集束化管理措施对降低ICU物体表面多药耐药菌检出率的效果分析  

Effect of bundle interventions on reduction of isolation rate of multidrug-resistant organisms from object surfaces in ICUs

作　　者：王振玲[1] 赖晓全[1] 徐敏[1] 韩颖[1] 许川[1] 熊薇[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院医院感染管理科,湖北武汉430030

出　　处：《中华医院感染学杂志》2015年第21期4990-4992,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(71473098)

摘　　要：目的研究集束化管理措施对减少重症监护病房(ICU)物体表面耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类鲍氏不动杆菌(CRAB)的效果,以寻找提高ICU物体表面清洁程度,降低多药耐药菌感染风险的有效可行的方式。方法于2014年7-9月在ICU实施一系列集束化管理措施,在干预前、后的物体表面各采样270份并进行培养,比较MRSA和CRAB物体表面检出结果是否存在差异。结果共采集ICU高频接触物体表面样本540份,除呼吸内科ICU外,其余科室ICU物体表面MRSA和CRAB检出率较干预前均不同程度下降;采取集束化策略可显著降低ICU内MRSA和CRAB检出阳性率,其中,MRSA检出阳性率由干预前的13.70%下降至干预后的7.03%,CRAB由9.26%下降至4.07%,差异均有统计学意义,且此期间多药耐药菌感染呈明显下降趋势。结论在ICU采取集束化综合管理方案能有效降低物体表面MRSA和CRAB的污染,有利于多药耐药菌的防治。OBJECTIVE To explore the effect of bundle interventions on reduction of isolation rates of methicillinresistant Staphylococcus aureus（MRSA）and carbapenem-resistant Acinetobacter baumannii（CRAB）from the objects surfaces in the intensive care units（ICUs）so as to seek for an effective and reliable way to improve the cleanliness of the objects surfaces and reduce the risk of multidrug-resistant organisms infections.METHODS A series of bundle interventions were carried out in the ICUs from Jul 2014 to Sep 2014,then 270 specimens were respectively collected from the objects surfaces before and after the intervention,and the isolation rates of MRSA and CRAB from the object surfaces were observed and compared.RESULTS Totally 540 specimens were collected from the surfaces of high-frequency-contact objects;the isolation rates of MRSA and CRAB were decreased in varying degrees in all the ICUs of the investigated departments except for the ICU of respiratory medicine department after the intervention.The bundle interventions could significantly reduce the positive rates of isolation of MRSA and CRAB in the ICUs;the positive rate of isolation of MRSA dropped from 13.70% before the intervention to7.03% after the intervention,and the positive rate of isolation of CRAB decreased from 9.26% to 4.07%,with significant difference.The incidence of multidrug-resistant organisms infections showed a distinct downward trend during the period.CONCLUSION The bundle interventions can significantly reduce the incidence of contamination of object surfaces with MRSA and CRAB in the ICUs and prevent the multidrug-resistant organisms.

关 键 词：物体表面 集束化 多药耐药菌 重症监护病房 

分 类 号：R197.323[医药卫生—卫生事业管理]