多学科协作管理模式在多重耐药菌管理工作中的实践及持续改进效果分析  

Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms

作　　者：孙睿[1] 陈丽萍[1] 肖亚雄[2] 汪明群[3] 雷曦兵 谭慕杨[1] 唐燕[1] SUN Rui;CHEN Liping;XIAO Yaxiong;WANG Mingqun;LEI Xibing;TAN Muyang;TANG Yan(Office of Hospital Infection Management, the First People's Hospital of Yibin City,Yibin,Sichuan 644000,P.R.China;Department of Laboratory, the First People's Hospital of Yibin City,Yibin,Sichuan 644000,P.R.China;Department of Pharmacy, the First People's Hospital of Yibin City,Yibin,Sichuan 644000,P.R.China)

机构地区：[1]宜宾市第一人民医院医院感染管理办公室,四川宜宾644000 [2]宜宾市第一人民医院检验科,四川宜宾644000 [3]宜宾市第一人民医院药学部,四川宜宾644000

出　　处：《华西医学》2019年第3期256-261,共6页West China Medical Journal

基　　金：宜宾市卫生和计划生育委员会科研课题(宜卫发〔2017〕734号)

摘　　要：目的探讨多学科协作(multi-disciplinary team,MDT)管理模式在多重耐药菌管理中的实践效果。方法 2015年成立多重耐药菌MDT团队,定期召开MDT会议,重点讨论多重耐药菌管理中存在的问题及预防和控制多重耐药菌医院感染的相关措施。结果 2014年—2017年多重耐药菌检出率分别为9.20%(304/3 303)、7.11%(334/4 699)、8.01%(406/5 072)、7.81%(354/4 533),差异有统计学意义(χ2=11.803,P=0.008),其中耐碳青霉烯鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRABA)、耐碳青霉烯铜绿假单胞菌、耐碳青霉烯肠杆科菌(carbapenem-resistant Enterobacteriaceae,CRE)的检出率变化明显(χ2=39.022、17.052、12.211,P<0.05)。2014年—2017年多重耐药菌感染的比例逐年下降,由84.54%降至52.82%,多重耐药菌医院感染的比例也呈下降趋势,从46.05%降至23.16%;多重耐药菌医院感染例次率逐年下降,由0.24%降到0.13%;多重耐药菌医院感染占医院感染总例次的比例有差异,分别为9.07%、11.17%、10.47%、6.16%;多重耐药菌医院感染细菌分布中,耐甲氧西林金黄色葡萄球菌、CRABA、CRE医院感染例数占该多重耐药菌检出数的比例逐年下降;抗菌药物使用率逐年下降,由2014年的46.58%降到42.93%,病原学送检率则由64.83%升高至84.59%。结论 MDT管理模式对多重耐药菌的管理和控制有效,能降低多重耐药菌检出率、感染率、医院感染例次率、抗菌药物使用率,提高病原学送检率,使多药耐药菌防控工作更加科学规范。Objective To explore the practical effects of multi-disciplinary team(MDT) management model in the management of multidrug-resistant organisms(MDROs). Methods In 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs. Results The detection rate of MDROs from 2014 to2017 was 9.20%(304/3 303), 7.11%(334/4 699), 8.01%(406/5 072), and 7.81%(354/4 533), respectively. The difference was statistically significant(χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii(CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae(CRE) changed significantly(χ2=39.022, 17.052, 12.211;P0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%;the nosocomial infection case-time rate decreased from 0.24% to 0.13%year-on-year;the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%,10.47%, and 6.16%, respectively;in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017. Conclusion The MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.

关 键 词：多学科协作管理模式 多重耐药菌管理 实践 持续改进 

分 类 号：R197.323[医药卫生—卫生事业管理]