times of patients were submitted in the intervention group ,significantly higher than 1 434 case‐times in the control group ,and there was statistically significant difference between the two groups （P〈0 .05） .The detection rate of MDROs was 11 .37% in the intervention group ,significantly lower than 15 .97% in the control group ,with statistical significance （P〈0 .05） .The detection rate of the methicillin‐resistant coagulase‐negative Staphylococ‐cus was 23 .92% in the intervention group ,51 .40% in the control group;the gram‐negative multidrug‐resistant bacteria were not isolated .CONCLUSIONS The active intervention may effectively reduce the detection rate of MDROs in the general ICU of grass‐roots hospitals ,significantly improve the environmental cleanliness of the general ICU ,and ensure the safety of shared environment of the health care workers and patients .

关 键 词：主动干预 综合重症监护病房 多药耐药菌 

分 类 号：R181.32[医药卫生—流行病学]