集束化管理策略在多重耐药菌管理中的应用  

Application of bundle strategies in the management of multidrug-resistant organisms

作　　者：吴淑梅[1] 黄小兰[1] 任泽娟[1] 

机构地区：[1]重庆市涪陵中心医院,重庆涪陵408000

出　　处：《中国感染控制杂志》2015年第12期840-842,845,共4页Chinese Journal of Infection Control

摘　　要：目的探讨集束化管理策略在多重耐药菌(MDRO)管理中的应用。方法 2013年7月1日起对某三甲综合医院住院患者MDRO管理实施集束化干预措施,监测常见MDRO感染/定植患者相关隔离措施的实施情况,2013年4—6月为干预前组,2013年7—9月为干预第1阶段,2013年10—12月为干预第2阶段,比较干预前后各项措施合格率及常见MDRO日感染率。结果 2013年4—12月共检出非重复菌株3 430株。"接触隔离"医嘱合格率干预前为78.14%,干预第2阶段为95.95%;悬挂床旁隔离标识、配置床旁速干手消毒剂、患者佩戴蓝色腕带合格率干预前分别为52.70%、66.89%、87.16%,干预第2阶段均达100.00%。医疗用品及环境消毒、病床安置合格率干预前分别为23.65%、15.54%,干预第2阶段分别为79.79%、77.66%。医务人员手卫生知识知晓率、依从率以及正确率干预前分别为69.70%、45.76%、76.35%;干预第2阶段分别为90.23%、87.50%、94.58%;干预前及干预后各阶段各项隔离措施实施的合格率比较,差异均有统计学意义(均P<0.01)。干预前阶段、干预第1阶段和干预第2阶段常见MDRO日发病率分别为3.24‰、2.63‰、2.20‰。结论应用集束化管理策略对MDRO进行监测和干预,各项隔离措施合格率提高,MDRO感染日发病率下降。Objective To explore the application of bundle strategies in the management of multidrug-resistant organisms（MDROs）.Methods From July 1,2013,bundle intervention measures were applied in the management of MDROs from inpatients in a tertiary first-class hospital,the implementation of isolation measures for MDRO-infected/colonized patients were monitored,April-June 2013 was pre-intervention group,July-September 2013 was the first stage of intervention,October-December 2013 was the second stage of intervention,the qualified rate of each measure and incidence of MDRO infection per 1 000 patient-days before and after intervention were compared.Results From April to December 2013,a total of 3 430 non-repetitive isolates were detected.The qualified rate of doctors＇ order＂contact isolation＂before intervention and in the second stage of intervention were 78.14%and95.95%respectively;the qualified rate of hanging bed-side isolation signs,providing bed-side quick-drying hand disinfectant,and patients wearing blue wristbands before intervention were 52.70%,66.89%,and87.16%respectively,and in the second intervention stage were all 100.00%.The qualified rate of disinfection of medical supplies and environment,as well as patients＇ bed assignments before intervention were 23.65% and 15.54% respectively,in the second stage were 79.79% and77.66%respectively.Health care workers＇ awareness rate of hand hygiene knowledge,hand hygiene compliance rate,and hand hygiene correct rate before intervention were 69.70%,45.76%,and 76.35% respectively;in the second stage were90.23%,87.50%,and 94.58% respectively;the qualified rate of implementation of each isolation measure before intervention and in different stages after intervention were all significantly different（all P0.01）.The incidence of MDRO infection per 1 000 patient-days before intervention,in the first and second intervention stages were 3.24‰,2.63‰,and2.20‰respectively.Conclusion After the monitoring and intervention in MDROs with bundle management strategies

关 键 词：集束化管理 多重耐药菌 接触隔离 医院感染 管理 

分 类 号：R181.32[医药卫生—流行病学]